输尿管镜下尿道会师术在尿道损伤中的临床研究

目的：分析探讨输尿管镜下尿道会师术在尿道损伤中的临床疗效。方法选取我院2013年1月~2014年6月收治的早期急性闭合性尿道损伤患者60例,将其随机分为观察组和对照组各30例。对照组患者采用传统的手术治疗方法,观察组患者采用输尿管镜下尿道会师术治疗方法。结果观察组患者的治疗效率明显比对照组患者好,手术时长不会超过45min,术中出血量范围为30ml以内;术后3个月内均经尿道扩张术,无须延长扩张时间,均无尿瘘、性功能障碍等并发症,且两组差异具有统计学意义(P<0.05)。结论运用输尿管镜下尿道会师术的治疗方法进行早期急性闭合性尿道损伤的治疗能够获得较为显著的治疗效果,且不易产生各种并发症及不良反应,安全性高,值得在临床上推广应用。     

输尿管镜在尿道损伤诊断和治疗中的应用（附56例报告）

目的探讨输尿管镜技术在尿道损伤诊断和治疗中的应用。方法回顾性分析输尿管镜直视下诊断和经尿道留置导尿管治疗56例尿道损伤患者的临床效果。结果 56例患者中,诊断前尿道破裂26例,后尿道破裂11例,均成功留置导尿管;诊断前尿道断裂13例,改行尿道损伤段切除加端端吻合术;诊断后尿道断裂6例,行膀胱造瘘术。前尿道损伤患者术后3周、后尿道损伤患者术后4周拔除尿管,随访6~12个月。37例尿道破裂的患者排尿通畅,尿流率在正常范围;后尿道断裂行膀胱造瘘术的患者术后第4个月行尿道造影检查明确尿道狭窄部位后行尿道狭窄段切除加端端吻合术。结论尿道损伤患者,输尿管镜检查可简单、快速地明确损伤类型;在输尿管镜直视下留置导尿管,具有视野清楚、创伤小、并发症少的特点,是尿道破裂理想和有效的治疗方法。     

腔镜下尿道会师术早期治疗闭合性尿道损伤69例报告

目的探讨腔镜下尿道会师术早期治疗闭合性尿道损伤的疗效。方法对69例闭合性尿道损伤病例行尿道镜及输尿管镜下尿道会师术治疗的临床资料进行回顾性分析。结果平均手术时间25 min（15～45 min）,平均住院天数8 d（4～14 d）。69例尿道损伤患者均能顺利留置尿管,术后4～8周拔除尿管。56例拔管后排尿通畅,常规定期尿道扩张1～3个月后最大尿流率18～25 mL/s;12例发生尿道狭窄,定期尿道扩张3～6个月后最大尿流率16～23 mL/s;1例拔管3个月后尿道严重狭窄,行冷刀内切开、尿道瘢痕汽化电切术治疗后排尿通畅。结论腔镜下尿道会师术操作简单,创伤小,手术时间短,住院时间短,有效恢复尿道连续性,可用于闭合性尿道损伤的早期治疗。     

输尿管镜下尿道置管术治疗前尿道损伤90例效果观察

目的：观察输尿管镜下尿道置管术治疗前尿道损伤的临床效果。方法选取150例前尿道损伤患者,按伤后入院时间分成实验组90例,对照组60例,对实验组进行输尿管镜下尿道置管治疗,对照组进行开放性尿道吻合术治疗,对比观察两组患者的临床治疗效果。结果实验组和对照组的治愈率分别为93.3%和50.0%,实验组总并发率为6.7%,对照组为40.0%,对比两组患者术后并发症情况差异显著,有统计学意义(P<0.05)。结论采用输尿管镜下尿道置管术治疗前尿道损伤,效果显著,值得临床推广应用。     

腔镜下尿道会师治疗单纯尿道球部断裂失败原因分析

单纯尿道球部断裂为泌尿外科急诊常见病,多为骑跨伤,尤其是建筑工人的高处坠落骑跨伤。传统诊治为试行留置导尿失败后行开放性尿道会师术或急诊行尿道断裂端端吻合术。随着近年腔道技术在泌尿外科的广泛应用,腔镜下尿道会师逐渐成为尿道球部断裂首选治疗。我科自2006至2011年共收治37例单纯尿道球部断裂,取得满意疗效。其中4例行膀胱镜下尿道会师失败,现总结并分析其原因报告如下。     

多孔尿道支架管在尿道成型术中的应用

目的:探讨多孔尿道支架管在尿道下裂患者尿道成型术中的应用.方法:对93例尿道下裂患者行尿道成型术治疗,术中采用多孔尿道支架管引流,不行膀胱造瘘.结果:本组80例患者伤口一期愈合,5例发生尿瘘(5.37%),6月后行尿瘘修补术,尿瘘愈合;8例尿道狭窄(8.6%),接受尿道扩张治疗.所有患者术后阴茎呈正常外观.结论:多孔尿道支架管有效地引流尿道分泌物和尿道积液,避免了对患者行膀胱造瘘术,减少了手术损伤及术后尿瘘、尿道狭窄等并发症的发生率.     

输尿管镜下钬激光治疗尿道尖锐湿疣的应用价值

目的探讨输尿管镜下钬激光治疗尿道尖锐湿疣的应用价值。方法回顾分析我院2005年7月至2011年12月采取手术治疗的尿道尖锐湿疣男性患者50例,其中观察组17例采用输尿管镜下钬激光汽化疣体,对照组33例采用尿道膀胱镜下电切（15例）及匙刮（18例）治疗,比较两组的治愈率、复发率及尿道狭窄率。结果术后随访6—12个月,观察组一次性治愈率高于对照组,复发率和尿道狭窄发生率低于对照组。结论相对于传统方法,输尿管镜下钬激光是一种治疗尿道尖锐湿疣安全、有效的方法。     

经尿道输尿管镜气压弹道碎石术的护理

气压弹道碎石术是在输尿管镜下应用气压弹道碎石机进行碎石的一种腔内新技术 ,是目前治疗中、下段输尿管结石的首选方法 ,具有操作简单、碎石效力高、碎石时间短及无热效应、对周围组织损伤小等优点[1 ] 。我院从 2 0 0 2年 5月至 2 0 0 3年 6月应用F 8 9.8Wolf牌输尿管硬镜治疗泌尿系统结石 10 8例 ,疗效满意。现对其护理体会报告如下。1　资料与方法1.1　临床资料本组共 10 8例 ,男 88例 ,女 2 0例 ,平均年龄 44岁。左侧输尿管结石 32例 ,右例输尿管结石 48例 ,双侧结石 4例 ,尿道结石 7例 ,膀胱结石 12例 ,肾盂结石 5例 ,结石横径 3～ 2…     

术前留置输尿管支架管对输尿管软镜碎石术疗效的影响

目的 探讨术前留置输尿管支架管对输尿管软镜碎石术治疗肾或输尿管上段结石临床疗效的影响。方法 选取2018年10月至2021年7月于北京市海淀医院泌尿外科接受输尿管软镜联合钬激光碎石的肾或输尿管上段结石患者256例,根据术前是否留置输尿管支架管分为实验组(n=192)和对照组(n=64),实验组又根据支架管留置时间长短分为长期组(14 d,n=64)和短期组(7 d,n=128)。记录各组一期手术成功率、手术时间、术中出血量、住院时间、术后并发症发生率及结石清除率,并进行比较分析。结果 对照组的手术时间及术中出血量明显高于实验组,组间比较有显著差异(P<0.001)。留置支架管短期组的住院时间较长期组短(P<0.001),但手术时间及术中出血量明显高于长期组(P<0.001)。对照组的一期手术成功率和结石清除率均低于实验组(P<0.05),并发症高于实验组(P<0.001)。留置支架管短期组与长期组的结石清除率无显著差异,不过短期组的手术并发症发生率明显高于长期组(P<0.05)。结论 术前留置输尿管支架管可以提高手术成功率、结石清除率,降低手术并发症...     

输尿管镜在泌尿外科中的临床应用

目的分析输尿管镜在泌尿外科中的临床应用。方法取截石位,应用气压弹道碎石机治疗,输尿管导管引导下经尿道输尿管镜液体灌注泵扩张法直接入镜。结果总成功率为84．6％。结论输尿管镜操作时的关键以及并发症等问题。     

The Distribution of Muscles Fibers and Their Types in the Female Rat Urethra: Cytoarchitecture and Three‐Dimensional Reconstruction

An attempt to explore urethral cytoarchitecture including the distribution of smooth muscles and fast and slow striated muscles of adult female Sprague Dawley rat—a popular model in studying lower urinary tract function. Histological and immunohistochemical stainings were carried out to investigate the distribution of urethral muscle fibers and motor end plates. The urethral sphincter was furthermore three‐dimensionally reconstructed from serial histological sections. The mucosa at the distal urethra was significantly thicker than that of other segments. A prominent inner longitudinal and outer circular layer of smooth muscles covered the proximal end of urethra. Thick circular smooth muscles of the bladder neck region (urethral portion) decreased significantly distalward and longitudinal smooth muscles became 2‐ to 3‐fold thicker in the rest of the urethra. An additional layer of striated muscles appeared externally after neck region (urethra) and in association with motor end plates ran throughout the remaining urethra as the striated sphincter layer. Most striated muscles were fast fibers while relatively fewer slow fibers often concentrated at the periphery. A pair of extraneous striated muscles, resembling the human urethrovaginal sphincter muscles, connected both sides of mainly the distal vagina to the dorsal striated muscles in the wall of the middle urethra. The tension provided by this pair of muscles, and in conjunction with the striated sphincter of the urethral wall, was likely to function to suspend the middle urethra and facilitates its closure. Comprehensive morphological data of urethral sphincter offers solid basis for researchers conducting studies on dysfunction of bladder outlet. Anat Rec, 296:1640–1649, 2013. © 2013 Wiley Periodicals, Inc.     

Serum Complement Activity in Pre-Term Pregnancies: Relationship to Duration of Ruptured Membranes and Clinical Infection

ABSTRACT: Physiologic changes occurring during the latent period of prematurely ruptured membranes (PRM) are poorly understood. Indicators predicting maternal and neonatal infectious morbidity do not correlate well with clinical outcomes. A previous report suggested that in vivo complement consumption occurred in response to the event of membrane rupture. In this prospective study, complement activity was measured serially throughout the latent period in cases of preterm PRM. In addition to total hemolytic complement activity (CH₅₀), C3-proactivator (C3PA), a primary component of the alternate complement pathway, was measured in maternal and cord sera. As with CH₅₀, cord serum C3PA levels are significantly less than those in matched maternal samples. Neither maternal nor cord serum complement activity correlated with either the duration of the latent period or maternal-neonatal infection.     

Innervation of the Epithelium and Lamina Propria of the Urethra of the Female Rat

The aim of this study was to characterize the number, type and distribution of immunochemically identified nerves in epithelium and lamina propria of the female rat urethra. Urethras from female Sprague–Dawley rats (n = 12) were fixed, frozen and sectioned (8 μm). Standard immunohistochemical techniques were used to identify putative nerves using the following antibodies: calcitonin gene related peptide (cgrp), neuronal nitric oxide synthase (nNos), tyrosine hydroxylase (TH) and vesicular acetylcholine transporter (vacht). The number, distribution and characteristics of all immunoreactive (IR) structures adjacent to the urethral epithelium and in the lamina propria was assessed. In the bladder, few cgrp-IR and vacht-IR fibers were associated with the urothelium or suburothelium of the lateral wall. In contrast, large numbers of vacht-IR, nNos-IR and cgrp-IR fibers were found close to the epithelium and subepithelium of the bladder neck and throughout the urethra. The number of cgrp-IR fibers was significantly higher in the urethra in comparison with the bladder neck. A population of undescribed cgrp-IR cells associated with the bladder neck and proximal urethra has been characterized. Each of these cells appears to be associated with a nerve fiber. In the distal urethra, the number of peptidergic fibers penetrating the epithelium was significantly higher than the rest of the urethra. Clearly, this study has revealed a highly complex and heterogeneous network of putative afferent nerves fibers along the length of the urethra. These structural specializations need to be taken into account when probing the different functions of the urethra. Anat Rec, 302:201–214, 2019. © 2018 Wiley Periodicals, Inc.     

治疗心房纤颤的两类导管消融术研究进展

心房纤颤在临床心律失常上很常见,有较高的致死率及致残率,其引发的一系列症状及其并发症严重影响人们的生活质量及寿命。射频导管消融术是最常用的肺静脉隔离治疗方法,而最新出现的冷冻球囊导管消融术有取而代之的优势。本文着重于论述这两种最常用导管消融术的最新研究进展,两种能源治疗房颤的损伤机制,二者之间的临床安全性和有效性对比,以及最新出现的联合消融治疗方法。     

Regional Structural and Functional Specializations in the Urethra of the Female Rat: Evidence for Complex Physiological Control Systems

This study characterizes the complex structural and functional elements of the female rat urethra that may be involved in controlling urethral closure and continence. Urethras were dissected from female Sprague‐Dawley rats (N = 12) euthanized by pentobarbital overdose. Tissues were fixed (4% paraformaldehyde), frozen, and sectioned (8 μm) for light microscopy and immunohistochemistry. Antibodies were used to detect immunoreactivity to calcitonin gene related peptide, nitric oxide synthase, vesicular acetylcholine transporter, and tyrosine hydroxylase. Measurements of urethral wall compliance were taken along its length and in different axes using a closed ended catheter with a circular aperture. The bladder neck and proximal urethra are characterized by a highly folded epithelium and lamina propria. A smooth muscle layer is apparent but not pronounced. Distal to this region the smooth muscle layer thickens and forms the body of the internal sphincter, which has a complex innervation. In the mid urethra, the smooth muscle is thickened resulting in a luminal protrusion, producing an occlusion of the lumen. The structure of the distal urethra is different. The epithelium has few folds and, immediately below the lamina propria large thin walled vascular lacunae can be found. Measurements of the urethral wall compliance demonstrate distinct regional differences with proximal and distal specialisations. These variations, which correlate with muscular and vascular elements, suggest the operation of discrete systems, hence effecting urethral closure during filling. An understanding of these systems may yield insights into urethral pathology and direct approaches to develop pharmacological interventions to promote continence. Anat Rec, 301:1276–1289, 2018. © 2018 Wiley Periodicals, Inc.     

传统胸腔闭式引流和中心静脉导管治疗创伤性血胸临床疗效对比观察

目的：探究传统胸腔闭式引流与中心静脉导管治疗创伤性血胸的临床疗效对比。方法参照组患者采用传统胸腔闭式引流手术治疗,给予治疗组患者中心静脉导管手术治疗,对比分析两组患者治疗后的效果。结果治疗组患者在留管手术时间、手术切口愈合时间等均少于参照组,其并发症发生率与切口感染率明显低于参照组,总有效率(96.67%)高于参照组(93.03%),两组差异显著。结论采用中心静脉导管治疗创伤性血胸的临床效果明显优于采用传统胸腔闭式引流治疗效果,具有临床应用价值。     

中医对留置导尿管伴随性感染防治的文献分析

目的分析中医在防治留置导尿管伴随性感染方面的研究状况,为今后的研究提供依据和方向遥方法以野中医OR中药冶 AND野感染冶AND野尿管冶为检索词,在中国生物医学文献数据库（CBM）尧中国知网（CNKI）尧万方数据库尧维普数据库（VIP）对采用 中医方法防治CAUTI的文献进行检索和分析遥结果本次共检索出30篇文献,其中23篇为干预类研究,1篇综述,4篇经验或个 案,涉及到的中医防治方法包括口服中药尧膀胱内冲洗尧中药外洗尧针灸或综合治疗方法曰2篇为基础研究,证实了中药的体外抑菌 作用遥结论中医防治CAUTI的基础深厚,但研究刚刚起步,减少CAUTI的重点在于预防,保持尿道口清洁是重要环节曰中药外 洗法简单易行,无侵入性,患者接受度高,可进一步规范研究,为其在预防尤其是高危及特殊患者CAUTI提供循证依据遥     

Making anatomic terminology of the prostate and contiguous structures clinically useful: Historical review and suggestions for revision in the 21st Century

Herein we review nomenclature of the prostate and contiguous structures in each of the 10 official publications from the 1895 [Basel] Nomina Anatomica to the 1998 Terminologia Anatomica. We then compare existing clinical terminology with official terminology endorsed by anatomists over the years with a goal to modernize official terminology. Problematic terms, namely, lobes and lobuli, fascia versus capsule, Denonvilliers' fascia, and transition versus periurethral zone, are addressed. The idea of recognizing prostate arteries, veins, nerves, and neurovascular bundles is introduced. Prostatic and membranous urethras and the closely related external urethral sphincter are covered. We believe urogenital hiatus should also be called anterior levator hiatus. Trapezoid zone should be discarded in future editions of nomenclature. Our recommended changes are supported by a series of pertinent photographs of gross and whole mount histologic specimens and magnetic resonance images. Finally, we provide a new table of terms for the prostate with recommended amendments and deletions to existing official nomenclature as contained in the 1998 Terminologia Anatomica. Clin. Anat. 23:18–29, 2010. © 2009 Wiley‐Liss, Inc.     

Assessing the Quality of Central Venous Catheter and Peripherally Inserted Central Catheter Videos on the YouTube Video-Sharing Web site

BackgroundVideo sharing networks such as YouTube have revolutionized communication. Whilst access is freely available uploaded videos can contain non peer-reviewed information. This has consequences for the scientific and health care community, when the challenge in teaching is to present clinical procedures that follow empirical methods.ObjectiveTo review 50 central venous catheter and peripherally inserted central catheter videos posted on YouTube. The aim was to appraise these videos using current evidenced-based guidelines.MethodsWe searched YouTube using the key words central venous cannulation and peripherally inserted central catheter insertion on September 21, 2012. We consecutively reviewed 50 videos for both procedures.ResultsThere was poor adherence to evidence-based guidelines in the critiqued videos. There was a difference in adherence with the use of appropriate skin antisepsis in the 2 groups (18% for central venous catheters vs 52% for peripherally inserted central catheters; p=0.009). And a large proportion in both groups compromised aseptic technique (37% for central venous catheters vs 38% for peripherally inserted central catheter; p=0.940). The use of ultrasound guidance during procedures was also different between the 2 groups (33% for central venous catheters vs 85% for peripherally inserted central catheters; p=0.017).ConclusionsThis critique of instructional videos related to the insertion of central venous catheters and peripherally inserted central catheters uploaded to YouTube has highlighted poor adherence to current evidence-based guidelines. This lack of adherence to empirical guidelines can pose risks to clinical learning and ultimately to patient safety.