通淋活血法治疗输尿管结石临床疗效观察

泌尿系统结石属临床常见病、多发病,患病率约1%~5%,治疗后易复发[1]。我们自拟通淋活血汤Correspondence to:A-KANG GE.E-mail:xinhuayiyuan@126.com治疗输尿管结石,临床疗效明显,兹报道如下。1资料与方法1.1一般资料2003年6月~2005年6月,选择来我院中医科门诊治疗,且中医辨证属下焦湿热、下焦瘀滞的输尿管结石患者共60例(所有患者均经B型超声检查、X线摄片或静脉肾盂造影确诊为输尿管结石)。60例患者随机分为通淋活血汤治疗组和复方金钱草治疗组。通淋活血汤治疗组30例,其中男24例,女6例;年龄25~66岁,平均42.5岁,病程1周~16个月,平均7…     

输尿管镜下气压弹道碎石术治疗146例输尿管中下段结石

目的:探讨在输尿管镜下气压弹道碎石术治疗输尿管中下段结石的疗效及临床价值。方法:回顾性分析经输尿管镜气压弹道碎石术治疗输尿管中下段结石146例。结果:一次性碎石成功率95%(138/146),2例联合应用体外震波碎石(ESWL)术成功(1.4%),因结石质硬失败6例(4.2%)。结论:输尿管镜气压弹道碎石术治疗输尿管中下段结石具有安全、可靠、创伤小及并发症少等优点,可作为输尿管中下段结石的首选方法。     

金桃消石散治疗胆囊结石临床研究

目的:观察金桃消石散治疗胆囊结石的临床疗效及其对胆囊收缩功能的影响。方法:选择胆囊结石患者67例,随机分为治疗组和对照组。治疗组32例,口服金桃消石散;对照组35例,服用胆石通。共治疗4个月,分别于治疗前及治疗后,B超检测胆囊结石及胆囊排空率变化情况。结果:治疗组痊愈6例,显效9例,有效15例,无效2例;对照组痊愈2例,显效6例,有效18例,无效9例,两组治疗后胆囊排空率均较治疗前好转,但治疗组与对照组比较,疗效更为显著。结论:金桃消石散可以明显改善胆囊的收缩功能,是治疗胆囊结石有效的方剂。     

双镜种联合技术治疗复杂输尿管狭窄的疗效

目的：探讨双镜种联合技术处理复杂输尿管狭窄的可行性及临床效果。方法：回顾性分析2016年2月至2018年6月在中南大学湘雅医院运用该技术治疗的16例复杂输尿管狭窄患者的临床资料。16例患者均为医源性狭窄。术前患侧肾脏重度积水4例,中度积水7例,轻度积水5例。根据输尿管狭窄的具体位置及长度选择相应的手术方式。结果：所有患者顺利完成手术,无中转开放手术和脏器损伤。术后随访患者8~18个月,患者患侧肾积水均不同程度减轻,未发生输尿管再狭窄。结论：双镜种联合技术在术中能精准定位狭窄段、检验吻合效果、扩张炎性狭窄、提高远端输尿管狭窄行端-端吻合术的可能性,是一种治疗复杂输尿管狭窄疗效确切且安全可行的新技术。     

Prospects for the research and application of biodegradable ureteral stents: from bench to bedside

Abstract

Ureteral stents are commonly used in urological practices but are frequently associated with patient discomfort, encrustation and stent-related infection. And a second procedure is needed to remove the stent. New biomaterials and designs have been attempted to solve these problems. The development of biodegradable ureteral stent shows promising prospects in future clinical applications. This article reviews the biomaterials and preparation methods commonly used in the present study of biodegradable ureteral stents. To date, none of the technological developments has lead to the ‘ideal’ biodegradable ureteral stent, but much progress has been made in the stent design by improving the physical characteristics and biocompatibility of the biomaterials. The controllability of degradation, the biggest problem faced currently, still needs to be further improved. In the future, the nanotechnology and chemical modification of biomaterials may be able to further optimize the properties of degradation.     

螺旋状套石篮辅助输尿管软镜钬激光碎石术治疗单侧直径大于1厘米输尿管上段结石临床研究

目的探讨螺旋状套石篮辅助输尿管软镜钬激光碎石术(FURL)治疗单侧直径1.0 cm输尿管上段结石临床疗效及安全性。方法研究对象选取该院2012年1月-2015年12月收治的单侧直径1.0 cm输尿管上段结石患者共140例,以随机抽签法分为对照组(70例)和观察组(70例),分别采用FURL术单用和在此基础上加用螺旋状套石篮辅助治疗;比较两组患者围手术期临床指标、碎石成功率、结石清除率、结石上移率及术后并发症发生率等。结果观察组患者手术时间明显长于对照组,差异具有统计学意义(P0.05);两组患者术中出血量和住院时间比较差异无统计学意义(P0.05);观察组患者碎石成功率和结石清除率均明显高于对照组,差异具有统计学意义(P0.05);观察组患者结石上移率明显低于对照组,差异具有统计学意义(P0.05);同时两组患者术后并发症发生率比较差异无统计学意义(P0.05)。结论螺旋状套石篮辅助FURL术治疗单侧直径1.0 cm输尿管上段结石可有效提高结石清除效果,降低结石上移风险,且未增加术后并发症发生概率。     

牙结石病人的ABO血型分布

目的探讨牙结石病人的ABO血型分布。方法分析200例牙结石患者(男119名,女81名)的A,B,O,AB血型,并与健康对照组人群进行比较。结果牙结石患者中A型血出现频率明显高于其他血型(P<0.01),与对照组相比A血型患者牙结石的相对危险率明显增加(RR=1.58)。结论牙结石的发病机会与A血型有明显关联。     

导滞排石方对单纯性肾阳性结石患者24h尿THP及尿钙水平影响的研究

目的：观察复方导滞排石方对单纯性肾阳性结石患者24 h尿THP（Tamm-Horsfall蛋白）及尿钙水平的影响。方法：120例单纯性肾阳性结石患者采用区组随机观察化方法分配到G1组、G2组、G3组和G4组。所有入选患者均在充分术前准备的情况下根据结石实际情况施行体外冲击波碎石（ESWL）或经皮肾镜下气压弹道碎石术或二者结合治疗。术后G4组按西医常规治疗,其它3组则在西医常规治疗的基础上配合口服导滞排石方。G1组每天3次,每次200 mL温服;G2组每天2次,每次200 mL温服;G3组每天1次,每次200 mL温服。用药7 d为1个疗程,共4个疗程。所有患者分别于术后第1天、第5天、第7天按《外科术后康复评价量表》进行评分,并运用双抗体夹心酶联免疫吸附法（ELISA）及全自动生化分析仪对所有患者治疗前后的24 h尿THP及尿钙进行测定。结果：治疗前4组间基线特征均衡性良好（P〉0.05）;治疗后G1、G2和G3组中所有患者24 h尿THP水平显著升高,尿钙水平明显下降,其中G1组效果最佳（P〈0.05）;而G4组中所有患者治疗前后24 h尿THP及尿钙水平变化不大（P〉0.05）。治疗后所有患者按《外科术后康复评价量表》进行评分,发现G1组中患者外科术后康复评分情况要明显优于其他3组（P〈0.05）。结论：复方导滞排石方不仅能够显著影响患者24 h尿THP（Tamm-Horsfall蛋白）及尿钙水平,还可提高患者术后康复评分,改善症状,促进术后恢复。     

球囊扩张治疗肾移植术后移植肾输尿管狭窄12例体会

目的探讨球囊扩张治疗肾移植术后移植肾输尿管狭窄的临床疗效。方法回顾分析我院于2009~2012年收治的12例肾移植术后移植肾输尿管狭窄患者的临床资料,根据狭窄情况采用球囊扩张法治疗,术后留置2根双J管6月。结果 12例患者肾积水均明显减轻,肾功恢复正常。结论球囊扩张治疗肾移植术后移植肾输尿管狭窄疗效确切,安全可靠。     

Holmium: Yttrium-Aluminum-Garnet Laser Endoureterotomy for Benign Ureteral Strictures: a Single-Centre Experience

Purpose: This study aimed to report the results of endoureterotomy for benign ureteral strictures using the holmium: yttrium-aluminum-garnet laser.

Material and methods: Nineteen patients (8 men and 11 women, mean age 51.47 years) underwent holmium: yttrium-aluminum-garnet laser endoureterotomy for benign ureteral strictures (8 proximal, 3 middle, and 8 distal) using semirigid ureteroscopy and 360-μm fibre at 1.2 J/pulse and 10 Hz. After completion of the incision, a 7-Fr double-J ureteral stent was left for 6 weeks. Thereafter, the patients were followed-up by ultrasound and/or intravenous urography at 36 monthly intervals.

Results: Success was defined as the absence of symptoms plus radiographic resolution of obstructions as assessed by diuretic renography and/or intravenous urography. With a mean follow-up of 40.2 months, success was achieved in 10 (52.6%) of the 19 patients. Nine patients developed recurrent strictures and were considered treatment failures. The stricture length and severity of hydronephrosis correlated with successful outcome, but gender, aetiology, side and location of strictures did not predict outcome.

Conclusions: Although endoureterotomy using a holmium: yttrium-aluminum-garnet laser has an equivocal outcome, the procedure is recommended as a safe, less invasive therapeutic option for the initial management of benign ureteral strictures.