双频双导管超声碎石系统治疗肾结石疗效分析

目的:评价超声引导经皮肾镜双频双导管碎石术处理复杂性上尿路结石的疗效。方法:78例82侧肾结石患者均在超声引导下穿刺建立F24经皮肾通道,采用双频双导管碎石系统(cyberwand)进行碎石和清石。结果:全部患者均获得手术成功,77侧行单通道取石,5侧行双通道取石,平均手术时间(79.8±43.2)min,平均结石处理时间为(42.0±17.3)min。总体结石清除率为90.2%(74/82)。3例患者接受输血,其中2例行选择性肾动脉栓塞治疗控制出血,无严重感染患者。结论:经皮肾镜结合双频双导管碎石系统处理肾结石碎石高效安全,并发症少。     

改良经腹腔途径腹腔镜下前列腺癌根治术的临床研究

Objective To evaluate the technique and clinical outcomes of modified transperitoneal laparoscopic radical prostatectomy. Methods A total of 105 patients received the operation with age ranging from 51 to 73 years from January 2008 to June 2010. Mean level of serum prostate specific antigen was 13. 6 μg/L and mean prostatic volume was 45 ml. Pathological studies of biopsy confirmed the prostate carcinoma with Gleason score 6-8. Radionuclide bone scan revealed no metastasis. Based on previously retroperitoneal radical prostatectomy, modified technique was applied involving surgical approach, bladder neck dissection and vesicourethral anastomosis. Results Mean operative time was 93 min (65-150 min).Intraoperative blood loss was 115 ml (50-400 ml). No complication of bowl injury occurred. Positive surgical margin was present in 24 patients. Normal continence were seen in 64 patients after catheter removed. Recovery of incontinence within 3 months was seen in 33 patients and 3 to 12 months in 5 patients respectively. Three patients with incontinence were still in the follow-up. Conclusions Transperitoneal laparoscopic radical prostatectomy provides large working space and clear anatomic exposure. Higher efficiency and lower complication rate are obtained through modified laparoscopic technique involving seminal vesicle isolation, bladder neck dissection and vesicourethral anastomosis.     

腹腔镜活体供肾切取术(附16例报告)

目的 总结腹腔镜活体供肾切取技术。方法 对16例腹腔镜活体供肾切取术资料进行分析。活体供。肾者16例，男7例，女9例，年龄36～53岁，平均46岁，均为左侧供。肾。受者原发病均为慢性肾小球肾炎。供受者血型相同，淋巴细胞毒性试验均为阴性。结果 手术成功15例，1例因术中出血改开放手术。手术时间3．1～5．2h，出血56～270ml，平均热缺血时间3．5min，住院时间9～12d。16例受者中移植。肾功能延迟恢复1例，术后第5周移植肾功能恢复正常；余15例受者血清肌酐均在10d内降至正常（SCr〈146μmol／L），其中出现急性排斥反应1例，应用激素冲击治疗后逆转。结论 腹腔镜活体供肾切取手术损伤小，术后恢复快，不影响肾功能。     

一种改良大鼠异体肾移植模型的建立

目的：为开展器官移植的实验研究，建立大鼠异体肾移植模型。方法：用SD大鼠作为供体和受体，采用原位低温灌注，原位修剪，移植肾放置左侧，血管直接吻合，输尿管带膀胱瓣与膀胱吻合。结果：经过60次的实验，克服了移植物灌注、血管吻合、膀胱吻合等技术难关，建立了稳定实用的肾移植动物模型。手术成功率为80％左右。结论：此模型可以在一般的实验室条件下开展。有较高的成功率，符合肾移植实验研究的需要。     

单层阴道环形皮瓣在经阴道修补膀胱阴道瘘中的临床应用

目的对比经阴道和经膀胱两种入路修补膀胱阴道瘘（Vesicovaginal fistula,VVF）的成功率及预后,重点探讨采用单层阴道环形皮瓣经阴道修补膀胱阴道瘘的技术特点和临床应用价值。 方法回顾性分析2007年1月至2021年12月南京医科大学第一附属医院泌尿外科收治的57例采用经阴道和经膀胱两种入路修补VVF患者的临床资料,对比2组患者的一般信息、瘘的特点、手术资料、手术成功率以及术后并发症等情况。 结果57例患者年龄27~75岁,平均50.4岁。病史7天~8年,平均20个月。主诉均为尿液经阴道漏出。56例（98.2%）VVF继发于妇科盆腔手术,1例（1.8%）继发于经阴道分娩（难产）。11例（19.3%）有既往手术修补失败史。57例手术均顺利完成,其中17例（29.8%）选择经阴道入路,40例（70.2%）选择经膀胱入路。平均手术时间：经阴道（90±8.2）min vs 经膀胱（150±4.3）min;术中出血量：经阴道（40±5.4）ml vs 经膀胱（220±10.2）ml;术后住院时间：经阴道（3±0.4）d vs 经膀胱（7±1.2）d;平均住院费用：经阴道（1.3±0.2）万元 vs 经膀胱（2.5±0.5）万元。术中经阴道组无一例行膀胱造瘘,经膀胱组12例（30%）行膀胱造瘘。2组无一例发生严重并发症。轻度并发症发生率为经阴道组3例（17.6%）vs 经膀胱组13例（32.5%）。随访时间为3~48个月,平均18.5月。一次性修补成功率分别为经阴道组82.3% vs 经膀胱组75%。 结论采用单层阴道环形皮瓣经阴道修补VVF,具有手术操作简便、并发症少、成功率高等优势,值得临床应用推广。     

改良经腹腔途径腹腔镜下前列腺癌根治术的临床研究

Objective To evaluate the technique and clinical outcomes of modified transperitoneal laparoscopic radical prostatectomy. Methods A total of 105 patients received the operation with age ranging from 51 to 73 years from January 2008 to June 2010. Mean level of serum prostate specific antigen was 13. 6 μg/L and mean prostatic volume was 45 ml. Pathological studies of biopsy confirmed the prostate carcinoma with Gleason score 6-8. Radionuclide bone scan revealed no metastasis. Based on previously retroperitoneal radical prostatectomy, modified technique was applied involving surgical approach, bladder neck dissection and vesicourethral anastomosis. Results Mean operative time was 93 min (65-150 min).Intraoperative blood loss was 115 ml (50-400 ml). No complication of bowl injury occurred. Positive surgical margin was present in 24 patients. Normal continence were seen in 64 patients after catheter removed. Recovery of incontinence within 3 months was seen in 33 patients and 3 to 12 months in 5 patients respectively. Three patients with incontinence were still in the follow-up. Conclusions Transperitoneal laparoscopic radical prostatectomy provides large working space and clear anatomic exposure. Higher efficiency and lower complication rate are obtained through modified laparoscopic technique involving seminal vesicle isolation, bladder neck dissection and vesicourethral anastomosis.     

腹腔镜下手术治疗肾盂输尿管连接部狭窄

目的 评价腹腔镜下手术治疗肾盂输尿管连接部狭窄梗阻(UPJO)的疗效.方法 UPJO患者102例.男56例,女46例.平均年龄31(6～62)岁.左侧53例,右侧49例.102例均经临床及影像学检查证实.肾盂分离平均28(20～46)mm,重度积水21例、中度63例、轻度18例.采用腹膜后径路行离断式肾盂输尿管成形术.术中打开肾周筋膜,以肾下极为标志游离出肾盂输尿管连接部,切除狭窄部分,肾盂输尿管端端连续吻合并留置双J管.结果 102例手术均成功.手术时间平均120(70～180)min,术中出血量平均80(50～100)ml.无严重并发症发生.术后住院平均8.5(6～14)d.102例随访平均9(3～15)个月,经B超复查肾积水消失30例,72例肾盂分离较术前平均减少12(8～26)mm.IVU检查85例吻合口无狭窄.结论 腹腔镜下离断式肾盂输尿管成形术治疗UPJO有效、可行,可以替代开放手术.     

改良经腹腔途径腹腔镜下前列腺癌根治术的临床研究

Objective To evaluate the technique and clinical outcomes of modified transperitoneal laparoscopic radical prostatectomy. Methods A total of 105 patients received the operation with age ranging from 51 to 73 years from January 2008 to June 2010. Mean level of serum prostate specific antigen was 13. 6 μg/L and mean prostatic volume was 45 ml. Pathological studies of biopsy confirmed the prostate carcinoma with Gleason score 6-8. Radionuclide bone scan revealed no metastasis. Based on previously retroperitoneal radical prostatectomy, modified technique was applied involving surgical approach, bladder neck dissection and vesicourethral anastomosis. Results Mean operative time was 93 min (65-150 min).Intraoperative blood loss was 115 ml (50-400 ml). No complication of bowl injury occurred. Positive surgical margin was present in 24 patients. Normal continence were seen in 64 patients after catheter removed. Recovery of incontinence within 3 months was seen in 33 patients and 3 to 12 months in 5 patients respectively. Three patients with incontinence were still in the follow-up. Conclusions Transperitoneal laparoscopic radical prostatectomy provides large working space and clear anatomic exposure. Higher efficiency and lower complication rate are obtained through modified laparoscopic technique involving seminal vesicle isolation, bladder neck dissection and vesicourethral anastomosis.     

IL-16基因-295T〉C多态性与肾透明细胞癌易感性的相关性研究

目的研究中国南方汉族人群中白细胞介素-16（IL_16）基因一295T〉C多态性与肾透明细胞癌（CCRCC）易感性的相关性。方法采用以医院为基础的病例对照研究模式,通过面访填写调查表并采用聚合酶链反应一限制性片段长度多态性（P（、R—RFI．P）方法检测年龄和性别匹配的中国南方汉族300例患者和300例正常人群的IL-16gene-295T〉C基因型。并采用分层分析进一步探讨与罹患CCRCC相关的可能因素。结果与TT型携带者相比,CT型（OR=0．78,95％CI=0．55～1．09）或CC型（0．37,0．19--0．73）携带者发生CCRCC的危险性明显降低。分层分析显示年龄、体重指数及饮酒与CCRCC危险性之间无明显关联,携带CT或CC型从不吸烟的女性患者发生CCRCC的危险性明显降低（从不吸烟：0．61,0．41～0．91;女性：0．52,0．30--0．91）。结论IL-16gene-295T〉C多态性可能与我国南方地区汉族人群CCRCC易感性有关,CC型或CT型携带者发生CATRCC的危险性要明显低于TT型携带者。     

急性上尿路梗阻性无尿的诊断及处理

目的 总结急性上尿路梗阻性无尿的诊治经验.方法 58例急性上尿路梗阻性无尿患者,诊断为输尿管结石48例,盆腔肿瘤压迫5例,腹膜后纤维化2例,膀胱癌术后尿流改道后输尿管梗阻3例.结果 急诊经膀胱镜下置双J管术27例,碎石加置管术18例,经皮肾穿刺造瘘术儿例,经造瘘口直接捕管术1例,血液透析过渡后采用输尿管镜碎石1例.所有患者无术中、术后并发症,肾功能有不同程度恢复,19例术后24 h血肌酐降至正常水平,54例术后1～2周后降至正常水平.结论 对急性上尿路梗阻性无尿的患者及早准确地作出诊断,采用合适的治疗方式,可取得良好的治疗效果.