单通道经皮肾镜取石术结合输尿管软镜治疗鹿角状肾结石

目的:探讨单通道经皮肾镜气压弹道碎石结合输尿管软镜钬激光碎石治疗鹿角状肾结石的手术效果.方法:单通道经皮肾镜气压弹道碎石结合输尿管软镜钬激光碎石治疗鹿角状肾结石96例.结石大小2.9cm×3.4 cm～3.8 cm×5.5 cm,平均3.5 cm×4.2 cm.结果:96例均采用单通道经皮肾镜气压弹道碎石结合输尿管软镜钬激光碎石,一期手术平均手术时间为118 min;结石清除率为82.3%(79/96),二期手术平均手术时间为55 min,结石总清除率92.7%(89/96).7例患者残留结石,大小0.3～1.0 cm,其中5例术后1个月接受ES-WL治疗.术后随访7例残留结石患者2～6个月,结石清除5例.结论:单通道经皮肾镜气压弹道碎石结合输尿管软镜钬激光碎石治疗鹿角状肾结石具有手术时间短、结石清除率高、创伤小、并发症少、周围脏器损伤风险小等优点,可作为鹿角状肾结石的治疗方法.     

Voice outcome measures after flexible endoscopic injection laryngoplasty

ObjectiveTo report voice outcome measures after injection laryngoplasty using the transnasal or transoral flexible endoscopic technique.MethodsA retrospective review of all patients who underwent flexible endoscopic injection laryngoplasty between June 2010 and August 2016 was carried out. Only those patients who had pre- and post-injection voice outcome measures recorded were included. Voice outcome measures recorded included perceptual voice evaluation using GRBAS, Voice Handicap Index-10 (VHI-10), maximum phonation time (MPT) and closed quotient (CQ) before and after treatment.ResultsForty-six patients were identified, of which 32 had pre- and post-injection voice outcome measures recorded. There were 19 males and 13 females. The mean age was 56.97 years (range 20–86 years) and the most common indication was unilateral vocal fold paralysis. Thirteen patients had a transnasal flexible endoscopic injection), while 19 patients were injected transorally. Following injection laryngoplasty, there was significant improvement in the mean grade of dysphonia (2.81 vs. 1.22, P < 0.01, roughness (2.44 vs. 1.34, P < 0.01), breathiness (2.72 vs. 1.13, P < 0.01), asthenia (2.78 vs. 1.06, P < 0.01), and strain (2.44 vs. 1.19, P < 0.01), MPT (3.85 s vs. 9.85 s, P < 0.01) and mean CQ (0.19 vs. 0.46, P < 0.01). There was also a decrease in the mean VHI-10 score (33.31 vs. 7.94, P < 0.01).Conclusions: Patients achieved significant improvement in both subjective and objective voice measures after flexible endoscopic injection laryngoplasty via the nasal or transoral route. Voice outcomes were comparable to those reported for other approaches. This technique provides an alternative approach for the management of patients with vocal fold paralysis or glottal insufficiency.     

A comparison of flexible prompt fading and constant time delay for five children with autism

Given the increasing rates of autism, identifying prompting procedures that can assist in the development of more optimal learning opportunities for this population is critical. Extensive empirical research exists supporting the effectiveness of various prompting strategies. Constant time delay (CTD) is a highly implemented prompting procedure that has been researched widely, and demonstrated as effective and efficient. A second approach, flexible prompt fading (FPF) has not been empirically tested but has been a part of numerous behavioral studies [Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Clinical and Consulting Psychology, 55, 3–9; Soluaga, D., Papovich, S., Leaf, J., McEachin, J., Leaf, R., & Taubman, M. (2003). Instruction in social competencies utilizing a social skills taxonomy for persons with autism (databased presentation). Paper presented at the National Conference of the National Association for Behavior Analysis, San Francisco, CA]. The purpose of this study was to compare the effectiveness and efficiency of CTD and FPF in teaching receptive skills for five children with autism. A parallel treatment design demonstrated that, overall, the FPF procedure produced better results in terms of individual mastery of targets and global mastery of all targets and comparable results were seen in terms of efficiency for the two prompting procedures.     

三种微创方法治疗输尿管上段结石的对照分析

目的探讨治疗输尿管上段结石的最佳方法。方法回顾分析170例输尿管上段结石患者临床资料，51例采用经尿道输尿管镜下碎石术（ureteroscope recessive lithotrity，URL），57例采用微创经皮肾输尿管镜碎石术（minimally invasive percutane nephrolithotomy，MPCNL），62例采用后腹腔镜下输尿管切开取石术治疗，并比较分析三种手术的治疗效果。结果术后3d、1月结石清除率三组分别为：URL组33．3％（17／51）、90．2％（46／51），MPCNL组94．7％（54／57）、98．2％（56／57），后腹腔镜下输尿管切开取石术组98．4％（61／62）、100％（62／62）；URL组显著低于后两组（P〈0．05），而后两组之间无显著差异。结论MPCNL与后腹腔镜下输尿管切开取石治疗输尿管上段结石均有很高的结石清除率，URL效果较差。     

输尿管镜气压弹道联合拦截网篮治疗输尿管结石的疗效分析

目的:回顾性分析输尿管镜气压弹道联合拦截网篮碎石在基层医院治疗输尿管结石的应用。方法:收集2015年3月至2018年12月输尿管镜碎石手术患者病历资料,将190例患者分为2组。A组:单行输尿管硬镜气压弹道碎石组85例,其中中、上段结石50例,下段结石35例;B组:拦截网篮联合输尿管硬镜气压弹道碎石组105例,其中中、上段结石65例,下段结石40例。比较2组患者的碎石成功率、手术时间、术后并发症发生率、住院时间和住院费用,并进一步比较2组中、上段及下段结石的碎石成功率。结果:A组碎石成功率为77.65%(66/85),B组碎石成功率达93.33%(98/105),差异有统计学意义(P<0.05),2组术后并发症、住院时间差异无统计学意义,但B组的住院费用高于A组。A组中、上段结石一次性碎石成功率低于B组,差异有统计学意义(P<0.05);A、B 2组下段结石的成功率差异无统计学意义。结论:采用输尿管硬镜联合拦截网篮可显著提高气压弹道碎石术的成功率。     

输尿管镜在泌尿外科急诊手术中的应用(附176例报告)

目的 探讨输尿管镜在泌尿外科急诊手术中的应用.方法 2006年1月～2008年3月吉林大学第二医院与吉林大学中日联谊医院应用输尿管镜治疗急诊患者176例,其中急性上尿路梗阻性肾衰52例,体外冲击波碎石(ESWL)后输尿管"石街"9例,急性肾绞痛93例,急性尿道结石嵌顿19例,急性尿道损伤3例.结果 所有手术均顺利完成,手术时间15～80min,平均30 min.无出血、穿孔、尿瘘等.术后均有肉眼血尿,一般2～7 d消失.12例患者术中结石返回肾盂,留置双J管情况下给予ESWL,将结石击碎.所有患者均获得随访,随访1～24个1月,平均6个月.肾功能恢复满意,无尿道狭窄病例.结论 急诊输尿管镜治疗有急诊手术指征的患者,效果满意.但急诊的麻醉与手术风险相对较大,要求由有经验的医师操作,注意细致周密的术前用药、术中监护和术后处理,灵活地处置各种情况.     

输尿管镜下气压弹道碎石术治疗输尿管结石 (附178例报告)

目的探讨输尿管镜下气压弹道碎石治疗输尿管结石的临床效果和操作体会。方法对178例输尿管结石患者采用输尿管镜下气压弹道碎石治疗。结果165例直视下1次碎石成功，总成功率为92．70％。其中输尿管上段结石碎石成功率为83．72％，中下段为94．81％。碎石时间为12～64min，平均26min。结论输尿管镜下气压弹道碎石术治疗输尿管结石具有微创、安全及高效的特点，是一种治疗输尿管结石有价值的方法。     

输尿管镜下弹道碎石术治疗膀胱结石的方法改进

目的 探讨经尿道弹道碎石治疗膀胱结石的新方法.方法 插入10～12F导尿管,导尿管旁输尿管镜进入膀胱内,气压弹道碎石术治疗28例膀胱结石患者.结果 均一次治疗成功,碎石、取膀胱结石时间20一50min,平均35 min.术后3～5 d拔除尿管,排尿通畅,无结石残留,无膀胱、尿道穿孔等并发症.结论 导尿管旁路输尿管镜气压弹道碎石治疗膀胱结石是一种操作简单、安全、有效的治疗方法.     

Analysis of the colonoscopic findings in patients with rectal bleeding according to the pattern of their presenting symptoms

Patients presenting with rectal bleeding were prospectively categorized according to the pattern of their presentation into those with outlet bleeding (n=115), suspicious bleeding (n=59), hemorrhage (n=27), and occult bleeding (n=68). All patients underwent colonoscopy and this was complete in 94 percent. There were 34 patients with carcinoma and 69 with adenomas >1 cm diameter. The percentage of neoplasms proximal to the splenic flexure was 1 percent in outlet bleeding, 24 percent with suspicious bleeding, 75 percent with hemorrhage, and 73 percent with occult bleeding. Barium enema was available in 78 patients and was falsely positive for neoplasms in 21 percent and falsely negative in 45 percent. Colonoscopy is the investigation of choice in patients with suspicious, occult, or severe rectal bleeding. Bleeding of a typical outlet pattern may be investigated by flexible sigmoidoscopy.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11–16, 1989.     

经输尿管硬镜钬激光碎石术与气压弹道碎石术治疗输尿管多发结石的临床研究

目的比较钬激光碎石术与气压弹道碎石术治疗单侧输尿管多发结石的临床效果和安全性。方法选择2008年11月-2014年12月该院收治的单侧输尿管多发结石患者45例,随机分为两组,钬激光组23例,气压弹道组22例。钬激光组采用输尿管镜下钬激光碎石术治疗,气压弹道组采用气压弹道碎石术治疗,比较两组患者的治疗效果和临床安全性。结果钬激光组手术时间为(57.6±9.3)min,住院时间为(2.3±1.1)d;气压弹道组手术时间为(68.0±11.7)min,住院时间为(3.6±1.5)d,两组比较差异有统计学意义(P0.05)。两组的碎石成功率、碎石总有效率均为100.00%。两组的结石排净率、术后并发症发生率差异无统计学意义(P0.05)。结论钬激光与气压弹道均可用于治疗单侧输尿管多发结石,钬激光碎石术更具有优势,值得临床推广应用。