经电切镜外鞘联合肾镜气压弹道碎石取石术治疗膀胱结石的临床观察

目的探讨经电切镜外鞘联合肾镜气压弹道碎石取石术治疗膀胱结石的临床疗效。方法回顾性分析采用经电切镜外鞘联合肾镜气压弹道碎石取石术治疗膀胱结石41例患者的临床资料。所有患者均经电切镜外鞘置入肾镜，采用瑞士第四代EMS气压弹道碎石机击碎膀胱结石后，用Ellick冲洗器冲出碎石。结果所有患者均一次性碎石成功，术中术后无膀胱穿孔、大出血、水中毒等并发症。结论经电切镜外鞘联合肾镜气压弹道碎石取石术是治疗膀胱结石的一种有效方法，安全、疗效确切。     

改良电切镜鞘途径输尿管镜下气压弹道碎石治疗膀胱结石87例分析

目的观察改良电切镜鞘途径输尿管镜下气压弹道碎石治疗膀胱结石的疗效。方法回顾性分析改良电切镜鞘途径输尿管镜下气压弹道碎石治疗膀胱结石87例患者的临床资料。具体方法为：经尿道置入电切镜鞘，接上带橡胶管的Ellick冲洗器连接头，将膀胱镜密封帽沿输尿管镜尖部套人，然后将输尿管镜通过带橡胶管的连接头沿电切镜鞘置入膀胱，输尿管镜直视下气压弹道碎石，结石碎片用Ellick冲洗器吸出。结果87例均顺利一次性将结石取尽，无大出血、膀胱穿孔等并发症。结论改良电切镜鞘途径输尿管镜下气压弹道碎石是处理膀胱结石的有效方法，具有操作简便、安全可靠、损伤小、并发症少、恢复快、效果确切等优点，值得临床推广应用。     

经电切镜外鞘输尿管镜下气压弹道碎石治疗膀胱结石

目的评价电切镜外鞘辅助输尿管镜气压弹道碎石取石术处理膀胱结石的应用价值,探讨该方法的手术技巧。方法回顾分析98例膀胱结石行输尿管镜碎石取石的患者临床资料,其中,52例采用电切镜外鞘辅助输尿管镜气压弹道碎石取石术（镜鞘辅助组）,46例直接采用输尿管镜气压弹道碎石取石术（传统碎石组）;两组术后均常规留置18F三腔导尿管;比较两组的手术时间、结石清除率及手术并发症情况。结果98例均全部成功碎石取石,无一例中转开放手术;镜鞘辅助组与传统碎石组的手术时间为（44．4±5．1）minVS（53．2±6．2）min（t=-7．71,P〈0．01）,传统碎石组术中2例发生膀胱穿孔,予留置尿管持续引流治愈;两组术后均得到3个月～1年随访,传统碎石组术后1例发生尿道狭窄,予定期尿扩治愈;两组超声随访复查均未见结石残留或复发。结论术中应用电切镜外鞘辅助输尿管镜气压弹道碎石取石能使术野保持清晰,减少输尿管镜反复进出损伤尿道,结合一定的弹道碎石技巧可明显缩短手术时间,疗效确切,在输尿管镜处理膀胱结石中有重要的临床应用价值。     

经尿道持续冲洗镜鞘配合输尿管镜碎膀胱结石疗效分析

目的探讨经尿道建立可控持续低压冲洗膀胱的方法,提高一期经尿道膀胱碎石疗效。方法经尿道进镜,在前列腺电切镜鞘和输尿管镜之间,用尿管喇叭形尾部与膀胱冲洗吸引器接头连接,使液体持续冲洗膀胱,并碎膀胱结石。结果 82例膀胱结石均一次手术成功,碎石时间10～50min,平均21min,一期膀胱结石清除率100%,术中无膀胱黏膜出血、膀胱穿孔;随访3～15个月,无结石复发、尿道狭窄等并发症。结论经尿道持续冲洗镜鞘配合输尿管镜气压弹道碎膀胱结石的疗法,具有术野持续清晰、高效碎石及吸石、损伤少、安全、成本低的特点,值得推广。     

经电切镜内鞘输尿管镜气压弹道碎石治疗膀胱结石45例报告

目的:探讨经电切镜内鞘输尿管镜气压弹道碎石治疗膀胱结石的疗效。方法:自2005年10月～2011年12月,采用经电切镜内鞘输尿管镜气压弹道碎石治疗膀胱结石45例。结果:45例手术均一次性取净结石,无结石残留及膀胱穿孔和尿道损伤等并发症。结论:此碎石方法安全、效果确切、不开刀、损伤极小,患者易于接受。     

尿道电切镜外鞘联合输尿管镜治疗膀胱结石(附68例报告)

目的 探讨尿道电切镜外鞘联合输尿管镜钬激光治疗膀胱结石的优点与疗效.方法 68例膀胱结石患者,先置入Wolf F24尿道电切镜观察膀胱内部情况,退出内鞘及镜体,留置外鞘,F8输尿管镜由外鞘进入膀胱,钬激光碎石.结果 68例均一次手术成功,术后无结石残留,碎石率100％,手术时间20 ～ 60 min,平均(36.7±...     

经电切镜外鞘肾镜气压弹道联合超声碎石清石系统治疗复杂膀胱结石60例报告

目的 探讨经电切镜外鞘肾镜气压弹道联合超声碎石清石系统治疗复杂膀胱结石的疗效及优点.方法 回顾性分析河南省临颍县人民医院于2008年6月至2012年10月采用经电切镜外鞘肾镜气压弹道联合超声碎石清石系统治疗膀胱结石60例患者的临床资料.结果 60例手术均一次性取净结石,无结石残留、膀胱穿孔和尿道损伤等并发症.结论 经电切镜外鞘肾镜气压弹道联合超声碎石治疗膀胱结石是一种安全有效的手术方法,具有创伤小、出血少、结石清除率高、恢复快等优点.     

经电切镜外鞘输尿管镜下气压弹道碎石治疗膀胱结石

目的探讨采用电切镜外鞘辅助输尿管镜下气压弹道碎石治疗膀胱结石的效果。方法将60例膀胱结石患者随机分为2组,各30例。对照组实施输尿管镜下气压弹道碎石,观察组应用经电切镜外鞘辅助输尿管镜下气压弹道碎石,比较2组治疗效果。结果 2组均成功碎石。观察组手术时间短于对照组,使用止痛剂例数少于对照组,观察组无并发症发生,对照组出现膀胱穿孔3例(10.00%)。2组比较,差异均有统计学意义(P0.05)。2组均获3个月~1 a随访,均无复发病例。结论经电切镜外鞘辅助输尿管镜下气压弹道碎石治疗膀胱结石,痛苦小、术后并发症发生率低、恢复快。     

肾镜在下尿路结石治疗中的应用

目的:探讨和推广应用肾镜和钬激光粉碎膀胱和尿道结石。方法:回顾性分析膀胱结石16例,尿道结石2例患者资料。结石大小1.5～4.5cm。先用扩张管带Peel-away鞘进入前尿道,至尿道球部时退出扩张管,保留Peel-away鞘。然后插入肾镜,在直视下进入膀胱。找到结石后,利用Peel-away鞘固定结石,置入钬激光进行碎石。碎石片直接经Peel-away鞘直视下冲洗出,无需用另外的冲洗球冲洗膀胱。结果:18例均成功碎石,手术时间18～45min,术后住院时间3～8d,2例尿道结石患者为门诊手术,碎石后即可带导尿管回家。术后10天随访,无结石残留,无尿道狭窄发生。结论:利用肾镜粉碎膀胱及尿道结石,其优点在于可以直视下用Peel-away鞘固定结石,减少结石碎片散落,并且碎石片直视下冲出,减少副作用,缩短手术时间。     

膀胱镜结合电切镜钬激光碎石治疗膀胱结石103例报告

膀胱结石治疗方法很多，如膀胱切开取石、大力碎石钳碎石等，但开放手术取石创伤大，住院时间长；大力碎石钳碎石容易发生尿道损伤。2004年1月～2007年12月，我院采用膀胱镜结合电切镜钬激光碎石治疗膀胱结石103例，均获成功，无并发症发生，现报道如下。     

输尿管导管在膀胱镜下钬激光碎石术中的引流作用

目的探讨膀胱镜下钬激光碎石术中输尿管导管的引流作用。方法回顾性分析了男性膀胱结石35例的临床资料,均采用膀胱镜下钬激光碎石术,将1条前端剪断的5F输尿管导管插入膀胱镜中做水循环通道用,钬激光光纤从另l通道中穿过,见到结石予以钬激光碎石。前列腺增生（BPH）患者同期行经尿道电切术（TURP）。结果本组35例均一次手术成功,碎石时间15～90min,平均45min。术中术后无膀胱穿孔和结石残留等并发症发生,结石清除率为100％。结论膀胱镜下应用输尿管导管能加快水循环,清晰视野,使钬激光碎石效率提高、尿道损伤的机会减小,是一种治疗膀胱结石有效、快速、安全的方法。     

SIMPLIFIED URETERAL STENT PLACEMENT WITH THE ASSISTANCE OF A URETERAL ACCESS SHEATH

PURPOSE: When using a ureteral access sheath following a ureteroscopic procedure, placement of an internal ureteral stent can be simplified by inserting the stent through the sheath without the need to reinsert the cystoscope. MATERIALS AND METHODS: An indwelling ureteral stent with the pull string attached is inserted over the guide wire into the access sheath followed by the pusher. The guide wire is partially withdrawn allowing the stent to form a coil in the renal pelvis, using the pull string to adjust the stent position. The fluoroscopy unit is then focused onto the bladder and the guide wire is slowly withdrawn until its tip is at the level of pubic symphysis. The pusher and guide wire are then removed and the pull string is cut at the urethral meatus. RESULTS: Among 71 cases studied 60 required ureteral stent placement. In 43 of the 60 cases (72%) the ureteral access sheath greatly facilitated ureteroscopy, and a stent was placed through the access sheath in 34 (79%). Stent placement through the access sheath was successful in all cases, with an average time saving of 2.3 minutes per case, compared to placing the stent by reinserting a cystoscope. CONCLUSIONS: If an access sheath has already been placed during a ureteroscopic procedure and stent insertion is deemed necessary, the stent can be easily placed through the access sheath under fluoroscopic guidance without the need to reinsert the cystoscope. Our experience suggests that all urologists who routinely perform ureteroscopic procedures can easily master this timesaving technique.     

螺旋状带蒂膀胱肌瓣输尿管成形术修复全程输尿管损伤的疗效分析(附6例报告)

目的:观察螺旋状带蒂膀胱肌瓣输尿管成形术修复全程或接近全程输尿管损伤的疗效,探讨膀胱肌瓣修复长段输尿管损伤(20cm)的手术方式。方法:回顾性分析6例因输尿管上段结石行输尿管镜下碎石术并发的全程或接近全程输尿管损伤患者的治疗过程:男4例,女2例;年龄37~59岁,平均49岁;左侧4例,右侧2例。其中输尿管黏膜全程撕脱2例,自肾盂至膀胱连接处输尿管完全离断4例;损伤长度21~25cm,平均22cm。6例均采用螺旋状带蒂膀胱肌瓣输尿管成形术。术中注意保护患侧膀胱上动脉的完整性,取瓣要循膀胱上动脉走行裁剪。其中5例术中同行肾脏下降固定术和膀胱腰大肌悬吊术,以缩短患侧肾和膀胱间距,1例切瓣卷管后直接与肾盂端吻合。酌情转移带蒂大网膜组织覆盖重建输尿管。结果:6例手术顺利,手术时间1~2h,平均1.5h。5例成形输尿管旁引流管术后第3天拔除,1例因漏尿于术后第10天拔除。6例切口均一期愈合。术后2周复查血肌酐和尿素氮正常,术后8周在膀胱镜下安全拔除双J管。1例术中未同行肾脏下降固定术和膀胱腰大肌悬吊术的患者术后3个月行静脉尿路造影(IVU)检查,发现重建输尿管明显狭窄且伴肾积水,重新置入双J管行保守治疗,2个月后复查ECT示患侧肾脏功能重度受损,于术后6个月行患肾切除术。1例术后6个月IVU复查时发现手术侧轻度肾积水及输尿管轻度扩张,但总肾功能正常。余4例随访2~4年,未见明显异常,IVU检查显示手术侧成形输尿管形态均正常,显影良好,均未发现明显的膀胱输尿管反流,因膀胱容量缩小导致的下尿路症状(LUTS)不明显。结论:螺旋状带蒂膀胱肌瓣输尿管成形术是长段输尿管损伤修复的理想术式,创伤小,并发症少,恢复快,尤其适用于缺损长度超过20cm乃至全程输尿管损伤的修复治疗,有较高的推广价值。     

膀胱白斑不同病变部位超微病理及其临床意义

目的 探讨膀胱白斑不同病变部位超微病理及其临床意义.方法 随机抽取膀胱白斑病变中部标本80例次,白斑边缘处、白斑边缘外1.0 cm处、2.0 cm处及2.5 cm处标本共89例次,用双肓法进行电子显微镜检查.并与非膀胱白斑患者的正常膀胱黏膜比较.结果 膀胱镜下所见白斑旁区均已存在早期病变.从白斑边缘外2 cm处到白斑中央,膀胱黏膜由移行上皮逐渐变为尿路上皮与鳞状生皮交错、鳞状上皮化生、鳞状上皮化生伴不全角化或角化.基膜由平直变弯曲,呈现出4型(5种)典型表现.病变中部的80例,0 Ⅰ型5例.0Ⅱ型8例,Ⅰ型12例,Ⅱ型42例.Ⅲ型13例.结论 以病变中部为准,可将膀胱白斑的超微结构表现分为4型,即0型(0 Ⅰ型、0Ⅱ型)、Ⅰ型、Ⅱ型、Ⅲ型.该分型能较好地说明膀胱白斑的发生、发展过程,对膀胱白斑的诊断及治疗方法的选择有参考价值.     

Giant vesical calculi in the female

We herein report a case of giant vesical calculi in the female bladder. To the best of our knowledge, these calculi represent the largest group of vesical calculi ever removed from the female bladder. The etiologic factors that contribute to bladder calculus formation in the female are discussed.     

Vesical calculi associated with vesicovaginal fistulas: management considerations

Vesical calculi were detected in 5 patients with a vesicovaginal fistula. Of these patients 3 had undergone unsuccessful repair of the fistula previously. The predisposing factors for vesical calculous formation in patients with a vesicovaginal fistula in whom urine leaks continuously into the vagina and urinary stasis does not occur in the bladder, as in patients with neurogenic bladder dysfunction or bladder outlet obstruction, are a foreign body (for example nonabsorbable suture material used during previous surgery), incrustation around an indwelling catheter and infection. The vesical calculus is removed transvaginally after enlarging the fistula by a vertical incision at the 6 o'clock position. The incised edges do not usually bleed because of fibrosis and scar formation, and they need not be approximated at that operation. Indwelling catheter drainage is not necessary after transvaginal cystolithotomy in this situation. This operation is preferable to suprapubic cystolithotomy, which may lead to more morbidity from urine leakage in the retropubic space and subsequent fibrosis, in addition to producing bladder scarring, hindering any future reconstructive surgery requiring the use of vesical flaps. Transvaginal cystolithotomy is contraindicated when the fistula is situated close to the bladder neck (for fear of damaging the bladder neck and the vesical continence mechanism) or when the stone is large. Repair of the fistula is undertaken after an interval of 3 months to allow for resolution of stone-induced edema and friability of the vesical wall.     

Ureteral endoscopy with passively deflectable, irrigating flexible ureteroscopes

Flexible, passively deflectable fiberoptic ureteroscopes were used in 18 selected patients. The flexible endoscope must be stabilized with a cystoscope, flexible introducer sheath, or guide wire for placement through the urethra and bladder into the ureter. Irrigation through the instrument is beneficial in clearing the visual field and distending the lumen. These instruments can visualize the lumen of the ureter, and the medial and superior portion of the renal pelvis and intrarenal collecting systems. Their diagnostic value is limited to selected clinical situations.     

宫腔镜代替膀胱镜行膀胱内检查及输尿管逆行插管在妇科腹腔镜手术中的应用（附28例分析）

目的探讨在妇科腹腔镜手术中,以宫腔镜代替膀胱镜行膀胱内检查及输尿管逆行插管的临床应用价值。方法对19例盆腔病变复杂的妇科腹腔镜手术,在手术前使用宫腔镜代替膀胱镜行输尿管逆行插管;另有9例腹腔镜术后使用宫腔镜代替膀胱镜观察双侧输尿管开口蠕动（喷尿）及膀胱内情况。结果术前行输尿管逆行插管的19例,术中借助导管的定位辨识,避免了输尿管损伤及相关并发症;9例术后宫腔镜代替膀胱镜检查,发现1例左侧输尿管开口蠕动消失,立即腹腔镜探查并拆除该侧输尿管周围组织缝合线,再次置镜观察,输尿管开口蠕动恢复;1例发现膀胱内菜花状新生物,定位活检病理回报为膀胱移行细胞癌,转泌尿外科诊治。28例术后肉眼血尿时间16～42h,无泌尿系感染及相关并发症发生。结论在妇科困难腹腔镜手术中,以宫腔镜代替膀胱镜进行膀胱内检查及输尿管逆行插管,能够降低和及时发现输尿管损伤,是预防妇科腹腔镜手术中输尿管损伤并发症的有效措施。     

A case of giant vesical calculus after ileocystostomy

A 52-year-old female, who had undergone nephrectomy and ileocystostomy for right-renal tuberculosis and contracted bladder 19 years earlier was seen with anemia and metabolic acidosis. Radiographic findings demonstrated that the patient suffered from a giant vesical calculus. Cystolithotomy was performed and the removed calculus weighed 460 g. Of the 66 cases of giant vesical calculus weighing more than 200 g reported in our country only 7 were in females.     

膀胱白斑膀胱镜影像系统显像特点及临床意义

目的 探讨膀胱白斑在膀胱镜影像系统的显像特点及临床意义.方法 采用双盲随机法抽取经病理检查确诊的膀胱白斑患者556例,观察膀胱镜影像系统中病变的显像特点.患者均予抗感染治疗1～2周,复查膀胱镜,对比观察治疗前后的变化.结果 556例患者膀胱镜显像中膀胱白斑病变呈4种表现,按病情轻到重分别为:充血型42例、斑点型56例、薄斑型399例、厚斑型59例.抗感染治疗后,病变各型可相互转化,其中好转131例、无变化304例、加重121例.统计学分析显示:膀胱白斑4种类型变化比率差异有统计学意义(x2=130.92,v=6,P<0.001),从充血型到斑点型、薄斑型、厚斑型,治疗后好转比率有逐渐减少趋势,无明显变化和加重比率有逐渐增多趋势.结论 在膀胱镜影像系统中膀胱白斑显像表现町初步分为充血型、斑点型、薄斑型、厚斑型4型,根据分型不同应采取不同的治疗方案.