聚丙烯网带经12肋悬吊术治疗肾下垂的远期疗效观察

目的：探讨聚丙烯网带经12肋悬吊术治疗肾下垂的远期疗效.方法：采用聚丙烯网带经12肋悬吊术治疗肾下垂患者32例,术后6、12、24、36、48、60个月进行随访.结果：32例患者中,获24个月以上随访者28例,随访24～48月者19例,随访48～60个月者10例.术后经站立位B超、KUB＋IVU等复查,1例由术前Ⅳ度恢复至Ⅰ度,余均恢复正常位置.2例因术前重度积水,术后出现肾萎缩、肾性高血压而行肾切除;4例术后复发,给予中药排石和（或）ESWL、输尿管镜下钬激光碎石治疗;2例经确诊合并有腺性膀胱炎,给予TURBT及羟基喜树碱灌注治愈;1例术后确诊为肾盂肿瘤而行肾输尿管全长切除术;术前合并Dietl危象者1例随访无复发.结论：聚丙烯网带经12肋悬吊术治疗肾下垂是一种操作安全、并发症少、治愈率高、远期效果好的方法.     

经阴道穿刺悬吊无张力聚丙烯网带的远期疗效

经阴道穿刺悬吊聚丙烯网带(MPB)治疗女性张力性尿失禁53例,不包括括约肌功能不全、有尿失禁手术史及神经原性患者。按Raz法将悬吊缝线安置在耻骨上区域,取1．5～2．0 cm×15．0 cm的MPB,将悬吊缝线多次穿过MPB两侧,但不穿过其中央2～3 cm处,将此处MPB无张力地置于距膀胱颈1～2 mm下方,使纤维组织以后可长入MPB     

应用Perfix-Plug治疗肾下垂1例报告

1资料与方法1.1临床资料患者，女，35岁。因右侧腰腹部包块伴疼痛1年于2000年8月1日入院。症状与体位有关，于久站或劳动后出现，平卧后可缓解。病程中无血尿。体检：立位时于右髂部可触及整个右侧肾脏，随呼吸上下移动，平卧后右肾上移。辅助检查：排泄性尿路造影示右肾盂立位时位于第4腰椎水平，比卧位时下降两个椎体，右肾盂及右侧输尿管上段轻度扩张积水。术前诊断：右肾下垂。1.2手术方法术中取右腰部第12肋下切口进入，游离右肾及右输尿管上段，先行肾包膜、腰肌缝合固定术，即以10－0丝线分别在右肾上、中、下极背侧包膜近肾外侧缘处…     

后腹腔镜下聚丙烯网带经腰肌肾固定术治疗肾下垂(附15例报道)

目的 探讨后腹腔镜下聚丙烯网带经腰肌肾固定术治疗症状性肾下垂的可行性和疗效.方法 2008年12月以来对15例行立卧位IVU或CT检查确诊为肾下垂患者行后腹腔镜下游离肾脏,采用自行修剪聚丙烯网带绕肾脏中下极,经腰部肌群(腹内外斜肌、腰大肌、腰方肌)穿出,并于皮下与肌筋膜缝合固定.结果 15例手术均获成功,无中转开放.手术时间40～ 120rin,平均80min.术中术后无并发症发生.随访12～48个月,术后所有患者腰部酸痛症状较术前明显缓解.术前伴有肉眼血尿和反复出现尿路感染的患者,术后症状消失.术后复查IVU均提示患肾复位固定良好.结论 后腹腔镜下聚丙烯网带肾固定术治疗症状性肾下垂技术可行,创伤小,恢复快,安全有效,并发症少,操作简单,疗效确切,是治疗症状性肾下垂的有效术式,值得推广.     

应用聚丙烯网带治疗肾下垂的临床研究

目的 回顾分析采用聚丙烯网带经12肋悬吊治疗43例肾下垂患者的安全性和近远期疗效.方法 肾下垂患者43例,其中男性14例,女性29例,平均年龄30岁(14～46岁);术前均经B超、CT、IVU等检查确诊为肾下垂,其中右侧29例,左侧10例,双侧4例;影像学分度:Ⅱ度9例,Ⅲ度28例,Ⅳ度6例.手术经腰12肋下切口,裁剪...     

Prolene编织网带尿道中段悬吊术治疗压力性尿失禁疗效观察

目的 :探讨Prolene编织网带尿道中段悬吊术治疗压力性尿失禁的疗效。方法 :对 5例压力性尿失禁患者使用Prolene编织网带尿道中段悬吊术治疗效果作回顾性总结分析。结果 :全组病例于术后均可自主排尿 ,轻度尿频、尿急和排尿不畅术后半年后消失。术中顺利 ,术后无膀胱损伤、耻骨后血肿、血管损伤和切口感染等并发症。结论 :Prolene编织网带尿道中段悬吊术治疗压力性尿失禁疗效好、安全、并发症少 ,值得在临床上应用。     

后腹腔镜下自制网袋肾悬吊固定术治疗肾下垂的初步疗效观察

目的：探讨后腹腔镜下自制网袋肾悬吊固定术治疗肾下垂的价值。方法：回顾性分析3例后腹腔镜下自制网袋肾悬吊固定术治疗肾下垂的临床资料,包括手术适应证、腔镜径路、具体操作、出血量、手术时间、住院时间及随访结果。结果：手术时间分别为240、115和110min。术中出血量少于50ml．术后均未用止痛针,当晚即进食,平卧2周．住院0．5个月。分别随访15、6和4个月,B超显示肾脏位置正常。结论：自制水囊扩张后腹膜腔暴露清楚．后腹膜腔手术时间并不长于其他手术方式,而微创优势明显．术后绝无肠粘连并发症。自制网袋悬吊肾脏固定牢靠．两者结合,疗效确切,值得推广。     

后腹腔镜肾固定术结合补中益气汤治疗肾下垂13例

目的:总结后腹腔镜下自制丝线网袋肾悬吊固定术结合补中益气汤加减治疗肾下垂的疗效。方法:术前服用补中益气汤加减治疗15～60d,均行后腹腔镜下自制丝线网袋肾悬吊固定术。结果:手术均成功,平均手术时间为100min,术后第2d开始继续服用中药15～30d。随访1.6年,12例症状完全消失,1例症状减轻。3个月后坐立位超声或IVU证实,肾脏位置正常。结论:后腹腔镜下自制丝线网袋肾悬吊固定术结合补中益气汤加减治疗肾下垂,临床疗效确切,值得推广应用。     

带蒂腰大肌肌瓣治疗肾下垂285例

目的总结带蒂腰大肌肌瓣治疗症状性肾下垂的疗效。方珐回顾性分析285例症状性肾下垂患者的临床病例资料，术前均行腹部平片和静脉尿路或逆行平卧与站立位的肾盂造影对比证实为肾下垂，均采用带蒂腰大肌肌瓣行肾固定术。站杲285例患者中共461个下垂肾脏，其中425个肾脏行手术处理（其余36个肾脏不需手术处理）；手术时间为40-85min（平均60．5min），术后卧床时间为6—12d（部分患者同期处理合并症，平均7．22d）；共261例患者获IVu、RP或CT随访（91．58％），随访时间1—10年（平均6．2年），未见复发及严重的手术并发症；患者对手术总体满意率为96．14％。站论带蒂腰大肌肌瓣肾固定术是治疗症状性肾下垂的安全、有效、简便的治疗方法。     

经12肋小切口离断式肾盂成型术28例报告

目的总结经12肋小切口离断式肾盂成型术的临床应用经验。方法2004年8月～2008年5月本院收治的28例肾盂输尿管连接部梗阻的患者接受经12肋小切口离断式肾盂成型术,对其手术入路、临床效果及并发症进行回顾性分析总结。结果28例手术均顺利完成,无需延长切口。手术时间55-140min（平均91min）,术中估计出血量20～210mL（平均53mL）。术后36h内恢复进食。1例术后出现漏尿,5d后消失。随访2～37月,27例肾积水减少,1例拔除输尿管支架后肾积水加重,予延长支架留置时间。结论经12肋小切口离断式肾盂成型术创伤小、恢复快、疗效确切,费用较低,是一种可以选择的微创手术方式。     

Changes of renal blood flow in nephroptosis: assessment by color Doppler imaging, isotope renography and correlation with clinical outcome after laparoscopic nephropexy

OBJECTIVE: Previously, we have detected changes in renal blood flow secondary to nephroptosis by assessing the renal resistive index (RI) using color Doppler imaging (CDI). The aim of the current study was to compare two diagnostic methods, CDI and isotope renography (IRG), for detection of renal blood flow impairment in patients with nephroptosis. METHODS: 26 patients with nephroptosis and flank pain underwent CDI and isotope renography (IRG) before and after laparoscopic nephropexy. The RI was assessed in segmental arteries with the patient in both the supine and erect position. Pre- and postoperative patient symptoms, results of Doppler measurements and IRG findings were assessed. RESULTS: Preoperatively, 23 of 26 symptomatic patients showed a mean reduction in RI of more than 0.10 on the affected side, while only 7 of 26 patients had abnormal findings on preoperative IRGs. Postoperatively, none of the patients with preoperative changes in Doppler parameters showed any posture-related changes in RI. On postoperative IRG, obtained in 4 of 7 patients, normalization of renal perfusion was documented. Twenty out of 26 patients were asymptomatic postoperatively; in the remaining 6 patients symptoms were markedly improved. CONCLUSION: Impairment of renal blood flow due to nephroptosis was detected with both CDI and IRG. RI measurement by CDI appears to be significantly more sensitive in detecting renal blood flow impairment. RI should be assessed in patients with nephroptosis and may impact on the decision for laparoscopic nephropexy.     

异位睾丸七例报告

目的　提高异位睾丸的诊治水平。　方法　回顾总结 7例异位睾丸患者临床资料。　结果　 7例中除 2例异位睾丸已萎缩外 ,5例术前经查体和 (或 )B超检查诊断和定位。 7例异位睾丸均经腹股沟切口 ,沿精索探及 ,其中 5例行复位固定术 ,2例行萎缩睾丸切除术 ,7例随访 2个月～ 8年 ,患者发育均正常 ,5例复位睾丸无移位、萎缩及恶变。　结论　异位睾丸的诊断主要依靠体检和B超 ,无论定位诊断明确与否 ,均应沿腹股沟管、精索径路行手术探查     

肾上腺囊肿的诊断与治疗（附七例报告）

１９６７～１９９４年共收治肾上腺囊肿７例，其中假性囊肿３例，内皮性囊肿２例，上皮性囊肿及包虫囊肿各１例。经Ｂ超、ＣＴ、ＭＲ可获确诊，良、恶性囊肿的鉴别比较困难。本组５例行手术切除，１例穿刺抽液治疗，１例观察未做处理，经随访效果满意。结合文献就其分类、病理、临床表现，诊断及治疗进行讨论。     

The use of polypropylene mesh as a transobturator sling for the treatment of female stress urinary incontinence (early experience with 40 cases)

This study evaluated the use of traditional polypropylene mesh, used in hernias repair, as a sling in the treatment of female stress urinary incontinence (SUI). Forty patients diagnosed with SUI underwent transobturator sling fashioned from the ordinary polypropylene mesh (vypro II®). Each lateral end of the tape is secured by a zero prolene suture. The procedure was then done outside-in, and the patients were followed up. The mean operative time was 40–60 min when the procedure was performed alone or accompanied with associated pelvic floor repair. Thirty-five patients (87.5%) were cured, and two patients (5%) significantly improved, but the procedure failed in three patients (7.5%), and the slings were removed because of vaginal erosion. Polypropylene mesh transobturator sling is an easy and cheap method for the treatment of female SUI with a high success rate.     

前列腺肉瘤(附七例报告)

目的　提高前列腺肉瘤的诊治水平。　方法　 7例前列腺肉瘤患者 ,2例行全膀胱前列腺切除、去带盲升结肠可控膀胱术 ;1例行前列腺摘除术 ,术后辅以化疗 ;3例行放疗 ;1例仅行前列腺穿刺活检。　结果　 2例行全膀胱前列腺切除者 ,1例存活 5年至今 ,1例术后 9个月死于肿瘤肺转移 ;余 5例均在 13个月内死亡。　结论　早期诊断并行根治性切除术可提高前列腺肉瘤患者的生存率     

Influence of polyglecaprone 25 (Monocryl) supplementation on the biocompatibility of a polypropylene mesh for hernia repair

Background: Supplementary polyglecaprone 25 (Monocryl) monofilaments were added to a lightweight pure monofilament polypropylene mesh (PP mesh) to improve intraoperative handling (PP+M mesh). This study was designed to evaluate the influence of this additional supplementation on the biocompatibility in a rodent animal model. Methods: Two mesh materials, a composite mesh (PP+M) and the pure polypropylene variant (PP), were compared after subcutaneous implantation in a standardized rat model. Histological analysis of the inflammatory response was performed after 28, 56 and 84 days of implantation. Material absorption, inflammatory tissue reaction, fibrosis and granuloma formation were investigated, as well as the percentage of proliferating and apoptotic cells at the interface. Results: Both mesh materials showed a slight foreign body reaction involving mainly macrophages and foreign body giant cells. Total absorption of the Monocryl filaments of the PP+M mesh occurred between 56 and 84 days of implantation. Both the inflammatory and the fibrotic reaction were decreased (n.s.) in the PP+M mesh group compared to the pure PP mesh. Whereas the percentage of proliferating cells showed no significant difference, the rate of apoptotic cells was significantly decreased in the PP+M mesh group over the whole implantation period. Conclusion: Compared to the pure polypropylene mesh, our data confirm that the use of a polypropylene mesh supplemented with absorbable Monocryl filaments is feasible without additional short-term mesh-related complications in the experimental model or negative side effects on biocompatibility.     

乳腺外佩吉特病七例报告

目的 对乳腺外佩吉特（Paget)病的临床表现、治疗方法及其预后进行分析。方法 对收治的7例乳腺外Paget病例资料进行回顾性分析。结果 3例有腹股沟淋巴结转移的患者均在5年内死亡,无腹股沟淋巴结转移者均存活。结论 乳腺外Paget病首选手术切除。一旦有淋巴结转移,其5年生存率极低。     

腹腔镜肾上腺嗜铬细胞瘤切除术七例报告

目的探讨腹腔镜手术治疗肾上腺嗜铬细胞瘤的可行性及安全性。方法2003年10月至2007年4月，我院行腹腔镜肾上腺嗜铬细胞瘤切除术7例，肿瘤最大径为3．0～6．5cm，平均5．0cm。6例患者术前均有不同程度的高血压。术前常规行降压、扩容处理。采用后腹腔镜入路6例，经腹入路1例，术中术后严密监测血压变化并给予相应处理。结果5例腹腔镜手术成功，2例中转开放手术。手术时间为70-360min，平均163min，术中出血50-600ml，平均300ml。7例患者术中均出现血压波动，无围手术期患者死亡。病理报告证实为嗜铬细胞瘤。随访7～49个月，5例患者术后2个月内血压恢复正常，1例仍需服用降压药物。结论腹腔镜肾上腺嗜铬细胞瘤切除术可行，疗效确切，充分的术前准备和熟练的腹腔镜操作技术是手术安全的保证。