上尿路结石与代谢

目的：近年来越来越多的研究表明泌尿系结石的发生与高蛋白饮食和肥胖有关。我们对151例泌尿系上尿路结石的患者进行了统计和研究，以了解泌尿系结石潜在的发病机理。方法：对151例泌尿系上尿路结石患者进行回顾性研究。所有结石患者均经IVP或逆行造影而证实。治疗开始前行血生化学检查，以了解是否有尿酸、血脂和血脂蛋白的变化情况。检查结果用SAS6．12 for windows软件进行统计分析。结果：患者平均年龄46．33岁。21－60岁占全部上尿路结石患者的76．8％。男女之比为2．43：1。对其中151例患者进行了血生化学检查，以了解是否存在蛋白和血脂的代谢异常。这些患者中血尿酸、血糖、总胆固醇、甘油三酯、HDL－CH、HDL2－C、HDL3－C、LDL－CH、载脂蛋白AI、载脂蛋白B、载脂蛋白AI／B和胆碱脂酶均未见明显异常，但是VLDL－C异常率高达55．48％。结论：结石的发生与多种因素有关，其中特别值得注意的是脂代谢异常。对结石患者积极纠正血脂代谢紊乱，对于预防结石的发生可能有重要意义。     

Metabolic abnormalities associated with calyceal diverticular stones

OBJECTIVE: To review the metabolic analyses of patients with calyceal diverticular stones who had surgical treatment of their calculi and to examine the effect of selective medical therapy on stone recurrence, as recent reports suggest that metabolic abnormalities contribute to stone development. PATIENTS AND METHODS: In all, 37 patients who had endoscopic treatment of symptomatic calyceal diverticular calculi were retrospectively reviewed. Stone composition and initial 24-h urine collections (24-h urinary volumes, pH, calcium, sodium, uric acid, oxalate, citrate, and the number of abnormalities/patient per collection) were compared with 20 randomly selected stone-forming patients (controls) with no known anatomical abnormalities. Stone formation rates before and after the start of medical therapy were calculated in the patients available for follow-up. RESULTS: Twelve of the diverticulum patients (five men and seven women) had complete 24-h urine collections, all of whom had at least one metabolic abnormality. Seven patients had hypercalciuria, four had hyperuricosuria and three had mild hyperoxaluria. The most common abnormality was a low urine volume; 11 of the 12 patients had urine volumes of <2000 mL/day (range 350-1950). Ten patients had hypocitraturia in at least one of the two 24-h urine samples; seven had low urinary citrate levels (172-553 mg/day) on both samples. The findings were similar in the control group. The diverticulum patients had 3.1 abnormalities/patient, and the controls had 2.9 abnormalities/patient (P > 0.05). No patients had gouty diathesis and none developed cystine stones. Stone analyses were similar in the two groups; both developed either calcium oxalate or mixed calcium oxalate/calcium phosphate stones. Six patients were followed for a mean of 23.1 months while on selective medical therapy; only one passed any additional stones, thought to be existing calculi, for a remission rate of five of six (83%). CONCLUSIONS: All patients with symptomatic calyceal diverticular stones who had comprehensive metabolic evaluation had metabolic abnormalities. There were similar abnormalities in the control random stone-formers. The abnormalities were corrected with selective medical therapy, as shown by the high remission rate. We recommend that, for patients with symptomatic calyceal diverticular calculi, a metabolic evaluation should be considered to determine stone forming risk factors.     

疏肝利胆健脾方治疗老年人腹腔镜胆囊切除术后综合征疗效观察

目的探讨疏肝利胆健脾方治疗老年人胆囊切除术后综合征的疗效。方法设治疗组50例,服中药疏肝利胆健脾方,疗程8周,对照组50例仅以西药对症治疗。结果治疗组总有效率为94%,对照组总有效率为64%(P<0.05)。结论通过中药疏肝利胆健脾方治疗胆囊切除术后综合征疗效显著。     

气压碎石加等离子体切割治疗前列腺增生并膀胱结石

目的探讨良性前列腺增生症并膀胱结石有效治疗方法.方法采用经电切镜外鞘气压弹道碎石术加经尿道前列腺等离子体双极电切术(TUPKRP)治疗BPH合并膀胱结石21例.结果所有病例结石均一次取尽,平均切除前列腺组织30.2g,无输血病例.患者术后排尿均恢复通畅,无严重并发症发生.IPSS评分由(27.9±4.5)分降至(5.7±2.6)分;Qmax由(5.2±1.5)mL/s升至(16.5±3.5)mL/s.结论经电切镜外鞘气压弹道碎石术加经尿道等离子体切割术,是治疗前列腺增生并膀胱结石安全有效的微创手术方法.     

布比卡因轻、重比重液腰麻-硬膜外联合麻醉在肾输尿管手术中的应用比较

目的对0．25％轻比重布比卡因与0．25％重比重布比卡因在肾输尿管手术腰麻一硬膜外联合麻醉（CSEA）应用中的麻醉效果及并发症进行比较。方法随机选择60例拟行肾或输尿管手术的患者，随机分为两组，均采用CSEA麻醉方法；分别向蛛网膜下腔注射0．25％重比重布比卡因3mL（重组）和0．25％轻比重布比卡因3mL（轻组）。结果重组起效时间与轻组比无明显差异；腰麻后15min麻醉平面高于轻组（P〈O．01）；低血压发生率：重组46．7％，轻组16．2％；恶心呕吐发生率：重组26．7％，轻组6．7％，有显著差异性；轻组的麻醉平面消退较重组快（68．9min对116．8min）。结论布比卡因轻比重液腰麻一硬膜外联合麻醉与布比卡因重比重液腰麻一硬膜外联合麻醉相比具有对循环影响小的特点，且麻醉后不需改变体位即可手术。     

螺旋CT平扫重建诊断输尿管结石合并肾功能衰竭的应用价值

目的 评价螺旋CT平扫重建诊断输尿管结石并肾功能衰竭的价值.方法 回顾分析10例因输尿管结石并肾功能衰竭就诊病例的临床及影像学资料.双侧输尿管结石导致尿闭6例,孤立肾输尿管结石2例,一侧肾萎缩对侧输尿管结石2例.BUN:16.8～42.4 mmol/L,Cr:531～1025 μmol/L.10例均行CT平扫重建尿路成像、KUB、超声检查;其中4例行MRU检查.结果 10例平扫CT重建均明确诊断输尿管不同部位的结石,诊断符合率100%.KUB结石显影2例(20%).超声仅1例提示腹段输尿管内结石(10%).平扫CT三维重建诊断符合率明显高于KUB、超声、MRU,差别有显著性(P＜0.01).结论 非增强螺旋CT输尿管重建可获得良好的输尿管成像,在输尿管结石并肾功能衰竭的诊断方面具有重要的临床价值.     

经输尿管镜治疗输尿管结石疗效分析

目的探讨经输尿管镜治疗输尿管结石的可行性和安全性。方法回顾性分析365例经输尿管镜治疗输尿管结石的临床资料。结果365例患者经输尿管镜成功取出结石310例，成功率为85．2％；中、下段结石患者为295例，273例成功地取出结石，成功率为92．5％。结论输尿管镜取石术，是治疗输尿管结石尤其中是中下段输尿管结石的重要手段。经输尿管镜配合ESWL、气压弹道及钬激光等多种碎石设备，可明显提高对输尿管结石的取石成功率，降低并发症。     

The Diagnosis and Differential Diagnosis of Ureteral Fibroepithelial Polyps

OBJECTIVE To study the clinical pathologic characteristics and differential diagnosis of ureteral fibroepithelial polyps. METHODS One case of ureteral fibroepithelial polyps was studied by clinical data analysis and light microscopy. RESULTS The tumor was located in the lower ureter. Histologically, the polyp was composed of expanded blood vessels and fibrous connective tissue under normal or proliferous transitional epithelium. CONCLUSION Benign ureteral fibroepithelial polyps are extremely rare, recognition of it's precise histological features can facilitate its correct diagnosis.     

原发性输尿管癌的影像诊断（附10例报告）

目的：评价原发性输尿管癌的各种影像学诊断方法的价值。方法：10例原发性输尿管癌均为移行上皮细胞癌。男性6例,女性4例,平均年龄67岁。选择应用了静脉尿路造影、逆行尿路造影、肾穿刺造影、B超和CT扫描。结果：肉眼血尿、腰痛和肾积水是本病三大临床表现。静脉尿路造影（IVU）诊断2例（18．18％）,逆行尿路造影和肾穿刺造影诊断5例（83．33％）,B超对10例均未发现输尿管肿瘤,CT扫描诊断2例。结论：逆行尿路造影为原发性输尿管癌影像学诊断最有价值的方法,CT对肿瘤的分期有一定帮助,B超可做筛选应用。     

症状性胆囊结石胆囊收缩功能测定的临床意义

目的:探讨Ｂ超检查下测定胆囊收缩功能的临床意义和其影响因素。方法:５８例症状性胆囊结石患者Ｂ超检查下测定空腹、脂餐后１小时和脂餐后１．５小时胆囊容积并计算脂餐后胆囊排空率(ＰＧＥＲ),分析胆囊结石的大小、个数及病史与胆囊收缩功能的关系。结果:脂餐后１小时ＰＧＥＲ ４１．８６±２７．９９%(０~８７%),脂餐后１．５小时ＰＧＥＲ４８．８２±２８．８６%(０~８７%),两者间比较无明显差异(ｔ＝１．１８,Ｐ＞０．０５)。研究表明胆囊收缩功能的好差与胆囊结石的个数密切相关(ｘ２＝５．５３,ｐ＜０．０５)。结论:胆囊收缩功能的测定在选择慢性胆囊炎、胆囊结石的治疗方案时是必要的。胆囊收缩功能测定采用脂餐后１小时即可。结石过多或较大及长期的慢性胆囊炎均影响胆囊收缩功能。