肾盂切开气压弹道碎石治疗鹿角形肾结石(附46例报告)

目的 探讨肾盂切开气压弹道碎石治疗鹿角形肾结石的疗效。方法 对46例鹿角形肾结石采用肾盂切开气压弹道碎石，将结石分解成数块，再逐一取出。双侧肾结石采用一次分侧手术取石。结果 46例鹿角形肾结石均较顺利取出，无黏膜撕脱、出血等并发症。25例肾功不全者均显著改善。结论肾盂切开结合气压弹道碎石是治疗鹿角形肾结石较好方法；双侧肾结石多有梗阻致肾功能受损，应双侧一次取石，有利于双肾功能恢复。     

尿结石理化性质检测在体外冲击波碎石中的意义

对３２例的尿结石采用化学定量分析法进行化学成分分析，利用材料力学原理和方 法测定密度、硬度和抗压强度，并对其中１３例的尿结石作体外碎石试验。结果表明碎石所需 冲击次数与结石成分有关，尤其是草酸钙结石所需冲击次数明显增加；冲击次数与结石物理特 性有关，随结石硬度增加而增加。因此，检测尿结石理化性质在体外冲击波碎石中具有重要意 义。     

体外冲击波碎石术后石街的处理(附41例报告)

目的总结体外冲击波碎石(ESWL)术后石街的处理经验。方法回顾性分析2001年8月至2006年3月我院41例上尿路结石行ESWL术后形成石街患者的临床资料。结果9例石街采用逆行引流体位后自行排净,25例再次行ESWL术后石街排净,5例改行输尿管镜碎石术,2例行开放手术。结论采用患侧卧位的逆行引流体位,再次行ESWL术和输尿管镜碎石术等方法处理,能有效提高石街的排净率。     

Inadvertent removal of foreign body via a flexible fiberoptic bronchoscope in a 4-year-old boy

We report the case of a 4-year-old child with an atypical presentation of an aspirated unwitnessed foreign body in the airway. During an attempt to obtain a biopsy of what appeared to be a mucosal growth, the foreign body was removed. This may be the first report of foreign body removal in a child this young, using a flexible fiberoptic bronchoscope. Pediatr Pulmonol. 1994; 18:51–52. © 1994 Wiley-Liss. Inc.     

Symptoms, diagnosis and endoscopic management of common bile duct stones

Symptomatic BDS commonly cause significant morbidity and attempt at stone removal should be attempted if possible. Complications of CBDS include biliary colic, jaundice, cholangitis and pancreatitis. Investigations aimed to predict the presence of stones within the bile duct include serum bilirubin, AST, ALP, common bile duct diameter and age as independent predictors of choledocholithiasis. TUS is a sensitive test in detecting bile duct dilatation but the sensitivity is reduced in its ability to detect choledocholithiasis. A NIH consensus statement found that ERC, MRC and EUS were comparable in their sensitivities, specificities and accuracy rates for detection of choledocholithiasis. ERC and stone removal using a balloon or basket is often performed following EST. EBD may be performed if patients have uncorrected coagulopathies but the risk of pancreatitis is higher than for EST (although the risk of bleeding complications is lower for EBD). ML is often required in difficult to remove CBDS and using this device, CBDS can be removed in 90–95% of cases. Other forms of lithotripsy including laser lithotripsy and EHL are confined to specialised centres and the evidence for their use is based on small studies. ESWL may clear stones from the bile duct in up to 93% of patients but frequently ERC and stone fragment removal is required post ESWL. The role of medical therapy in difficult to remove CBDS (or in CBDS in patients with severe co-morbid illness preventing ERC + stone removal) is still currently uncertain due to a lack of large randomised control trials.     

NE系列两种常用冲击波源碎石机治疗输尿管结石的疗效分析

目的分析并比较NE系列的两种冲击波源碎石机治疗输尿管结石的疗效、碎石时的疼痛程度、碎石时间及副作用。方法回顾性分析应用NE-IV型液电冲击波源碎石机治疗输尿管结石患者1290例及应用NE-VB型电磁冲击波源碎石机治疗输尿管结石患者1196例的临床资料,并进行疗效、碎石时间、碎石时的疼痛程度及副作用的比较。结果应用电磁冲击波源碎石机治疗输尿管上段结石患者的总有效率为85.4%,治疗时间23~60min,平均(35.3±5.7)min;输尿管下段结石患者的总有效率为94.6%,治疗时间3~60min,平均(30.5±6.1)min。碎石时患者的疼痛感觉轻。液电冲击波源碎石机治疗的输尿管上段结石患者的总有效率为75.7%,治疗时间25~110min,平均(38.0±9.8)min;输尿管下段结石为85.7%,治疗时间4~90min,平均(35.8±7.7)min。碎石时患者的疼痛感觉明显。此外,肾绞痛、血尿、恶心、呕吐、皮肤瘀斑等副作用明显高于电磁冲击波源碎石机治疗组。结论电磁冲击波源碎石机治疗输尿管结石疗效优于液电冲击波源碎石机,而且更安全、有效、痛苦小。     

复式脉冲低能量ESWL治疗肾结石769例报告

目的探讨复式脉冲HB-V型低能量体外冲击波碎石机治疗肾结石的治疗效果.方法采用复式脉冲HB-ESWL-VG型低能量碎石机治疗直径<2.0 cm的各类肾结石769例，治疗工作电压3～9 kV，平均冲击次数2 300次.结果肾盏结石总粉碎率为97.4%，其中上中盏结石复打率为13.1%，术后3个月排净率为89.4%，下盏结石复打率为17.3%，排净率为81.5%；肾盂结石粉碎率为98.3%，复打率为6.1%，术后3个月排净率为93.0%.结论复式脉冲低能量ESWL治疗肾结石具有治疗成功率高、复打率低、无严重并发症、副作用少之优点.     

输尿管镜气压弹道碎石治疗输尿管结石110例

目的总结输尿管镜气压弹道碎石治疗输尿管结石的临床效果。方法采用F8/9.8 Wolf硬性输尿管镜、JUN—AIR气压弹道碎石机治疗110例输尿管结石。结果输尿管镜直视下一次碎石成功105例，成功率95．5％（105／110），1～6周内结石全部排净。2例因置镜失败改开放手术，3例输尿管上段结石上移至肾脏行ESWL2例，口服排石药物治疗1例。术后泌尿系感染5例，轻度肉眼血尿1～3d。结论输尿管镜气压弹道碎石是治疗输尿管中、下段结石的有效方法之一，具有碎石率高、安全、并发症少、操作简单的优点。     

3种微创手术治疗复杂性输尿管上段结石的疗效比较

目的比较经尿道输尿管镜钬激光碎石(URSL)联合体外冲击波碎石(ESWL)、微创经皮肾镜取石(mini-PCNL)、后腹腔镜输尿管切开取石术(RLU)治疗复杂性输尿管上段结石的疗效。方法153例复杂性输尿管上段结石患者按治疗方法分为三组:URSL联合ESWL(联合组)治疗60例,mini-PCNL治疗65例,RLU治疗28例。结果联合组有5例转开放手术取石,余50例患者平均手术时间(65.45±16.39)min,术后并发症发生率为23.64%(13/55),1个月后结石清除率为90.91%(50/55)。mini-PCNL组无中转,平均手术时间(50.38±12.91)min,术后并发症发生率为9.23%(6/65),1个月后结石清除率为100%。RLU组有2例转开放取石,平均手术时间(81.73±17.89)min,术后并发症发生率为15.38%(4/26),1个月后结石清除率为100%(26/26)。mini-PCNL组的手术时间、术后住院时间均显著短于联合组和RLU组;并发症发生率明显低于联合组;1个月后结石清除率明显高于联合组。结论mini-PCNL治疗复杂性输尿管上段结石具有手术时间短、结石清除率高、术后并发症少、恢复快的优点。     

Eigenstructure assignment with control gains optimization

Eigenstructure assignment using output feedback is reformulated using an auxiliary principle of minimization of control effort. In the general eigenstructure assignment procedure, the feedback gain matrix is uniquely determined for a set of explicitly specified desired eigenvalues and eigenvectors. However, for the controller design proposed in this paper, only the most necessary constraints are imposed on the desired eigenvalues and eigenvectors, and the unspecified model parameters of the closed-loop system are determined by minimizing the control effort. Numerical examples are presented for comparison of the proposed method with standard eigenstructure assignment methods, and an experimental example gives an insight into the feasibility of the proposed control algorithm with application to the vibration control of flexible structures undergoing forced vibration.