APPRAISAL OF SURGICAL AND ENDOSCOPIC MANAGEMENT OF CHOLEDOCHOLITHIASIS

One hundred and ten patients with common bile duct (CBD) stones were treated in the Department of Surgical Gastroenterology at SGPGIMS, Lucknow, India between January 1989 and December 1992. The primary modality of treatment was surgery in 62 patients (group I) and endoscopic sphincterotomy (ES) in 48 (group II). The two groups were well matched with respect to clinical features and presence of medical risk factors. Surgical clearance of CBD stones was achieved in 58 patients (93.5%; group Ia). Four patients (7%) had retained stones following surgery (group Ib). In group II, the CBD was cleared by endoscopic means in 20 out of 48 patients (42%) and was categorized into group IIa. In the remaining patients ES was followed by CBD exploration (group IIb). Significantly higher morbidity was seen in patients needing CBD surgery following attempted endoscopic clearance, because of ES-related complications, such as bleeding, cholangitis, septicaemia and numerous others. Use of ES to treat CBD stones on a routine basis was therefore not found to be any better than one-time surgical exploration.     

小儿重复肾合并其他尿路畸形（附60例报告）

６０例重复肾中，４８例合并输尿管口异位，７例合并输尿管囊肿，４例伴巨大输尿管积水，５例合并肾发育不良，１例为肾积水。年龄４个月～１３岁。临床表现：滴沥性尿失禁４８例，尿路感染１０例，腹部包块６例，排尿困难５例，尿道口有肿物脱出４例。诊断主要依靠ＩＶＵ。５８例经手术治疗，其中５１例作患侧上肾部及输尿管切除，７例行患侧肾切除。术后除１例尿内仍有异常外，均恢复满意。     

Cystitis as a correlate of female urinary incontinence

The objectives of the research were to study the association between prevalent urge and stress urinary incontinence (UI) and a history of cystitis in adult females. A cross-section of the adult female population, aged 30–59 years, in the Municipality of Aarhus, Denmark, was studied, using self-reported data based on postal questionnaires. The sample consisted of 3114 women, out of whom 2613 (84%) delivered the information requested. The main outcome measures were period prevalence in 1987 of episodes of UI provoked by physical stress and UI associated with a feeling of urge, prevalence of experience of episodes of cystitis and UI related to cystitis in adult life, and prevalence of relative risks, as indicated by odds ratio (OR), of UI conditional on cystitis experience. Results indicated that the 1987 period prevalences of UI provoked by physical stress and UI associated with a feeling of urge were 15% and 9%, respectively. Forty-five per cent reported a history of cystitis and 10% of UI during episodes of cystitis. Both UI provoked by stress and UI associated with a feeling of urge were significantly correlated to cystitis (OR 2.1, P<0.0001, and 1.8, P<0.0001, respectively) and to UI during episodes of cystitis (OR 7.1, P<0.0001, and 5.7, P<0.0001, respectively). When corrected for the stress aspect, UI being associated with a feeling of urge showed no association of its own to a history of cystitis. However, stress and urge aspects were both correlated to the experience of UI during episodes of cystitis. The prevalence of experience of cystitis increased with increasing number of urologic (per operation OR 2.1, P<0.0001) and gynecologic operations (per operation OR 1.5, P<0.0001), e.g. curretage (per operation OR 1.2, P<0.001), but not with the number of abdominal operations or the number of childbirths. It was concluded that cystitis may be an important component of UI etiology. Stress and not urge UI seems to be the key type related to a history of cystitis in general. The experience of UI during cystitis is connected to both stress and urge UI. A history of cystitis may possibly itself by initiated by surgery.     

经阴道无张力吊带术治疗女性压力性尿失禁的体会

目的探讨经阴道无张力吊带术(TVT)治疗女性压力性尿失禁(SUI)的疗效及安全性。方法对2002年5月至2004年12月施行TVT的114例女性SUI患者资料进行回顾性研究。根据Stamey尿失禁分级系统评价TVT手术的有效性。术后较术前尿失禁等级评分改善2级或2级以上为显著改善,1级为改善,无改善甚至加重为无效。术后尿失禁等级为0~1级为完全控尿,2级为有效控尿,3~4级为无效。评估术前、术后的24h尿垫试验及尿动力学检查结果。并对并发症进行统计和分析。结果随访110例(96.5%),随访时间6~30个月。24h尿垫试验术前(38.3±10.4)g,术后(8.8±7.4)g;尿失禁症状评分从术前42.3±11.4,术后20.4±9.2;尿失禁等级评分显著改善者94例(85.5%),改善者12例(10.9%),无效者4例(3.6%)。术后完全控尿者89例(80.9%),有效控尿者14例(12.7%),无效者7例(6.4%)。术中发生膀胱穿孔2例(1.8%),出血14例(12.7%)。术后1个月内有排尿不畅者9例(8.2%),尿频、尿急者12例(10.9%),尿潴留者1例(0.9%);术后6个月后有耻骨上不适者8例(7.3%),排尿不尽者2例(1.8%),尿频、尿急者3例(2.7%)。1例反复尿潴留患者经保守治疗无效,最终将吊带切断。术后未出现吊带处阴道黏膜糜烂和明显盆腔血肿。结论TVT术是目前治疗女性SUI的一种有效、安全的微创手术。     

老年患者尿路感染菌群分布及其耐药性分析

目的 :了解老年患者尿路感染致病菌的菌群分布及其对抗生素的耐药情况 ,为临床合理使用抗生素提供依据。方法 :收集湖北省 15所三级甲等医院 2 0 0 2年尿路感染老年患者清洁中段尿细菌培养分离的 5 34株致病菌 ,对其进行耐药性监测。药敏采用K B法 ,用WHONET 5软件进行数据分析。结果 :共收集致病菌 5 34株 ,其中革兰阴性菌 4 0 9株 (76 .6 % ) ,革兰阳性菌 12 5株(2 3.4 % )。革兰阴性菌中大肠埃希菌检出率最高 (2 6 4株 ,4 9.4 % ) ,其次为克雷白杆菌 (44株 ,8.2 % )。 16 .7%的大肠埃希菌和 2 2 .7%的克雷白杆菌产超广谱 β 内酰胺酶。亚胺培南、阿米卡星、头孢他啶对革兰阴性菌的抗菌活性最强 ,而革兰阴性菌对环丙沙星、庆大霉素、哌拉西林的耐药率均在 5 0 %以上。革兰阳性菌以肠球菌最多见 (6 4株 ,12 % ) ,其次为葡萄球菌属 (43株 ,8.1% )。革兰阳性菌对SMZco、红霉素等的耐药率均在 4 0 %以上 ,但对万古霉素均敏感。结论 :老年患者尿路感染以革兰阴性菌为优势菌株 ,且耐药性日益严重 ,对亚胺培南、阿米卡星、头孢他啶最为敏感。革兰阳性菌宜以万古霉素为首选。     

无张力性吊带术治疗女性压力性尿失禁

目的探讨无张力阴道吊带术(tension-free vaginal tape，TVT)治疗女性压力性尿失禁的疗效。方法13例经尿动力学检查证实为压力性尿失禁在连续硬膜外麻醉下经阴道前壁行无张力阴道吊带术，低平截石位，经阴道前壁向上穿刺尿道两侧间隙，从耻骨上腹壁引出TVT吊带，调整张力，关闭切口。结果手术时间15～45min，平均35min。13例随访6～24个月，平均13个月，12例治愈，1例改善，无尿失禁复发或排尿困难。结论TVT操作简单，创伤小，手术时间短，术后恢复快，治疗压力性尿失禁疗效好。     

老年肝内外胆管结石的腹腔镜手术治疗

目的 :探讨老年肝内外胆管结石行腹腔镜手术的可行性、特点及围手术期处理。方法 :应用腹腔镜胆总管切开纤维胆道镜取石治疗老年性肝内外胆管结石 2 0例 ,显露肝门 ,切开胆总管 ,取石 ,胆总管均放置T形管引流。结果 :2 0例手术均获成功 ,1例术后肝内胆管残余结石 ,术后 6周经T管窦道纤维胆道镜取石治愈。 1例 16d拔T管后胆汁性腹膜炎 ,开腹引流治愈。结论 :老年性肝内外胆管结石腹腔镜手术 ,患者创伤小 ,安全 ,疗效满意。     

创伤性泌尿系出血的急诊动脉栓塞治疗

目的探讨经导管选择性动脉栓塞在创伤性泌尿系出血急诊治疗中的价值. 方法 1998年1月～2003年6月对27例创伤性泌尿系出血根据损伤出血部位行数字减影血管造影检查,明确出血动脉,明胶海绵颗粒或弹簧钢圈栓塞靶动脉. 结果 23例一次栓塞成功止血,2例2次栓塞后止血,2例栓塞失败改行其他治疗方法.栓塞后不良反应为发热16例,局部疼痛、恶心、呕吐14例,1例髂内动脉栓塞出现一过性臀部疼痛. 结论选择性动脉栓塞是治疗创伤性泌尿系出血的有效措施,具有创伤小、见效快的优点,为进一步治疗创造条件.     

多层螺旋CT成像技术对输尿管微小结石的临床应用价值

目的 探讨多层螺旋CT（MSCT）在输尿管重建中显示输尿管结石的临床应用价值。资料与方法 实验组：27个取自患者的泌尿系结石，分别经设置不同扫描参数的单层螺旋CT（SSCT）和MSCT扫描。比较在设置不同扫描参数下SSCT和MSCT的结石检出率，检验不同扫描层厚与检出结石数的关系。临床组：35例腹部平片（KUB）阴性但临床高度怀疑输尿管结石患者均行B超和MSCT扫描及输尿管重建。输尿管重建方法有：曲面重建、最大密度投影和表面遮盖成像。结果 实验组MSCT 5mm和10mm层厚扫描，然后分别以0．62．5mm和1．25mm层厚重建所得的图像，其质量及其显示出的结石数与MSCT相应同等薄层扫描（0．625mm和1．25mm层厚扫描）所得的结果完全一致。临床组35例40个输尿管结石，B超发现23例25个，检出率为62．5％；MSCT薄层重建结合输尿管重建后结石检出率为100％。并能清楚显示结石位置、大小及输尿管梗阻扩张的程度及范围。结论 MSCT常规平扫结合薄层重建特别是CT尿路造影（CTU）可提高结石检出率及评价输尿管有元梗阻及其程度。必要时增强扫描可评价患侧肾功能。