普通超声引导经皮肾镜取石术的效果分析

目的:探讨普通超声引导经皮肾穿刺行经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)的方法及效果.方法:利用普通超声引导经皮肾穿刺方法的改进,行PCNL 169例,对每处建立经皮肾通道的穿刺成功率、手术出血情况、术后并发症等进行回顾性分析.结果:169例患者建立经皮肾通道198处,穿刺成功率96.0%(190/198),8处术中寻找残余结石进行二次穿刺未成功,联合C-臂机穿刺成功;术后输血(200~400 mL)7例,无选择性肾动脉栓塞止血;胸腔积液18例,1例需闭式引流;术后发热11例,无感染性休克及不良预后发生;无肺脏及其他内脏损伤等严重并发症.结论:通过对普通超声引导经皮肾穿刺方法的改进,行PCNL操作简便、迅速、准确、经济,成功率高,可有效降低穿刺的难度,值得基层医院推广.     

SonixGPS穿刺定位系统在经皮肾镜碎石取石术中应用体会

目的:探讨SonixGPS超声引导穿刺定位系统在PCNL中应用的有效性及安全性。方法:2015年4月-2016年8月,笔者应用SonixGPS超声导航引导下行经皮肾穿刺,建立16~22F皮肾通道处理上尿路结石患者72例,患者术前均行尿培养,尿常规、彩超、CT和IVU等检查。手术均采用全麻,俯卧位,在SonixGPS超声定位系统的引导下,16G穿刺针穿刺目标肾盏并扩张建立16-22F皮肾通道,应用钬激光或第五代超声碎石清石系统进行碎石清石。结果:本组72例均一期穿刺成功并行一期碎石,手术时间30~145 min,平均(52±4.5)min;经皮肾穿刺时间1~7 min,平均(3.0±1.2)min。术中术后未出现大出血、肠道损伤、气胸等并发症,术后复查KUB,一期清石率为84.7%(61/72),7例患者残余结石行二次PCNL,4例有残余结石患者行ESWL治疗,1个月后均顺利排出。结论:SonixGPS影像穿刺定位系统在PCNL穿刺中可实时监控,及时显示穿刺针的位置,准确建立皮肾通道,穿刺时间短,可有效减少手术副损伤,提高穿刺成功率。     

超声引导建立经皮肾镜钬激光碎石通道治疗复杂性肾结石

目的探讨介入性超声引导穿刺在经皮肾镜钬激光碎石术中的有效性及安全性。方法超声引导下对58例上尿路结石患者行经皮肾穿刺建立碎石通道,在输尿管镜下行钬激光碎石取石术。结果 58例病例在超声引导下均穿刺成功,通过单通道或双通道行Ⅰ期或Ⅱ期镜钬激光碎石术,结石总清除率94.8%,手术平均时间80min,术中、术后未出现严重并发症。结论术前选择适宜的穿刺点和穿刺路径,在超声引导下建立经皮肾镜钬激光碎石通道,可提高经皮肾镜钬激光碎石术治疗上尿路结石的手术时效,且更为安全。     

螺旋CT联合B超引导微创经皮肾镜碎石取石术治疗上尿路结石临床分析

目的探讨螺旋CT联合B超引导微创经皮肾镜碎石取石术治疗上尿路结石的安全性和有效性。方法对834例肾结石和复杂性输尿管上段结石患者,术前采用肾脏32层螺旋CT扫描和三维重建,根据重建CT三维成像以设计经皮肾穿刺通道。术中采用超声引导经皮肾穿刺,建立经皮肾通道碎石取石术。总结分析手术方法、手术时间、结石清除率和并发症等情况。结果 834例手术均一次性穿刺成功,其中单通道取石810例,双通道取石24例,术中穿刺通道与术前预设通道符合798例;一期碎石取石803例,一期造瘘二期碎石31例;手术时间54~182min;术中平均出血约70mL;肾造瘘管留置时间平均6.5d;术后平均住院日9d;无一例出现大出血、肾盂穿孔和邻近脏器损伤等严重并发症;834例患者中一期结石取净率达84.17%(702/834)。结论术前肾脏螺旋CT扫描加三维成像以设计经皮肾穿刺通道,结合术中实时超声定位引导,可以提高经皮肾镜手术成功率,增加手术安全性,降低手术并发症,提高结石清除率,在上尿路结石的治疗中具有很好的应用价值。     

超声引导精准经皮肾穿刺病理活检中50ml注射器针头的应用价值

目的探究超声引导精准经皮肾穿刺病理活检中50 ml注射器针头的应用效果。方法选取该院2015年3月至2018年3月收治的行肾穿刺活检患者100例作为研究对象,在超声引导经皮肾穿刺中利用50 ml注射器针头进行辅助穿刺,回顾性分析100例患者的临床资料,对100例患者的穿刺时间、术中周围脏器损伤情况、回抽尿液颜色等情况进行观察记录。结果 100例患者中一次穿刺成功者95例,占比95%,穿刺时间在18～62 s,平均(30.28±4.51) s,术中穿刺返抽尿液出血1例,未见其他并发症。结论在超声引导经皮肾穿刺病理活检过程中应用50 ml注射器针头,具有经济实惠、穿刺精准性高、穿刺时间短、一次穿刺成功率高等优势,是一种有效、安全的改良穿刺技术。     

CT引导建立经皮肾通道行微创经皮肾镜取石术

目的评估CT引导下建立经皮肾穿刺通道行微创经皮肾镜取石术的方法及效果.方法回顾性分析26例肾结石患者在CT引导下建立经皮肾通道行微创经皮肾镜碎石取石术.结果该组26例次均成功建立理想的穿刺通道,无通道建立过程中的常见严重并发症发生,术后结石梗阻均获解除.结论CT引导建立经皮肾通道行微创经皮肾镜取石术安全可行,对于复杂结石尤其具有独特的优势.     

超声引导下经皮肾镜治疗肾结石129例体会

【目的】评价超声引导在经皮肾镜碎石术中的应用价值。【方法】2006年3月-2007年8月，采用超声引导穿刺建立通道，肾镜下气压弹道联合超声碎石术治疗129例肾结石。【结果】所有患者均在超声引导下一期成功建立皮肤。肾脏通路，2例因通道建立过程出血明显，留置。肾造瘘管后改Ⅱ期碎石。单通道取石123例，双通道取石4例。手术时间30～160min，平均95min，无气胸、腹腔脏器损伤等严重并发症发生，120例术后随防2～3个月，未见结石复发。【结论】超声引导穿刺经皮。肾镜治疗。肾结石简便、安全、疗效可靠，是一种值得推广的微创高效的方法。超声可准确显示。肾结石的数量、大小及部位，确定经皮。肾穿刺位置，降低手术并发症。     

移植肾穿刺活检的必要性探讨及并发症分析

目的探讨移植肾穿刺活检的必要性及并发症,以指导临床治疗,并促进移植肾活检在肾移植患者中的广泛应用。方法2006年12月～2009年12月行肾移植术的146例患者,术后常规行超声引导下经皮移植肾穿刺活检,采用自动活检枪及配套16G或18G活检针穿刺,移植肾穿刺组织按Banff97分类标准进行病理诊断,并对并发症进行分析。结果146例患者共行移植肾穿刺术180次,取材成功率97．3％,光镜标本平均每份含肾小球数为（8．8±2．1）个,穿刺后出现肉眼血尿的发生率为1．10％,经对症处理后缓解。结论超声引导下移植肾穿刺活检术成功率高,并发症少且可预防,总体较为安全,值得在肾移植患者中广泛使用。     

B超引导下PCNL术治疗上尿路结石的临床体会

目的探讨B超引导下PCNL术治疗上尿路结石。方法 2016年1月至2018年2月采用B超定位下穿刺,行PCNL术治疗上尿路结石60例。结果 60例均一次穿刺成功,顺利建立皮肾通道,术中未出现肾脏大出血、肾穿透及周围脏器损伤等并发症。结论超声引导经皮肾穿刺成功率高,创伤小,安全可靠。     

B超引导经皮肾镜取石术治疗上尿路结石85例

目的探讨B超引导经皮肾镜气压弹道碎石术治疗肾及输尿管上段结石的可行性和安全性。方法回顾性分析2007年4月—2010年12月我科采用B超引导下经皮肾镜气压弹道碎石治疗上尿路结石85例患者的临床资料,并对治疗效果及手术并发症进行总结。结果 83例成功施行经皮肾穿刺并建立F24经皮肾通道进行碎石术;2例经皮肾穿刺或扩张通道失败改行开放手术;1例由于经皮肾通道扩张出血行Ⅱ期经皮肾镜碎石术。所有结石均被粉碎,手术时间60～180min,平均90min。术中失血量100～500ml,平均200ml。3例需输血,输血量平均400ml。结论 B超引导下经皮肾镜碎石术治疗肾结石和上段输尿管结石具有简单、安全、微创、成功率高等优点。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.