微创治疗方法在输尿管上段结石中应用进展

输尿管上段结石为临床中常见泌尿系结石类型之一,如不能及时诊治,可引起重度积水、泌尿系感染,甚至脓毒血症,对患者肾功能、健康造成严重影响。随着微创治疗技术在泌尿系结石中应用,微创治疗方法能降低对患者造成治疗性创伤,降低相关并发症发生率,促进患者康复,了解临床中微创治疗输尿管上段结石方法,对临床中合理治疗输尿管上段结石有重要价值。     

Post-nephrectomy pulmonary thromboembolism

The association of pulmonary thromboembolism with nephrectomy is well documented in malignant conditions. However, the data for incidence of pulmonary thromboembolism following nephrectomy in nonmalignant conditions remains scarce. We report the first case of an incidence of pulmonary thromboembolism following nephrectomy in a patient with a nonfunctional kidney due to multiple renal calculi.     

RPLU、FURL及PCNL治疗输尿管上段嵌顿性结石的疗效研究

目的探讨后腹腔镜切开取石术（retroperitoneal laparoscopic lithotomy，RPLU）、输尿管软镜碎石清石术（lithotripsy with flexible ureteroscope，FURL）及经皮肾镜碎石清石术（percutaneous nephrolithotomy，PCNL）种不同方法治疗输尿管上段嵌顿性结石的疗效，以明确直径大于1.5 cm的输尿管上段嵌顿性结石的最佳处理方案。 方法回顾性分析159例输尿管上段嵌顿性结石，收集其术前术中资料，按术式不同分为RPLU组56例、FURL组55例、PCNL组48例。对手术时间、术后住院时间、结石清除率、术后并发症等数据进行统计学分析。 结果FURL组手术时间和术后住院时间明显短于RPLU组和PCNL组，差异均有统计学意义（P＜0.05）。RPLU组术后3 d和术后1个月的结石清除率（100%，100%）稍高于FURL组（90.9%，94.5%）和PCNL组（93.8%，93.8%），3组患者术后无严重并发症出现，差异均无统计学意义（P＞0.05）。 结论3种不同手术方法治疗嵌顿性输尿管上段结石均安全有效，FURL组手术时间及住院时间更短，患者术后恢复更快，更具有优势。     

Secondary stone formation 8 weeks after percutaneous nephrolithotomy treatment: A case report

Introduction:This work reports a patient with recurrent renal calculi subjected to three surgeries in half a year to be in the same position, and the high-throughput sequencing data showed different species in the renal pus and urine samples, which suggested that partial renal infection or stone formation can be judged by the bacteria in urine.Patient concerns:The female patient aged 43 years was referred to the authors’ department on April 13, 2020, due to left waist pain and fever for 3 days.Diagnosis:Kidney stones and hydronephrosis were determined by a urinary system computed tomography scan.Interventions:On April 20, 2020 and June 15, 2020, the patient was successfully treated with left percutaneous nephrolithotomy twice under general anesthesia. An investigation on the health and eating habits of the patient within 6 months was completed at the last admission. The components of the second renal calculus sample were analyzed with an infrared spectrum analyzer. The third renal stone (renal pus, triplicates) was subjected to microbial metagenome sequencing, and urine samples before and after surgery were subjected to 16S RNA sequencing by SEQHEALTH (Wuhan, China).Outcomes:After percutaneous nephrolithotomy, the left kidney stones were basically cleared, stone analysis revealed that the main components were calcium oxalate monohydrate, silica, and a small amount of calcium oxalate dehydrate. Although the urine samples exhibited differences, the renal pus and urine sample shared a single species.Conclusion:It is not clear that the prospects of partial renal infection or stone formation can be judged by the bacteria in urine.     

中医尿路排石汤联合体外冲击波碎石治疗上尿路结石的临床观察

目的：探讨中医尿路排石汤联合体外冲击波碎石中西医结合治疗上尿路结石的疗效。方法：回顾分析我院 2012年 6 月—2017 年 6 月治疗的上尿路结石患者 889 例，按治疗方式分为单纯体外冲击波治疗（对照组）与中西医结合治疗（治疗组）。对照组给予常规西医体外冲击波碎石治疗，治疗组采用尿路排石汤联合体外冲击波碎石中西医结合治疗。观察两组治疗效果、住院天数、平均需要碎石次数、腹痛减轻时间、肉眼血尿消失时间。结果：对照组总有效率为 80%，治疗组总有效率为 90%（P<0.05），对照组平均碎石治疗次数为（2.1±1.1）次，治疗组平均碎石治疗次数为（1.4±1.2）次（P<0.05），对照组平均腹痛时间为（3.76±2.24）天，治疗组平均腹痛时间为（3.01±1.54）天（P<0.05）。结论：中西医结合治疗效果优于单独使用体外冲击波碎石术治疗。     

Role of Oxalobacter formigenes in preventing calcium oxalate kidney stones

Objective To screen Oxalobacter formigenes (OxF) from fresh feces of healthy adults, and study its effect on the the prevention of calcium oxalate kidney stones. Methods OxF was screened and cultured from fresh feces of healthy adults. The rat model of calcium oxalate stone was established by esophageal gavage of 0.8% of ethylene glycol. Rats were divided into a control group and four groups of rats with ethylene glycol-induced calcium oxalate kidney stones according to random number table. Three groups were treated with 106 CFU, 107 CFU, 108 CFU viable OxF every day, respectively, for 4 weeks. The blood and 24-hour urine samples were collected to detect the serum creatinine, urea nitrogen, serum and urine calcium, phosphorus, magnesium and urine oxalate every week. At the end of the 4th week, the rats were sacrificed and the kidney tissues were stained with HE and Yasue. The deposition and content of calcium oxalate crystals were observed under a light microscope. Results The bacteria strain isolated from fresh feces of healthy adults was 100% as same as the known ATCC35274 bacteria strain, which means the strain screened is OxF. Among the 5 groups, there were no significant differences in body weight, Scr, BUN, serum calcium, blood magnesium, blood phosphorus, urinary magnesium and urinary phosphorus. The 24-hour urinary calcium excretion in the model group was significantly lower than that of the control group (P＜0.05). After intervention with OxF solution, the 24-hour urinary calcium excretion in the 108 CFU OxF group was significantly higher than that in the model group (P＜0.05), while there was no significant difference between the other intervention groups and the model. The oxalic acid excretion of 106 CFU OxF group and 107 CFU OxF group was lower than that of the model, but the difference did not reach statistical significance (P＞0.05). The 24 h oxalic acid excretion in the 108 CFU OxF group was significantly lower than that of the model at the end of first week (P＜0.05), and continued to decrease for the next 3 weeks. After 4 weeks of intervention, no crystal formation was observed in the control group under the deflection microscope, but a large amount of calcium oxalate crystals were formed in the renal cortex and renal medulla. The crystals were piled up and connected to each other. Yasue staining coincided with the calcium oxalate crystal in the same part of the kidneys. Compared with the model, there was no significant change in the score of calcium oxalate crystal in the kidneys of 106 CFU OxF group and 107 CFU OxF group, while the score of calcium oxalate crystal in the kidneys of 108 CFU OxF group was significantly lower (P＜0.05). Conclusions OxF are successively screened from healthy adults. Daily administration of 108 CFU OxF can safely and effectively reduce the urinary oxalic acid excretion, prevent the formation of calcium oxalate crystals and inhibit the formation of stones in kidneys of rats.     

经皮肾镜治疗>2 cm肾结石伴肾积水的疗效分析

目的分析经皮肾镜治疗>2 cm肾结石的疗效与肾积水程度的情况。方法选取2017年1月至2019年12月在十堰市人民医院泌尿外科应用经皮肾镜气压导弹碎石术治疗的105例肾结石>2 cm患者临床资料,根据肾结石伴不同程度的肾积水分为轻度积水组(A组)、中度积水组(B组)和重度积水组(C组),每组35例。比较并分析3组术中出血量、手术时长、术后住院时长及一次性清石率等情况。结果3组一次性清石率比较,差异无统计学意义(P>0.05)。3组术中出血量、手术时长及术后住院时长比较,差异有统计学意义(P<0.05)。A组术中出血量多于B组,且手术时长较B组长(P<0.05);A组手术时长较C组长,术后住院时长较C组短(P<0.05)。A组与C组术中出血量比较,差异无统计学意义(P>0.05)。B组术中出血量少于C组,且手术时长、术后住院时长较C组短(P<0.05)。结论经皮肾镜碎石取石术在>2 cm肾结石伴中度肾积水的治疗上较轻、重度积水具有一定的疗效优势。对于>2 cm肾结石伴轻、重度积水的治疗,经过了术前对患者情况及手术风险的充分评估。若术中术后出现大出血、肾功能减退等并发症多的患者,可考虑使用其他方法或联合其他方法碎石。