目的:比较微通道与标准通道经皮肾镜取石术(PCNL)治疗上尿路结石的临床手术参数.方法:回顾性分析2017年1～12月在洪湖市人民医院行单通道PCNL患者,根据所建立取石通道大小不同分为微通道PCNL组和标准通道PCNL组.其中微通道PCNL 43例,标准通道PCNL 74例.比较两组患者的总手术时间、术前术后血红蛋白下降值、血清肌酐变化值、术后发热发生率、一期手术清石率、术后住院日及其他并发症发生率等指标.所有术中数据均现场采集并记录.结果:微通道PCNL组和标准通道PCNL组的平均手术时间分别为(58.6±11.2) min和(35.4±7.9)min,两组比较差异有统计学意义(P＜0.05);术前术后血红蛋白下降值分别为(6.8±6.3) g/L和(9.2±7.1) g/L,两组比较差异有统计学意义(P＜0.05);两组术前术后血清肌酐变化值、术后发热发生率、一期手术清石率及术后住院日比较差异均无统计学意义.结论:微通道PCNL与标准通道PC-NL比较,手术时间明显更长,但手术出血量更少,2种手术方式各有优劣.

膀胱平滑肌瘤是一种罕见的间叶组织来源良性肿瘤,华中科技大学同济医学院附属同济医院泌尿外科于2018年8月收治1例巨大膀胱平滑肌瘤患者,采用经尿道激光剜除术治疗,取得满意疗效,现报告如下. 患者,男,70岁,排尿中断伴下腹部胀痛3月余,伴有尿频、尿急症状,偶有肉眼血尿,血尿症状能自行缓解,无发热及腰痛.既往2年前因前列腺增生症行前列腺激光剜除术,术后恢复良好.入院体格检查及 PSA未见明显异常.全腹部增强CT提示膀胱尿道内口处见不规则团块状软组织密度影,突向膀胱腔内,边界可见散在高密度钙化灶,增强不均匀强化,大小约55 mm×46 mm ×62 mm ,腹膜后及盆壁未见肿大淋巴结影(图1). MRI平扫+DWI提示膀胱左前壁可见菜花样稍长T1 稍长 T2 信号,可见低信号"蒂"影,DWI弥散明显受限,肌层未见明显侵及,盆腔内未见肿大淋巴结(图2) .经尿道膀胱镜检查提示膀胱颈口可见巨大新生物,类圆形,表面光滑,基底部位于膀胱颈左上方,因肿瘤遮挡,双侧输尿管口无法窥及.膀胱镜病理活检:梭形细胞肿瘤,结合免疫组化,考虑平滑肌来源;免疫组化:EM A (+) ,DES (+) ,CaLdesmon(+) ,SDHB (+) ,SMA (弱+) ,ALK (散在+) ,CD117(－) ,CD34 (－) ,DOG1 (－) ,S‐100 (－) ,SOX10 (－) ,ST A T6 (－) ,PCK (－) ,GAT A‐3 (－) ,HMB45 (－) , MeLanA (－) ,Ki‐67 LI约5%.

Objective:To evaluate the safety and efficacy of percutaneous nephrolithotomy (PCNL) without retrograde introduction of ureteral catheter (e.g.stimulated diuresis PCNL).And also we try to discuss the indi cations and contraindications of PCNL without retrograde introduction of ureteral catheter.Method:In this retrospective study,we enrolled 367 cases who underwent PCNL at our hospital from January 2013 to December 2016.Two hundred and twenty four patients underwent PCNL with retrograde introduction of ureteral catheter and 143 accepted PCNL with stimulated diuresis (e.g.without retrograde introduction of ureteral catheter).Tract creation time,renal hemorrhage,overall renal function,tract dilation failure,immigration of stone fragments down into the ureter and failure of antegrade placement of ureteral stent were compared between the two groups.Result:There was no significant difference on mean tract creation time,mean decrease in hemoglobin concentration or overall renal function between the two groups (P＞ 0.05).There was no dilation failure or immigration of stone fragments down into the ureter cases presented in both groups.It was hard for us to finish the aim calyx puncture in one patient in stimulated diuresis group with thick renal parenchyma and without hydronephrosis,though we finished the PCNL without retrograde induction of ureteral catheter at last.Conclusion:The stimulated diuresis PCNL is safe and efficacious.The presence of thick renal parenchyma without hydronephrosis may be taken as a eontraindication of stimulated diuresis PCNL.