目的 探讨经皮肾穿刺造瘘术治疗输尿管结石合并尿脓毒血症的临床效果.方法 选取2015年2月至2017年10月在洛阳东方医院治疗的50例输尿管结石合并尿脓毒血症患者,按随机数表法分为观察组和对照组,各25例.观察组经B超引导下行经皮肾穿刺造瘘术,对照组行膀胱镜下双J管置入术,比较两组感染指标、并发症以及引流情况.结果 观察组NEUR、WBC、CRP、PCT水平均低于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为8.00％,对照组并发症发生率为32.00％,观察组并发症发生率低于对照组,差异有统计学意义(P<0.05);观察组引流成功率为96.00％,对照组为84.00％,两组相比,差异无统计学意义(P>0.05).结论 经皮肾穿刺造瘘术与膀胱镜下双J管置入术治疗输尿管结石合并尿脓毒血症的效果相当,但经皮肾穿刺造瘘术并发症相对较少.

目的 观察经皮肾穿刺造瘘处理肾盂输尿管连接部狭窄的临床疗效.方法 选取2015年7月～2017年1月我院收治的肾盂输尿管连接部狭窄患者35例作为对象,按照治疗方式不同分为观察组和对照组,观察组18例采用经皮肾穿刺造瘘处理,对照组17例采用经尿道逆行输尿管镜肾盂输尿管连接部狭窄内切开术治疗,比较临床疗效.结果 观察组手术耗时、 术中出血量、 住院时间优于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为5.56％,优于对照组并发症率为35.29％,差异具有统计学意义(P<0.05);观察组总有效率94.44％,优于对照组82.35％,差异有统计学意义(P<0.05).结论 采用经皮肾穿刺造瘘处理肾盂输尿管连接部狭窄效果确切,能有效减少并发症发生,值得临床推广.

目的 探讨直肠指检与磁共振波谱成像联合血清前列腺特异抗原(PSA)检测在前列腺癌诊断中的应用效果.方法 选取洛阳东方医院99例疑似前列腺癌患者,均先行血清PSA检测,并进行直肠指检与磁共振波谱成像检查,以病理结果 为金标准,统计不同检查方法诊断结果.结果磁共振波谱成像与直肠指检联合血清PSA诊断准确率为88.89%(88/99)、灵敏度为88.89%(80/90)、特异度为88.89%(8/9)、误诊率为11.11%(1/9)、漏诊率为11.11%(10/90),均高于各单一检测,差异具有统计学意义(P<0.05).结论 直肠指检与磁共振波谱成像联合血清PSA对前列腺癌具有较高诊断价值,诊断准确率高,误诊、漏诊率低.

Objective To investigate the efficacy and safety of anterograde and retrograde ureteroscopy in treating complicated upper ureteral calculi.Metbods Ninety patients with complicated upper ureteral calculi were treated by anterograde and retrograde ureteroscopy,including transurethral ureteroscopy supplemented with pneumatic lithotripsy and push stones,and percutaneous ureteroscopy supplemented with high-pressure water jetting stone removal.Results The first time success rate of lithotripsy for 90 cases of ureteral calculi was 94％ (85/90).None of the patient had complications,such as significant hemorrhage,urethral false passage,perforation,or urinary tract infections,and no blood transfusion treatment was required.Conclusions The treatment of complicated upper ureteral calculi by anterograde and retrograde ureteroscopy has the advantages of minor injury,safe surgery,convenient stone removal and low residual stone rate,which is worthy of further promotion.

目的:探讨输尿管镜手术中输尿管开口寻找困难的原因及相应对策。方法:回顾性总结分析2007年8月-2011年8月收治的380例输尿管结石患者施行输尿管镜手术中出现的25例输尿管开口寻找困难病例,针对不同情况,采用辅助水冲,更换导丝,穿刺,注射药物,电切等方法,帮助寻找开口。结果:25例手术均获成功,手术时间50~127min,平均75min。结论:遇到输尿管开口寻找困难的情况,通过耐心细致地寻找开口,配合冲水、换用导丝,采用穿刺、注射、电切等方法,均有助与手术取得成功。

Objective To discuss the efficacy of transurethral electrovaporization of the prostate(TUEVP) combined with percutaneous bladder pneumatic lithotripsy(PBPL) for patients with benign prostate hyperplasia(BPH) complicated with bladder stones.Methods Since January 2008 to January 2011,we performed TUEVP combined with PBPL on totally 33 patients with BPH complicated with bladder stones.The weight of the prostate ranged from 50 to 80 g,and the size of the stones was 2.5-5.0 cm in diameter.Results The procedures were completed in all the cases in one session without blood transfusion.No patients developed tranurethral resection syndrome or severe infection after the operation.Re-examination at one week postoperation showed no residual stones by KUB.The mean hospital stay of this series was 9 days(ranged from 7 to 12 days).One-month postoperative maximum urinary flow rate was 18-26 ml/s with a mean of 20 ml/s.Conclusions TUEVP plus PBPL is effective,safe,and minimally invasive for patients with BPH and bladder stones.The operation and recovery time of the procedure are short.

目的探讨经皮肾镜取石术并发出血的原因及防治措施。方法回顾性分析2007年6月～2011年6月收治的500例次经皮肾镜取石术临床资料,发生大出血8例。结果 8例出血病人中,采用保守疗法5例,超选择性介入栓塞3例,出血停止,均治愈出院。结论充分认识经皮肾镜取石术出血的原因,术前准备充分、术中规范操作,术后准确判断出血原因及积极治疗,对经皮肾镜取石术出血的防治有重要意义。

Objective:using nephroscopic joint vaporization cutting mirror outer sheath pneumatic treatment of large bladder calculi.Methods:using vaporization cutting F26 mirror established outer sheath,nephroscopic belt F24,metal scabbard bladder channel inserted on nephroscopic lithotripsy treatment under pressure trajectory 56 cases,large bladder calculi of operation efficiency analysis.Results:the 56 cases,54 cases of surgical success,2 cases of urethral stricture couldn't cut into F26 vaporization mirror outer sheath turn bladder made fistula nephroscopic lithotripsy treatment under pressure trajectory bladder calculi.Conclusion:nephroscopic joint vaporization cutting mirror outer sheath pneumatic therapy greatly improve operation efficiency of bladder calculi,greatly shorten the time of surgery,is a kind of natural channel and minimally invasive surgery,rapid recovery.

我院2005-02～2007-02对32例前列腺增生患者行经尿道前列腺汽化电切术,术中应用膀胱穿刺双通道微造瘘预防经尿道电切综合征(TURS),效果满意.现报告如下.

我院2004-10～2006-10行经尿道前列腺电切术(transurethral resection of prostate,TURP)治疗前列腺体积巨大(>75 g)的良性前列腺增生(benign prostatic hypertrophy,BPH)患者25例,术中应用膀胱微造瘘术预防经尿道电切综合征(transurethral resection syndrome,TURS),效果满意,现报告如下.