输尿管镜气压弹道碎石术治疗输尿管结石临床分析

目的总结输尿管镜下气压弹道碎石术治疗输尿管结石的方法和疗效。方法2002年12月-2006年12月采用输尿管镜气压弹道碎石术治疗186例（197侧）输尿管结石,其中上、中、下段结石分别为41侧、36侧和120侧。结果输尿管镜气压弹道碎石成功率,上、中、下段结石分別为58.5%、69.4%和97.5%。一次碎石成功率为84.3%（166/197）;配合ESWL后成功率达94.4%（186/197）。除11侧未完成气压弹道碎石外,余186侧中97侧（52.1%）碎石于当日排净,84侧（45.2%）1月内拔除双J管后排净,5侧（2.7%）3月内排净。并发症发生率为2.7%（5/186）,主要为术中输尿管穿孔3例和术后高热2例。结论采用输尿管镜气压弹道碎石术治疗输尿管结石成功率高,安全可靠,尤其适于输尿管中下段结石的治疗。     

经皮肾造瘘大功率钬激光碎石术治疗复杂性肾结石35例报告

目的探讨经皮肾造瘘大功率钬激光碎石术治疗复杂性肾结行的疗效。方法采用经皮肾造瘘大功率（40～60W）钬激光碎石术治疗35例复杂性肾结石。伴肾盂输尿管连接部狭窄（UPJO）的5例同时行钬激光内切开。结果35例手术均成功,平均碎石时间65min。29例（82．9％）单次碎石后排净结仃,残余结石6例,经ESWL1～3次治疗后结石排净。34例随诊半年,无结石残留或复发。UPJO者尿流通畅,无再狭窄发生。结论经皮肾造瘘大功率钬激光碎石术具有创伤小,碎石快,安全可靠等优点,术后残石可经ESWL后排出,是治疗复杂性肾结石的有效方法。     

输尿管镜气压弹道碎石术治疗输尿管结石

目的 探讨输尿管镜气压弹道碎石术治疗输尿管结石的操作方法和疗效.方法 回顾性分析308例应用硬性输尿管镜和气压弹道碎石术治疗输尿管结石资料.其中男192例,女116例;平均年龄42岁.上段结石33例,5例行经尿道输尿管镜气压弹道碎石术,28例并大量肾积水患者行微创经皮肾输尿管镜气压弹道碎石术;中段结石91例,下段184例,均行经尿道输尿管镜气压弹道碎石术.结果 一次性结石碎石成功率为98.4%,其中1例输尿管上段结石,4例中段结石因结石上移至肾盂放置双J管,术后行ESWL碎石成功.1例下段结石因输尿管断裂而改行开放手术吻合输尿管,术后随诊无并发输尿管坏死、狭窄.303例术后平均住院2.8天,术后随访2周-3个月,肾盂积水由术前(3.4±0.8)cm降至(1.4±0.4)(p＜0.01)cm,无输尿管狭窄发生.结论 输尿管镜气压弹道碎石术治疗各段输尿管结石效果好,损伤小,并发症少.     

中医五音疗法对经T管窦道胆道镜联合激光碎石术患者生理和心理应激的影响

目的:探讨中医五音疗法对经T管窦道胆道镜联合激光碎石术患者生理和心理应激的影响。方法:选取2018年10月～2019年2月行经T管窦道胆道镜联合激光碎石术的90例患者,随机分为对照组和实验组,每组45例。围手术期内,对照组给予常规护理,实验组在常规护理的基础上采用中医五音疗法护理,根据患者的不同证型选用对应的传统乐曲。采用状态-特质焦虑问卷中状态焦虑分量表评估两组患者围手术期的状态焦虑程度,采用疼痛视觉模拟量表评估两组患者围手术期疼痛程度,采用简化舒适状况量表评估两组患者围手术期的舒适状况,并比较两组患者围手术期的平均动脉压和心率水平。结果:术前1 d,两组平均动脉压、心率、状态焦虑程度、疼痛视觉模拟量表评分和简化舒适状况量表评分相比较,差异均无统计学意义,P0.05;术前30min和术后6 h,实验组的状态焦虑程度评分、平均动脉压和心率水平均显著低于对照组,差异均有统计学意义,P0.05;术后6 h,实验组的简化舒适状况量表评分显著高于对照组,疼痛视觉模拟量表评分显著低于对照组,差异均有统计学意义,P0.05。结论:中医五音疗法可以改善经T管窦道胆道镜联合激光碎石术患者围手术期焦虑状况,保持血流动力学稳定,减轻术后疼痛,提高患者舒适度,有利于减轻患者的生理和心理应激,可以作为心理护理和舒适护理的辅助措施。     

双J管在输尿管镜气压弹道碎石术中的临床应用

目的探讨双J管在输尿管镜气压弹道碎石术治疗泌尿系结石中的临床疗效。方法自1999年11月至2003年11月,采用输尿管镜下气压弹道碎石术治疗输尿管结石546例,术后16例未留置任何支架管引流,其他患者留置双J管或输尿管导管。结果留置双J管的451例患者术后无一例出现并发症,留置输尿管导管并发症发生率为22．7％（18／79）,未留置任何导管并发症发生率为56．2％（9／16）,主要是肾绞痛及急性肾盂肾炎、血尿。结论输尿管镜术后常规留置双J管可明显减少术后并发症的发生。     

输尿管软镜碎石术后尿源性脓毒症的影响因素和生存质量研究

目的研究输尿管软镜碎石术后尿源性脓毒症的影响因素以及调查患者生存质量。方法选取2014年1月至2018年12月蚌埠市第一人民医院行输尿管软镜碎石术治疗的130例上尿路结石患者临床资料作为研究对象。对这130例患者作回顾性分析。根据术后是否发生尿源性脓毒症分为尿源性脓毒症组(n=50)及未发生组(n=80),对两组基本资料进行比较后,利用多因素Logistic回归分析法总结输尿管术后尿源性脓毒症的独立影响因素。结果两组患者性别、年龄、病程时间、手术时间、一次结石清除率、结石直径、肾积水程度、白蛋白、尿素氮差异无统计学意义(P>0.05),血小板计数、结石CT值、有无合并糖尿病、体温、心率、呼吸频率、C反应蛋白、血常规(白细胞计数、中性粒细胞百分比)相比较,差异具有统计学意义(P<0.05);多因素Logistic回归分析结果提示,血小板计数减少、结石CT值>1000HU为输尿管术后尿源性脓毒症的独立影响因素,差异具有统计学意义(P<0.05);两组生存质量相比较,未发生组高于尿源性脓毒症组,差异具有统计学意义(P<0.05)。结论血小板计数减少、结石CT值>1000HU为输尿管术后尿源性脓毒症的独立影响因素并且发生尿源性脓毒症的患者生存质量更低。     

Extracorporeal shock wave lithotripsy for lower pole calculi: Our experience

INTRODUCTION: This study was performed in order to evaluate the immediate and long-term outcome of patients undergoing extracorporeal shock wave lithotripsy (ESWL) for isolated lower pole calculi. METHODS: Three hundred and seventy renal units of 350 patients (240 men and 110 women; mean age 55 years) with isolated lower pole renal stones of smaller than 2 cm2 were studied. Follow up ranged from 1 to 52 months (mean, 15 months) to time of censorship, significant period of secondary urologic evaluation. RESULTS: Out of 370 renal units in 350 patients, 212 (57, 29%) were stone-free 1 month after ESWL and 21 (5.67%) spontaneously became stone-free within another 1-52 months (mean, 15 months). Intervention was required after 1-52 months (mean, 17.5 months) and accomplished by ESWL alone (30/350 patients 8.57%) or combined with retrograde endoscopy (10/350 patients 2.85%) while retrograde manipulation was necessary in two of the 350 patients (0.57%). CONCLUSION: Extracorporeal shock wave lithotripsy is the initial treatment of choice in patients with lower pole stones < 2 cm2, because the overall stone-free rate is acceptable and because even in the residual calculi, the risk of suffering symptomatic episodes requiring secondary intervention is low.     

ESWL对男性体内精子的影响

目的 探讨体外冲击波碎石（ＥＳＷＬ）对男性生殖细胞的影响。方法 对３５例生育能力的输尿管下段结石男性患者进行ＥＳＷＬ治疗,并对术前,术后即刻,术后１周及１个月的体内精液进行观察。结果 术后精子密度和活动率均下降,其中以术后即刻和１周较明显,有显著性差异（Ｐ〈０．０１）,术后１个月恢复正常,结论 ＥＳＷＬ对男性体内精子的影响为一过性可复性损害。     

体外冲击波碎石治疗输尿管结石121例报告

目的　总结体外冲击碎石 (ESWL)治疗输尿管结石的临床经验。方法　对ESWL治疗的输尿管结石 121例进行回顾性分析。结果　ESWL治疗输尿管结石成功 116例 (95. 9% )。无效 5例 (4 1%,均为合并肾盂中 -重度积水 )。结论　ESWL是治疗输尿管结石的重要方法。肾盂积水的程度是选择ESWL治疗输尿管结石与否的重要依据。     

The impact of preoperative percutaneous nephrostomy as a treatment strategy before flexible ureteroscopy for impacted upper ureteral stones with hydronephrosis

BackgroundThe treatment of impacted upper ureteral stones with hydronephrosis remains a challenge for urologists. The current study aimed to evaluate the impact of preoperative percutaneous nephrostomy (PNS) as a treatment strategy before flexible ureteroscopy (f-URS) of asymptomatic impacted upper ureteral stones with hydronephrosis.MethodsThis multicenter retrospective study included patients who underwent PNS (group A, n=61) and those who did not (group B, n=75) before f-URS for asymptomatic impacted upper ureteral stones with hydronephrosis. Impacted ureteral stones are defined as those that remain in one position for >2 months. Operative outcomes, including stone-free rate, operation time, postoperative hospital days, and complication rate, were evaluated.ResultsThere were no significant differences in age, sex, and stone size between the two groups except in the grade of hydronephrosis, with group A having more cases of advanced hydronephrosis than group B. The stone-free rate was significantly higher in group A than in group B [95% vs. 77% (P=0.004)]. However, there were no significant differences between the groups in operation time [55 vs. 55 min (P=0.84)], postoperative fever [5% vs. 5% (P=1.00)], and postoperative hospital days [2 vs. 2 days (P=0.44)]. In group A, preoperative PNS placement was performed 4 days before f-URS, and the PNS was removed postoperatively on the same day of the f-URS. Additionally, subgroup analysis was performed in cases of grade 2 and 3 hydronephrosis. A total of 110 patients, 60 who underwent f-URS with PNS and 50 who underwent f-URS without PNS, were included. The stone-free rate was significantly higher in f-URS with PNS than in f-URS without PNS [95% vs. 76% (P=0.005)]. However, no significant differences were found between the groups in operation time, ureteral injury, postoperative fever, and postoperative hospital days.ConclusionsAt grade 2 or 3 hydronephrosis, preoperative PNS as a treatment strategy for a few days prior to f-URS for impacted upper ureteral stones improved the stone-free rate without increasing the operation time and postoperative length of hospital stay.