不同途径腔内碎石治疗输尿管上段嵌顿结石的疗效对比

目的 探讨腔内碎石治疗输尿管上段嵌顿结石的最佳途径。方法 将94例体外冲击波碎石（ESWL）失败的输尿管上段嵌顿结石患者随机分组，50例采用经尿道输尿管镜碎石（URL），44例经皮肾微造瘘输尿管镜碎石（MPCNL），并对临床资料进行比较。结果 URL组术后1周结石清除率22．00％。其余病例均因结石或较大碎石漂移到肾内而需联合ESWL，联合ESWL后1个月结石清除率为96．00％。MPCNL组术后1周结石清除率为95．45％，1个月结石清除率为97．73％。其中1例血尿明显，持续8d后停止。结论 MPCNL治疗输尿管上段嵌顿结石疗效更佳，结石清除率高。单用URL治疗效果较差，而联合ESWL可达到满意效果。     

输尿管镜下钬激光碎石与气压弹道碎石治疗输尿管结石的疗效比较

【目的】比较输尿管镜下钬激光碎石（LL）与气压弹道碎石（PL）治疗输尿管结石的疗效,为临床选择最佳的治疗方法提供依据。【方法】本院2009年1月至2011年12月应用输尿管镜下LL或PL治疗输尿管结石患者299例,其中采用LL151例,PL148例。比较两组的碎石时间、一次性碎石成功率及并发症发生率。【结果】LL组在平均碎石时间、并发症发生率分别为（34．5±4．6）min和0．67％,明显低于PL组的（39．8±5．5）min和4．73％;而LL组的一次性碎石率则高于PL组,分别为92．05％和81．76％;差异均有统计学意义（P均〈0．05）。【结论】输尿管镜下钬激光碎石术治疗输尿管结石的效果和安全性较气压弹道碎石术具有一定的优势,是一种较为安全有效的碎石方法。     

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.     

Ureteroscopy and pneumatic lithotripsy, followed by extracorporeal shock wave lithotripsy for the treatment of distal ureteral stones

BACKGROUND: We retrospectively reviewed our experience with retrograde ureteroscopy (URS) and a pneumatic lithotriptor in 160 patients with distal ureteral stones to determine whether prior extracorporeal shock wave lithotripsy (ESWL) is a limiting factor in the ureteroscopic procedure. METHODS: From January 1999 to September 2000, we performed URS and pneumatic lithotripsy in 160 patients with distal ureteral stones. Seventy-four patients were treated with URS primarily (Group 1), while the remaining 86 patients received URS only after ESWL had failed (Group 2). For URS and lithotripsy, we used a 9.5 French rigid instrument and vibrolith (Elmed, Ankara, Turkey). RESULTS: In Group 1, 73 of 74 patients (98.6%) were treated successfully by URS alone, as were 81 of 86 patients (94.4%) in Group 2. Impacted stones were also observed in 17 patients from Group 2. In these patients, endoscopic observation revealed edematous inflammation above and below the calculus. Ureteral perforation occurred in one patient from Group 2, which required surgical repair. There was no significant difference in the stone-free rates of the two groups t = 1.4 < 1.96t( infinity,0.05). CONCLUSION: Our data demonstrate that when ESWL fails, URS and pneumatic lithotripsy is as safe and effective as primary URS. Pneumatic lithotripsy also seems to be an effective treatment modality for impacted stones.     

输尿管镜在梗阻性上尿路感染治疗中的应用

目的探讨输尿管镜对梗阻性上尿路感染的治疗作用。方法采用输尿管镜治疗上尿路感染15例。直视下向梗阻性感染侧上尿路插入输尿管镜，采用镜体直接扩张、活检、电灼、激光碎石等微创技术解除梗阻，并适当处理原发疾病，妥善留置F7-9双J管、Foley’s导尿管，配合有效抗菌素治疗。结果12例患者上尿路感染临床症状迅速好转（80％），8例同时完成病因治疗（53．3％）。结论微创输尿管镜技术对梗阻性上尿路感染具有肯定的治疗作用。     

硬性输尿管镜嵌顿于输尿管内的处理

目的探讨硬性输尿管镜嵌顿于输尿管内的处理方法。方法对20例行输尿管镜手术时硬性输尿管镜嵌顿于输尿管内的患者资料作回顾性分析。结果 2例输尿管镜嵌顿于输尿管内直接退镜时致输尿管撕脱,18例经直肠辅助退镜和摆动输尿管镜镜体退镜成功。结论硬性输尿管镜嵌顿于输尿管内时强行退镜时将导致输尿管撕脱,经直肠辅助退镜和摆动输尿管镜镜体是硬性输尿管镜嵌顿于输尿管内较为理想的退镜方法。     

Proficiency of virtual reality simulator training in flexible retrograde ureteroscopy renal stone management

Background Minimally invasive flexible ureteroscopy techniques have widely adopted in the management of patients with renal stones. We performed this study to investigate the value of virtual reality simulator training in retrograde flexible ureteroscopy renal stone treatment for catechumen.     

T管造瘘在晚期宫颈癌患者输尿管支架置入中的应用

目的：探讨在晚期宫颈癌患者行常规膀胱镜检无法找到输尿管开口时,T管输尿管造瘘在输尿管支架置入中的应用效果.方法：12例晚期宫颈癌合并肾积水患者,行常规膀胱镜检未找到输尿管开口18侧例,通过背部直切口下输尿管T管造瘘、灌注美蓝、X线下斑马导丝探寻、顺行造影等多种方法,引导经尿道输尿管镜找到输尿管开口,逆行进入输尿管并置入支架.结果：17侧例输尿管支架放置成功,1侧例由于下段输尿管完全闭锁予留置T管行体外引流,并于1个月后更换引流管.结论：晚期宫颈癌常规镜检无法找到输尿管开口的患者,仍有很大机会获得内引流成功,外引流并非首选.背直切口下行输尿管T管造瘘创伤小、成功率高,在为外引流做好准备的同时,大幅提高了内引流成功率,提升了患者的生活质量,值得推广.     

输尿管镜钬激光碎石术治疗输尿管结石96例分析

目的探讨输尿管硬镜钬激光碎石术治疗输尿管结石的有效性和安全性。方法回顾性分析2006年7月-2010年8月96例输尿管镜下钬激光碎石治疗输尿管结石患者的临床资料,对碎石率、排石率和并发症进行统计分析。结果 96例输尿管结石患者一次手术结石粉碎率为95.8%(92/96),输尿管镜置镜成功率为99.0%,输尿管上、中、下段碎石、排石成功率分别为81.8%(9/11)、97.1%(34/35)和99.0%(49/50)。在输尿管上段碎石过程中并发输尿管穿孔2例。全组均有不同程度的肉眼血尿,无输尿管撕脱、断裂等严重并发症发生。结论输尿管镜下钬激光碎石取石治疗输尿管结石是安全和有效的,尤其对下段输尿管结石,术后常规放置D-J是安全和需要的。