孤立肾并发复杂性结石32例的治疗探讨

目的探讨孤立肾并发复杂性结石的处理方式,提高其治疗的有效性和安全性。方法回顾性分析32例孤立肾并发复杂性结石的临床资料。其中先天性孤立肾6例（18．8％）、后天原因26例（81．2％）;左侧12例（37．5％）、右侧20例（62．5％）。均为铸形或鹿角状、多发性结石,9例合并输尿管结石,8例因梗阻性无尿急诊入院;铸形或鹿角状结石首选体外冲击波碎石术（ESWL）后经皮‘肾镜取石术（PGNL）治疗,多发性结石先行PCNL后行ESWL处理,部分病例配合腔内碎石。结果29例（90．6％）经ESWL及PCNL联合治疗痊愈,12例PCNL术中辅以腔内碎石,8例梗阻性无尿者急诊ESWL或腔内碎石后12h内恢复排尿;3例（9．4％）因肾盂输尿管畸形、梗阻改行开放手术,1例继发反复感染需长期肾造瘘。随访4～36个月,29例（90．6％）肾功能良好,3例（9．4％）存在肾功能不全,2例（6．2％）结石复发。结论联合应用ESWL及PCNL可安全有效地清除多数孤立肾的复杂性结石;梗阻性无尿者行急诊ESWL是必要的,对输尿管下段梗阻性结石可首选腔内碎石;伴肾盂明显畸形或输尿管连接部严重狭窄者以选择开放手术为宜。     

Ureteroscopic holmium laser lithotripsy in patients with renal impairment

Objectives In this study, we try to evaluate the efficacy and safety of holmium lasers for treatment of ureteric stones in patients with renal impairment or obstructive anuria. Patients and methods Twenty-six patients were included in this study, of which 20 patients presented with elevated blood urea and serum creatinine (2.1–7.6 mg%), and six patients presented with calcular anuria (mean serum creatinine 22 mg%). None of the patients had a ureteric stent or nephrostomy tube before the ureteroscopy. All patients were treated with holmium laser. A stone basket or grasper was used to remove significant stone fragments at the end of the procedure in seven patients. In these seven patients, ureteric stents were placed at the end of the procedure. Results All patients were free of any stone fragments at 1 week and at 3 months postoperatively. In all patients, including the six with obstructive anuria, the renal impairment resolved or improved as evidenced by normalization or fall in blood urea and creatinine. Thus, in this small group of uremic patients, the success rate for treatment of ureteral stone was 100%. Conclusions A holmium laser is a safe and effective modality of ureteroscopic lithotripsy in patients with significant renal impairment or even obstructive anuria. The use of holmium laser with ureteroscopy may be considered in this group of patients as long as the general condition of the patient permits the safe administration of anesthesia.     

硬性输尿管镜联合钬激光碎石术治疗反复发作肾绞痛38例

目的探讨应用硬性输尿管镜与钬激光碎石术治疗反复发作肾绞痛的方法和影响结石排出的原因.方法对38例反复发作肾绞痛患者实施硬性输尿管镜并钬激光碎石术;用异物钳等器械配合处理结石或其他梗阻原因.结果成功解除梗阻36例,术后疼痛即刻缓解33例,1～2 d后缓解3例.主要并发症为血尿21例,输尿管穿孔1例.术中发现影响梗阻解除的主要因素有输尿管口狭窄、水肿,结石形态不规则,结石下方输尿管狭窄以及息肉、妊娠、肥胖等.结论肾绞痛反复发作者可能存在影响输尿管通畅因素,硬性输尿管镜联合钬激光碎石术是治疗此类患者安全、有效的方法.     

Ultrasonography and biliary extracorporeal shock-wave lithotripsy

The results of shock-wave treatment of gallbladder stones depend to a very high degree on the quality and expertise of ultrasonography applied before, during, and after shock-wave disintegration of the stones. Ultrasonography is decisive in evaluating the inclusion criteria; it is the method of choice for directing the shockwave energy at the stones and monitoring the disintegration process. It is the only diagnostic modality to really demonstrate the gallbladder being free from stones. © 1993 John Wiley & Sons, Inc.     

钬激光输尿管碎石手术失败原因探讨(附8例报告)

目的：探讨钬激光输尿管碎石手术失败的原因。方法：报告以钬激光经输尿管镜进行输尿管结石碎石手术失败的8例临床资料。结果：8例中3例由于术中结石移位致使结石进入肾盂，无法继续碎石；2例由于输尿管走行迂曲或输尿管狭窄，输尿管镜无法通过而放弃手术；1例由于结石阻塞输尿管，冲洗液引流不畅导致手术视野不清而停止手术；2例因为输尿管开口内陷，置镜受阻而终止手术。结论：结石移位、输尿管走行迂曲或狭窄、手术视野不清及输尿管开口异常导致置镜失败，是该手术失败的主要原因。术前合理选择病例，使用适宜光纤，术中适时调整冲洗液流速、压力及激光的参数，从结石边缘起碎石等措施是提高手术成功率的关键。     

高能冲击波对正常人体细胞遗传物质的影响

本实验通过将正常人体外周血淋巴细胞经ＨＥＳＷ处理后培养９６小时制片，观察染色体损伤指标（染色体畸变率，异常细胞率），以期了解国产ＪＴ－Ⅱ型水槽式碎石机对正常人体细胞遗传物质染色体力影响情况。实验结果表明ＨＥＳＷ对正常人体细胞遗传物质有影响，且与接受冲击被处理次数，标本距Ｆ＿２的距离成正相关     

腔内钬激光治疗输尿管结石并发息肉

目的：探讨输尿管结石并发输尿管息肉的腔内钬激光治疗的效果。方法：用输尿管镜下钬激光碎石；同时气化、切割息肉72例，术后均放置输尿管支架管1～12周。结果：72例术后症状均好转或消失，3个月后，随访到68例，B超检查肾积水均有不同程度的减轻，其中有23例消失。32例作腹部平片(KUB)及静脉尿路造影(1VU)检查显示结石均消失，输尿管未见狭窄。也未见息肉复发。结论：对输尿管结石停留在同一部位3～4个月以上，及ESWL两次以上未见排石，要考虑到同时并发输尿管息肉的可能。用输尿管镜下钬激光碎石和气化切割息肉对治疗结石伴息肉是一种有效的方法。     

TUVP配合气压弹道碎石术治疗前列腺增生合并膀胱结石(附5例报告)

目的 :探讨经尿道前列腺汽化电切术 (TUVP)配合气压弹道碎石术治疗良性前列腺增生 (BPH)并膀胱结石的疗效。方法 :采用TUVP结合气压弹道碎石术治疗BPH并膀胱结石 5例 ,结果均一次治疗成功 ,无膀胱穿孔 ,术后大出血等并发症 ,术后 1个月复查最大尿流率平均 >1 6 .2ml/s。结论 :TUVP结合气压弹道碎石术是治疗BPH并膀胱结石一种安全、有效的方法