输尿管镜在妊娠合并输尿管结石中的应用

目的 探讨输尿管镜下手术对妊娠合并输尿管结石患者的临床应用价值.方法 17例妊娠合并输尿管结石患者均于连续硬脊膜外阻滞麻醉下行输尿管镜下手术,其中13例行输尿管镜下取石碎石术,4例结石上移入肾盂或输尿管迂曲未见结石者改为输尿管镜下留置双J管.结果 肾绞痛、发热、肾功能不全等均明显好转.1例术后发热较术前加重达38℃,2d后恢复正常,3例间断出现淡红色血尿,拔除双J管后消失.结论 输尿管镜手术治疗妊娠合并输尿管结石效果满意,安全,损伤小,值得推广.     

输尿管软镜应用于小儿肾、输尿管上段结石钬激光碎石术的手术配合

[目的]探讨输尿管软镜下钬激光碎石术治疗小儿肾、输尿管上段结石的手术配合.[方法]对47例行输尿管软镜下钬激光碎石术的肾、输尿管上段结石患儿进行完善的术前护理准备、密切术中配合;术后对仪器设备进行及时的清洗和保养.[结果]经全面完善的手术配合,47例患儿共52侧结石中49侧入镜顺利寻及结石并碎石成功,其中5侧因软镜导引鞘置入不成功或结石太大、多发结石留置双J管2周后进行第二次软镜碎石达到良好效果.其他3侧下盏结石软镜下未寻及结石,2侧改由经皮肾镜碎石取石,1侧观察.术后2个月清石率为92.3％（49/52）.手术时间25～115 min,平均45 min.所有病例均未发生护理并发症.[结论]输尿管软镜下钬激光碎石术手术配合要求高.完善的术前准备、熟练掌握术中配合步骤是保证手术成功的关键;而仪器设备的正确使用、清洗和保养是保持其性能完好、确保手术得以顺利进行的重要环节.     

输尿管镜联合气压弹道碎石治疗妊娠输尿管结石32例临床护理

为探讨输尿管镜联合气压弹道碎石在治疗妊娠输尿管结石中的安全性、有效性及护理措施,回顾性分析32例妊娠输尿管结石患者在应用该技术治疗中的临床护理资料,结果本组一次性碎石取石成功率93.8%(30/32),2例输尿管上段结石碎石失败,留置双J导管.表明经榆尿管镜联合气压弹道碎石治疗妊娠输尿管结石微创、安全、疗效确切,熟练掌握进镜技术及碎石技巧是手术成功的关键,精心护理对患者术后恢复具有重要意义.     

输尿管镜气压弹道碎石术治疗小儿输尿管结石的围手术期护理

目的总结输尿管镜气压弹道碎石术治疗小儿输尿管结石的围手术期护理经验。方法对32例输尿管结石行输尿管镜气压弹道碎石术的患儿的临床和护理资料进行回顾性分析。结果一次性治疗成功29例,成功率90.6%,术后无明显血尿、感染及输尿管、尿道狭窄等并发症。结论输尿管镜气压弹道碎石术治疗小儿输尿管结石效果确切、创伤小,是治疗小儿输尿管结石的理想方法;而耐心全面的术前宣教、术后细致的观察和护理是手术成功的重要保障。     

妊娠合并肾绞痛患者经膀胱镜双J管置入术的护理

目的 研究妊娠合并肾绞痛患者行经膀胱镜双J管置人术的护理方法与效果.方法 通过膀胱镜将双J管置入15例妊娠合并肾绞痛患者的患侧输尿管行内引流,给予针对性护理.结果 13例患者成功置人双J管后肾绞痛症状消失,顺利度过围生期,并顺产健康新生儿.结论 密切监测患者及胎儿情况并做好术前心理护理、完善术前准备;术中密切监测患者生命体征;术后做好并发症护理;并完善出院指导在患者的康复及胎儿的顺产中起重要作用.     

经尿道输尿管镜钬激光治疗输尿管结石的临床护理

目的：讨论经尿道输尿管镜治疗输尿管结石的护理方法。方法：对244例输尿管结石患者进行经尿道输尿管镜钬激光碎石取石术进行术前、术后护理的回顾性分析。结果：所有患者顺利接受手术，除3例输尿管上段结石被水流冲回肾内，术后辅以ESWL治疗，2例并发输尿管穿孔后改开放取石术外，经尿道输尿管镜钬激光碎石成功率97.9％（239／244）.所有患者均顺利放置双J管，无1例发生严重并发症。结论：准确、充分的术前准备、心理护理、术后护理是保证手术成功的重要保障。     

健康教育流程在乳腺癌术后患肢功能锻炼中的应用

2007年1月～2008年3月，我们采用经皮肾镜气压弹道联合超声碎石术治疗输尿管结石患者37例，经精心护理，效果满意。现将围术期护理体会报告如下。1临床资料本组37例，男21例，女13例，17～76岁。诊断左侧输尿管结石15例，右侧输尿管结石19例，双侧输尿管结石3例。本组患者均在腰硬联合麻醉下行输尿管镜下气压弹道联合超声碎石术，术后留置导尿管、双“J”管引流。     

妊娠期合并肾绞痛应用双J管13例的护理

目的 探讨妊娠期输尿管结石致肾绞痛患者行双J管内引流术的护理方法与效果.方法 回顾分析南阳市医专第一附属医院2009-2011年收治的13例放置双J管治疗妊娠期输尿管结石的临床资料,并进行针对性护理.结论 13例共14侧置入双J管后肾绞痛全部缓解,未出现先兆流产,并顺利度过围生期,顺产健康新生儿.结论 置入双J管治疗孕妇输尿管结石是安全、有效的方法.     

一例钬激光治疗小儿输尿管囊肿的护理

输尿管囊肿又称输尿管膨出,关于发病率各家的报告各异[1].目前手术是治疗输尿管囊肿确切有效的方法.小儿输尿管囊肿现多采用开放手术治疗,但开放性手术创伤大、住院时间长,而腔镜手术治疗鲜有报道[2].我院2010年9月收治1例小儿输尿管囊肿患儿,经输尿管镜钬激光治疗,术后患儿排尿通畅,无输尿管尿液返流,效果满意.现将围术期护理报告如下.     

输尿管阴道瘘15例诊治体会

【目的】探讨榆尿管阴道瘘的诊断、治疗方法与手术时机。【方法】回顾性分析2002～2008年本院诊治的15例输尿管阴道瘘患者的临床资料。诊断手段包括B超、静脉尿路造影（IVU）、美兰试验、膀胱镜及逆行肾孟插管造影;其中,13例早期行输尿管镜下放置双J管术,6例（包括输尿管镜下放置双J管术失败的4例）行输尿管膀胱再植术。【结果】15例患者中13例早期行输尿管镜下放置双J管术后有9例（69．2％）获得治愈,4例输尿管镜下放置双J管术失败后改为输尿管膀胱再植术获得治愈,另外2例病程3个月以上者直接行输尿管膀胱再植术获得治愈,随访6～31个月（平均10．3个月）,所有患者均无阴道流尿。【结论】输尿管镜下置入双J管术是早期处理输尿管阴道瘘的首选治疗方法,失败后可再选择输尿管膀胱再植术。     

Ruptured renal angiomyolipoma presenting as renal colic

The case of a patient with acute onset of flank pain and hematuria is presented. Initial therapy was directed toward relief of pain believed to be caused by renal colic. It was not until the patient developed atypical features that the true diagnosis, ruptured renal angiomyolipoma, was discovered. The case and discussion emphasize the need to carefully consider a complete differential diagnosis when evaluating patients with flank pain and hematuria who have atypical clinical features or an atypical course.     

Functional renal imaging: nonvascular renal disease

Functional renal imaging—a fast-growing field of MR-imaging—applies different sequence types to gather information about the kidneys other than morphology and angiography. This update article presents the current status of different functional imaging approaches and presents current and potential clinical applications. Apart from conventional in-phase and opposed-phase imaging, which already yields information about the tiusse composition, BOLD (blood-oxygenation level dependent) sequences, DWI (diffusion-weighted imaging) sequences, perfusion measurements, and dedicated contrast agents are used.     

Cardiac enzymes, renal failure and renal transplantation

Diagnostic accuracy of the currently available serum markers of cardiac injury, such as myoglobin, creatine kinase and its myocardial isoform, are altered in patients with renal failure. It is shown that cardiac troponins have decreased diagnostic sensitivity and specificity in patients receiving renal replacement therapy. Data regarding serum levels of these cardiac biomarkers, especially those of the cardiac troponins, in patients with a transplanted kidney are limited. Current data show that levels of cardiac troponin I are unaltered in patients who have undergone renal transplantation, while levels of cardiac troponin T may be elevated.We believe that cardiac troponin I should be the biomarker of choice for diagnosis of myocardial injury in these patients. However, further trials are required for conclusive results.     

Cortical renal leiomyoma with extension to renal pelvis

We describe a case of renal leiomyoma in a 21-year-old woman who presented with flank pain and hematuria. Urographic and computed tomographic (CT) studies revealed a large right renal mass with polypoid outgrowth protruding into the renal pelvis. Cortical renal leiomyoma with this radiographic manifestation is extremely rare.     

Epidemiology of renal recovery after acute renal failure

PURPOSE OF REVIEW: Recovery of renal function after acute renal failure is an important clinical determinant of patient morbidity. Herein, the epidemiology of renal recovery after acute renal failure will be described, along with potential predictive factors and interventions. RECENT FINDINGS: Renal recovery has been variably defined, most often as recovery to independence from renal replacement therapy. A recent consensus definition for acute renal failure has been published and included provisions for defining renal recovery. Renal recovery to renal replacement therapy independence occurs in the majority by hospital discharge and peaks by 90 days. All of older age, female sex, co-morbid illnesses, especially chronic kidney disease, and late initiation of renal replacement therapy or conventional intermittent renal replacement therapy have been coupled with non-recovery. Analysis of the literature suggests several interventions may influence recovery. SUMMARY: The prognosis is generally good for recovery after acute renal failure. Most patients will be independent of renal replacement therapy by 90 days. Additional research is necessary, however, to understand recovery rates not only to independence from renal replacement therapy, but also to complete and partial recovery. Future studies need to consider the health economic implications for survival and non-recovery. Finally, questions on the role of various interventions require characterization in randomized controlled trials to determine how they may influence renal prognosis.     

Biomarkers of acute renal injury and renal failure

Acute renal failure (ARF) is a frequent problem in the intensive care unit and is associated with a high mortality. Early recognition could help clinical management, but current indices lack sufficient predictive value for ARF. Therefore, there might be a need for biomarkers in detecting renal tubular injury and/or dysfunction at an early stage before a decline in glomerular filtration rate is noted by an increased serum creatinine. A MEDLINE/PubMed search was performed, including all articles about biomarkers for ARF. All publication types, human and animal studies, or subsets were searched in English language. An extraction of relevant articles was made for the purpose of this narrative review. These biomarkers include tubular enzymes (alpha- and pi-glutathione S-transferase, N-acetyl-glucosaminidase, alkaline phosphatase, gamma-glutamyl transpeptidase, Ala-(Leu-Gly)-aminopeptidase, and fructose-1,6-biphosphatase), low-molecular weight urinary proteins (alpha1- and beta2-microglobulin, retinol-binding protein, adenosine deaminase-binding protein, and cystatin C), Na+/H+ exchanger, neutrophil gelatinase-associated lipocalin, cysteine-rich protein 61, kidney injury molecule 1, urinary interleukins/adhesion molecules, and markers of glomerular filtration such as proatrial natriuretic peptide (1-98) and cystatin C. These biomarkers, detected in urine or serum shortly after tubular injury, have been suggested to contribute to prediction of ARF and need for renal replacement therapy. However, excretion of these biomarkers may also increase after reversible and mild dysfunction and may not necessarily be associated with persistent or irreversible damage. Large prospective studies in human are needed to demonstrate an improved outcome of biomarker-driven management of the patient at risk for ARF.     

急性肾功能损伤与衰竭生物标志物

急性肾功能损伤（ARI）与急性肾功能衰竭（ARF）是加强医疗病房（ICU）的常见疾病．ICU中80％的ARF由急性肾小管损伤所致，而非肾小球或间质性病变引起。其死亡率较高，寻找敏感性和特异性较好的ARI或ARF生物标志物，对早期诊断、治疗和改善预后有着重要意义。本文介绍和评估了ARI或 ARF生物标志物的研究现状。并展望了其未来的前景。[第一段]