鹿角形肾结石的微创治疗进展

鹿角形肾结石的治疗一直是泌尿外科较为棘手的问题.随着微创泌尿外科的发展,鹿角形肾结石的治疗发生很大的改变.目前认为凡是新诊断的鹿角形肾结石,都需积极的外科处理方法清除结石,经皮肾镜取石术(PCNL)已成为临床治疗鹿角形肾结石的主要方法.本文对鹿角形肾结石的几种微创治疗方法进展作一综述.     

镰刀状肾实质切开术的设计及临床应用

复杂性鹿角状肾结石的治疗是泌尿外科工作中经常遇到的难题,其治疗十分困难.迄今,该疾病仍然威胁着人类健康.也有报道采用一些微创技术可治疗复杂性肾结石,但费用高,需多次处理[1].因此,努力寻求一种能全部一次性取尽结石又能完好地保护肾功能、并发症少的方法势在必行.     

镰刀状肾实质切开术的设计及临床应用

复杂性鹿角状肾结石的治疗是泌尿外科工作中经常遇到的难题,其治疗十分困难.迄今,该疾病仍然威胁着人类健康.也有报道采用一些微创技术可治疗复杂性肾结石,但费用高,需多次处理[1].因此,努力寻求一种能全部一次性取尽结石又能完好地保护肾功能、并发症少的方法势在必行.     

镰刀状肾实质切开术的设计及临床应用

复杂性鹿角状肾结石的治疗是泌尿外科工作中经常遇到的难题,其治疗十分困难.迄今,该疾病仍然威胁着人类健康.也有报道采用一些微创技术可治疗复杂性肾结石,但费用高,需多次处理[1].因此,努力寻求一种能全部一次性取尽结石又能完好地保护肾功能、并发症少的方法势在必行.     

经皮肾镜碎石取石术穿刺引导新进展

肾结石为泌尿外科常见病,而复杂性肾结石的处理一直是泌尿外科所面临的难题。经皮肾镜碎石取石术(percutaneous nephrolithotomy,PCNL)创伤小,恢复快,清石率高,并发症少,被认为是≥2 cm肾结石或鹿角形结石的首选治疗方法[1]。然而PCNL仍然存在严重并发症,如大出血、感染、器官损伤等,据报道大出血发生率为1%~11%[2]。Michel等[3]对1000例以上的PCNL文献进行统计分析,发现大出血、邻近脏器损伤等严重并发症的发生很大程度与工作通道建立不顺利相关。     

含钙肾结石复发的危险因素及个体化防治策略

近年来,虽然体外冲击波碎石和腔内泌尿外科技术的发展使含钙肾结石的治疗已全面进入微创化时代,但术后患者的结石复发率仍然居高不下。因此,如何有效地预防含钙肾结石发生和降低复发率,已成为当前研究的重点内容。本文通过分析含钙肾结石形成的病因,进一步阐述含钙肾结石复发的危险因素及防治策略,为制定恰当的、个体化的预防方案提供有效参考。     

肾结石与代谢综合征相关性的研究进展

肾结石是泌尿外科的多发病及常见病之一,其发病原因复杂,复发率高。随着对肾结石病因的深入研究,代谢综合征在肾结石发病中的作用也日益受到重视。本文对肾结石与代谢综合征的相关性进展进行综述,为肾结石的病因学研究、预防及治疗提供了新的思路。对于合并有代谢综合征的高危因素患者,采取针对性的预防和治疗策略,从而有利于减少肾结石的复发。     

微创经皮肾镜碎石术的护理

<正>肾结石是泌尿外科常见疾病之一,微创经皮肾镜碎石术作为现代治疗复杂性肾结石的首选方法[1],具有创伤小、恢复快、住院时间短等优点,临床已经得到广泛应用。我院自2006-01~2010-01共行经皮肾镜碎石术26例,疗效满意,     

经肾盂通道弹道超声碎石清石术治疗复杂性肾结石（附12例报告）

复杂性肾结石是指肾鹿角状结石、多发性结石、孤立肾结石、异位肾结石、马蹄肾结石、海绵肾结石或直径〉2．5cm的肾结石。对其治疗仍是当今泌尿外科的难题,文献报道有多种治疗方法,但受术者操作技巧、经验等因素影响,效果不一。2006年8月～2007年12月,我们对12例复杂性肾结石采用。肾盂通道下EMS第3代弹道超声碎石系统进行碎石清石,取得满意疗效,报道如下。     

复杂性肾结石的微创治疗新进展

正复杂性肾结石是指直径2.5 cm的肾结石,绝大多数指的是鹿角型结石,还包括肾解剖及功能异常的肾结石(如马蹄肾、海绵肾、独肾等)[1]。随着腔镜泌尿外科技术的迅速发展,经皮肾镜碎石取石术(percutaneous nephrolithotomy,PCNL)、输尿管软镜碎石术、腹腔镜肾盂切开取石术均广泛应用于治疗复杂性肾结石,本文拟对复杂性肾结石的微创治疗相关进展作一综述。     

微创经皮肾镜碎石取石术治疗鹿角形肾结石52例分析

目的:探讨微创经皮肾镜碎石取石术(mPCNL)治疗鹿角形肾结石的疗效和安全性。方法:应用PCNL治疗52例鹿角形肾结石,采用实时彩色多普勒超声引导穿刺、扩张建立F16微通道,钬激光粉碎结石。统计结石清除率以及手术并发症等。结果:52例均一期建立通道。一次治疗结石清除率71.2%,总清除率84.7%,术后2例出现发热,未发生脏器损伤和感染性休克病例。结论:mPCNL治疗鹿角形肾结石效率高、出血量少,是治疗鹿角形肾结石的安全、有效方法。     

输尿管囊肿伴发结石的腔内微创治疗

目的：评价腔内微创治疗输尿管囊肿伴结石的疗效。方法：回顾性分析2004年3月～2008年12月收治的12例输尿管囊肿伴发结石病例资料。囊肿位于左侧8例,右侧4例,均为单侧发病。9例伴输尿管囊内结石,3例并输尿管结石。输尿管囊肿采用经尿道输尿管囊肿切除术,术时保留上方囊壁作为抗反流的活瓣。结石采用输尿管镜钬激光碎石术。结果：12例患者均一次手术成功。术后随访3个月～1年,临床症状均消失,8例B超提示肾积水消失,4例明显减轻。4例行排尿性膀胱尿道造影未见明显反流现象。结论：使用腔内镜微创治疗输尿管囊肿伴发结石是一种简单有效的治疗方法。     

输尿管镜下气压弹道碎石术治疗小儿尿道结石14例报告

目的：探讨小儿尿道结石较好的治疗方法。方法：应用输尿管镜下气压弹道碎石术治疗小儿尿道结石患者14例，其中前尿道结石8例，后尿道结石6例。结果：14例尿道结石均被击碎，治愈出院。结论：输尿管镜下气压弹道碎石术是一种治疗小儿尿道结石创伤小、安全有效的治疗方法。     

Laparoscopically guided transperitoneal percutaneous nephrolithotomy for calculi in pelvic ectopic kidneys

Although percutaneous nephrolithotomy is a well-established endourological modality for the management of calculi in the normally placed kidney, it is not easy to apply in the management of calculi in pelvic ectopic kidneys. We report the cases of three patients who were found to have large calculi in pelvic ectopic kidneys and subsequently underwent laparoscopically guided transperitoneal percutaneous nephrolithotomy, all with successful outcome. In all patients, complete stone clearance was achieved in a single operation with no intraoperative or postoperative morbidity. They remain asymptomatic and recurrence-free at a follow-up ranging from 2 to 38 months. Laparoscopic guidance allows the transperitoneal route to be used safely for percutaneous nephrolithotomy in patients with calculi in pelvic ectopic kidneys. We believe it to be a feasible, safe, and valid minimally invasive management option for this uncommon but challenging urological condition.     

Management of urinary calculi in pregnancy

During the twenty-seven-month period ending April 1, 1982, 9 patients presented to the Milton S. Hershey Medical Center for evaluation and management of urinary calculi during pregnancy. During the same period, 1,696 deliveries were performed. This incidence of deliveries complicated by urinary calculi compares with previous series reporting an average incidence of approximately deliveries. In this review, we discuss the management of and the need for surgical intervention of calculi during pregnancy.     

Management of staghorn calculus: single puncture with judicious use of the flexible nephroscope

PURPOSE OF REVIEW: To focus on the technique and results of a single percutaneous puncture for the management of staghorn renal calculi. RECENT FINDINGS: The success rate for treating staghorn calculi with a single percutaneous puncture is over 90%. Animal and clinical studies seem to suggest that a single percutaneous access may be associated with reduced morbidity when compared with multiple percutaneous access punctures. SUMMARY: A single percutaneous access, whenever feasible, offers reduced morbidity without compromising excellent stone-free rates in the management of staghorn calculi.     

Radio-contrast enhancement of a urinary tract calculus.

We report the case of a woman who presented with obstruction and urosepsis of her left kidney secondary to small cystine calculi. The calculi could not be seen on initial plain abdominal X-ray. However, following percutaneous nephrostogram the calculi became more radio-dense and visible on later X-rays. Experimental enhancement of calculi has been described before but not in man. We presume that the contrast medium was adsorbed by the calculus to increase the radio-density. Further investigation of this phenomenon could prove useful in the management of complex radiolucent calculi.     

EST后再发结石的原因分析和治疗对策

目的探讨内窥镜括约肌切开(EST)术后再发胆管结石的原因及最佳处理策略。方法回顾性分析昆明医学院第二附属医院自1999年2月至2009年2月期间收治的EST后再发结石的96例患者的临床资料,根据再发胆管结石的大小(术前MRCP提示结石的直径大小)将其分为手术组(再发结石直径≥1.0 cm)和非手术组(结石直径1.0 cm,再次行EST),比较2种治疗方法的再发胆管结石率。结果手术组79例(82.29%),均采用胆总管切开取石、横断胆总管、胆管空肠Roux-en-Y吻合;非手术组17例(17.71%),即再次行EST。非手术组再发胆管结石率为70.59%(12/17),明显高于手术组的2.53%(2/79),差异有统计学意义(P0.05)。结论EST术后再发胆管结石的主要原因是十二指肠乳头切开导致Oddi括约肌舒缩功能受损,引发返流性胆管炎所致。手术治疗是EST术后再发胆管结石的最佳处理方法,效果肯定。术式以胆总管切开取石、横断胆总管、胆管空肠Roux-en-Y吻合为首选。     

肾盂切开联合PL及纤维内镜下取石治疗肾鹿角状结石34例

目的 总结肾盂切开术中采用气压弹道碎石(PL)及纤维内镜下套石篮取石治疗肾鹿角状结石的临床疗效。方法 术中PL将结石碎成小块取出，残留于各小盏及黏附于肾盂粘膜的结石在纤维内镜下用套石篮取出。结果结石碎成小块易于取出，结合纤维内镜下套石篮取石，结石取净率达94．1％。结论 该方法安全、易掌握、疗效肯定、损伤小。     

Surgical management of renal staghorn calculi by selective hypothermic perfusion.

18 patients with unilateral staghorn calculi managed by selective hypothermic perfusion are presented and the results reported. The procedure proved to be simple, safe and effective in the management of most staghorn calculi.