纤维胆道镜在肾盂切开取石术中的应用

目的探讨肾盂切开取石术中应用纤维胆道镜协助治疗肾盂多发结石或肾盂、肾盏多发结石的效果。方法对18例肾盂多发结石或肾盂、肾盏多发结石的患者行常规肾盂切开取石,术中应用纤维胆道镜经肾盂切口钳夹取石。结果 18例手术均成功,手术时间50~120 min,术后复查腹部平片16例无结石残留,2例结石(直径4 mm)残留。结论肾盂切开取石术中应用纤维胆道镜取石效果满意,可减少术后残石发生率。     

纤维膀胱镜在肾结石肾盂切开取石术中的应用

为减少肾结石肾益切开取石术后的残余结石，我院自1996年6月采用OLYMPUSCYF－3型纤维膀尬镇（以下简称CYF－3膀胱镜）作膀胱尿道检查及肾盂切开取石水中残余结石检查，取得了良好的效果，现报告如下。1资料与方法1.1一般资料本组13例，男10例，女3例，年龄17～60岁，平均32．5岁。其中8例10只肾脏为多发性肾结石。1·2操作方法根据术前X线片行肾盂切开取石术。取石完毕后，用CYF－3膀优镜自肾益切口插入，接上冷光源，注尔孔以生理盐水冲洗保持视野清晰，对肾益及肾盏逐个检查，发现残余结石，可用取石错取出或用生理盐水冲出，并可…     

胆道镜在腹腔镜上段输尿管肾盂切开取石术中的应用

目的：探讨腹腔镜下输尿管肾盂切开取石术中使用胆道镜的临床意义和初步经验。方法：5例经腹腔途径在腹腔镜下使用胆道镜取出移位的结石,术后放置双J管,缝合输尿管肾盂切口和肾周筋膜。结果：手术均获成功,手术时间65～185min,平均112min,失血50～100ml,术后住院5～11d。无一例发生尿漏、腹腔感染,随访3～12个月,复查BUS无结石残留,肾功能改善,无输尿管狭窄发生。结论：腹腔镜下配合使用胆道镜取石创伤轻,不增加手术痛苦,恢复快,疗效好,手术并发症少,降低了中转开腹的几率,是可行的多镜联合微创技术,有临床推广的价值。     

纤维胆道镜在腹腔镜胆总管切开取石术中的应用

目的 探讨纤维胆道镜在腹腔镜胆总管切开取石术中的应用方法及疗效. 方法 回顾性分析我院2000年10月～2005年12月178例腹腔镜胆总管切开取石术中纤维胆道镜取石的临床应用体会. 结果 全部手术均于腹腔镜下完成,术后放置胆道内置引流管、胆总管一期缝合107例,余71例放置T管引流,无一例中转开腹,胆道镜检查取石时间平均31 min（6～92 min）,162例肝外胆管结石均于术中成功取净,术后1个月经B超检查内置管组107例中104例已排出,3例经胃镜取出,107例胆道内置引流管者随访3～51个月,平均27.8月,无胆道残余结石及胆道狭窄.16例肝内胆管结石术后检查发现胆管残余结石5例,均为术中已知残余结石,术后6周经T管窦道1～3次取出. 结论 腹腔镜胆总管切开取石术中熟练技巧应用纤维胆道镜,能可靠彻底地清除肝外胆管结石,疏通主要肝管,为胆道探查术后胆总管一期缝合提供了安全保障.     

纤维膀胱镜在肾盂多发性结石手术中的应用

我科从 1996年 1月至 2 0 0 0年 12月 ,采用纤维膀胱镜配合肾盂切开取石术治疗肾脏多发性结石 15例 ,效果满意。报告如下。临床资料　本组 15例。男 6例 ,女9例。年龄 19～ 6 4岁 ,平均 4 2岁。术前超声及ＩＶＵ检查 ,左肾盂多发性结石伴右侧输尿管上段结石 2例 ;肾盂结石伴中、下盏结石 8例 ;鹿角形结石 2例 ;肾内各盏多发性结石 1例 ;中、下盏多发性结石合并单纯性肾囊肿 2例。手术方法　常规肾盂切开取石术操作 ,采用ＯｌｙｍｐｕｓＣＹＦ 2型纤维膀胱镜帮助取出小结石。膀胱镜镜鞘外径5 .1ｍｍ ,末端外径 5 .3ｍｍ ,末端可向上弯曲 2 10…     

后腹腔镜肾盂切开联合膀胱软镜碎石取石术8例报告

目的探讨后腹腔镜肾盂切开联合膀胱软镜碎石取石术的有效性、安全性及可行性。方法回顾分析2011年7月至2014年3月我院8例后腹腔镜肾盂切开联合膀胱软镜碎石取石术患者的临床资料。结果 8例手术均成功,一期取石率为100%,平均手术时间(85.0±5.6)min,平均术中出血量(17.0±2.1)mL,术后平均住院天数(7.0±0.5)d,围手术期无明显并发症发生。术后复查腹平片未见结石残留,术后随访1~3月未发现吻合口狭窄,无继发肾结石形成。结论后腹腔镜肾盂切开联合膀胱软镜碎石取石术是安全可行的,是处理肾盂结石的一种"双镜联合"治疗的新术式,可作为经皮肾镜碎石术(PCNL)及设备欠缺单位的替代术式,但临床使用价值有待进一步求证。     

超声检查在肾结石取石术中的应用

在23例多发性肾结石取石术中应用超声监测，具有如下优点：操作简便，对于阳性及阴性结石都能进行三维定位，缩短手术时间并有效减少术后结石残留。     

新型软性肾镜在经皮肾镜取石术中的应用

目的:探索新型软性肾镜在经皮肾镜取石术(percutaneous nephrolithotomy, PCNL)中的应用效果。方法:回顾性分析2022年1月—2023年2月海军军医大学第一附属医院通过标准通道PCNL治疗的肾结石患者临床资料,依据术中是否使用新型软性肾镜将患者分为联合软性肾镜组和单用硬镜组;比较2组患者手术相关临床数据。结果:联合软性肾镜组52例,单用硬镜组42例,2组患者年龄[(55.9±11.3)岁vs (53.7±13.7)岁,P=0.407]、体重指数(BMI)[(24.7±3.3) kg/m² vs (24.6±3.3) kg/m²,P=0.915]及结石最大径[(33.5±13.6)mm vs (39.0±17.0) mm,P=0.085]比较差异无统计学意义。联合软性肾镜组11例患者术中通过软性肾镜成功寻找到硬镜无法处理的残余结石并成功碎石取石。联合软性肾镜组结石清除率显著高于单用硬镜组的患者(84.6%vs 57.1%,P=0.003)且术后住院时间更短[(3.4±1.4) d vs (4.81±2.2) d,P...     

膀胱镜镜鞘在膀胱内异物取出术中的应用

膀胱内异物多为人为因素造成，异物种类各异，多数异物可应用常规方法在镜下用异物钳夹持后取出，否则，往往需要开放手术治疗。对部分夹持困难的异物，笔者采用以膀胱镜镜鞘作为通道，依靠重力作用将异物排出体外的方法获得成功，现报告如下。     

可弯性肾镜在肾多发性结石经肾盂切开取石术中的应用：附1 …

目的 探讨可弯性肾镜在肾多发性结石经肾盂切开取石术中的应用价值。方法 将可弯性肾镜用于肾多发性结石肾盂切开取石术，术中经可弯性肾镜介入液电碎石，并配合钳夹冲洗等方法取出结石。结果 １１例成功，１例失败。可弯性肾镜对肾盂肾盏内其他病变也能起到检查及治疗作用，具有对肾脏损伤小，恢复快，并发症少等优点。结论 肾多发性结石经肾盂切开并配合可弯性肾镜治疗是一种安全有效的方法。     

EXCRETION OF BIKUNIN AND ITS FRAGMENTS IN THE URINE OF PATIENTS WITH RENAL STONES

PURPOSE: Bikunin is a Kunitz-type protease inhibitor found in serum and urine. It has been implicated in urinary stone formation. This study was designed to investigate the role of urinary bikunin in stone formation. MATERIALS AND METHODS: Urinary concentrations of bikunin were measured in 18 male formers of urinary stones 28 to 74 years old and in 77 healthy controls, including 39 males and 38 females, without urological abnormality. A sensitive competitive solid phase enzyme immunoassay was established for urinary bikunin. Bikunin was also qualitatively assessed by Western blot analysis. RESULTS: The mean urinary bikunin-to-creatinine ratio plus or minus standard deviation in stone formers was significantly elevated compared with that in healthy male and female controls (52.9 +/- 46.0 microg./mg. creatinine versus 28.0 +/- 30.4 and 26.5 +/- 21.7, p = 0.005 and 0.006, respectively). By Western blot analysis all urine samples contained authentic 40 kDa. bikunin species. However, a significantly higher proportion of patients was found to have aberrant 25 kDa. bikunin species compared with controls (10 of 18 or 55.6% versus 15 of 77 or 19.5%, p = 0.002). Experiments on de-glycosylation with chondroitinase ABC, amino acid sequencing of the aberrant bikunin species and calcium oxalate crystal growth inhibition assay demonstrated that the 25 kDa. bikunin fragment was identical to de-glycosylated bikunin and less inhibitory on calcium oxalate crystal growth. CONCLUSIONS: If urinary bikunin is important in the pathogenesis of urolithiasis, its effect is probably attributable to the concentration and degree of glycosylation.     

肾后唇部分切除术治疗复杂性肾结石

目的 探讨复杂性肾结石的手术方法。方法 应用肾后唇部分切除术治疗复杂性肾结石48例。结果 术中无需阻断肾蒂，无一例输血，术后复查腹部平片，结石一次性取净44例(91．7％)，残留结石4例(8．3％)。结论 本术式具有操作较简单，易掌握，取石容易且结石一次性取出率高，出血少的优点，是治疗复杂性结石的较好方法。     

IN VITRO STUDY OF ULTRASOUND BASED REAL-TIME TRACKING OF RENAL STONES FOR SHOCK WAVE LITHOTRIPSY: PART 1

PURPOSE: We developed a real-time tracking system for renal stones that decreases the number of shock waves and treatment time of shock wave lithotripsy. MATERIALS AND METHODS: Ultrasound images were analyzed to identify the renal stones. A computer software module for ultrasound image processing was developed to monitor stone location instantaneously. Another computer software module controlled generator movement in real time for tracking the stone. We used 13 ultrasound stone trajectories recorded from patients to test the system in vitro. Two tests were established to verify tracking system reliability. One test focused on improvement in the coincidence ratio, which denotes the matching extent of the stone within the effective focal area. The other test focused on improvement in the efficiency ratio, that is a decrease in the number of shocks for stone fragmentation. For each recorded stone trajectory 2 experiments were done under tracking and nontracking conditions. RESULTS: The average coincidence and efficiency ratios plus or minus standard deviation were 79.6% +/- 9.8% and 45.0% +/- 12.7% without tracking, and 97.0% +/- 3.0% and 85.5 +/- 6.8% with tracking, respectively. All tests were statistically significant (paired t test p <0.01). CONCLUSIONS: An ultrasound based real-time tracking system proved to be significantly helpful for in vitro lithotripsy. It appears that the tracking system may greatly decrease the number of shocks and treatment time for renal stones.     

复杂性肾结石不同开放手术疗效比较

目的评价不同的开放性手术治疗复杂性肾结石的疗效,以期降低结石残留率及保护肾功能. 方法回顾性分析采用不同术式治疗154例复杂性结石的临床资料,比较结石取净率、阻断肾血流时间及术后肾功能恢复情况. 结果肾窦内肾盂切开取石61例、肾盂 肾放射状切开取石18例、肾盂肾下段切开取石11例、肾盂肾实质(多处、小切口)切开取石42例、肾实质Brodel线剖开取石10例及肾部分切除术12例,阻断肾血流的时间平均分别为0、31、36、45、162及28 min.肾功能恢复情况:12例肾部分切除取石术肾功能恢复良好,肾窦内肾盂切开取石术、肾盂肾下段切开取石术、肾实质Brodel线剖开取石术各有1例未恢复,肾盂 肾放射状切开取石术有2例、肾盂肾实质多处、小切口切开取石术有6例未恢复. 结论对复杂性肾结石开放手术需根据结石的大小、肾盂形态、积水程度、所需时间及难度确定术式,同时选择静注肌苷或(/和)局部低温下进行.尽可能选用对肾功能损害小的肾窦内肾盂切开取石术或加作肾实质切口,减少肾实质Brodel线剖开取石术的应用.     

PERCUTANEOUS NEPHROLITHOTOMY IN THE PEDIATRIC POPULATION

PURPOSE: Percutaneous nephrolithotomy is an established technique used in children with renal calculi. We review our experience with percutaneous nephrolithotomy for treating nephrolithiasis in childhood. MATERIALS AND METHODS: We retrospectively reviewed the records of children who underwent percutaneous nephrolithotomy procedures for renal calculi from 1985 to 1996. Antegrade percutaneous access was obtained in all patients and the tract was dilated to 24F. Grasper forceps, ultrasound and/or electrohydraulic lithotripsy was used to remove and disintegrate stones. In all patients a nephrostomy tube was placed intraoperatively, and a plain abdominal x-ray and nephrostogram were done postoperatively. The nephrostomy tube was removed after ensuring free drainage down the ureter and no untoward effects from clamping. Complete anatomical and metabolic evaluation was performed in all cases. Patients were followed 2 to 6 weeks, and 3 and 6 months postoperatively with a plain abdominal x-ray and excretory urography or renal ultrasound. RESULTS: In 5 boys and 3 girls (9 renal units) 4 to 11 years old (mean age 6.4) a total of 10 percutaneous nephrolithotomy procedures were performed. At presentation 6 children had flank and/or abdominal pain, 5 gross hematuria and 3 urinary tract infection. Three patients had associated metabolic abnormalities. One patient with a staghorn calculus had hydronephrosis and multiple infundibular stenoses. No underlying urological anatomical abnormalities were noted in the remaining cases. Four renal units that were obstructed at presentation required initial nephrostomy tube insertion. Average operative time was 131.8 minutes (range 58 to 240). An 87.5% stone-free rate was achieved using percutaneous nephrolithotomy monotherapy. Percutaneous nephrolithotomy was not successful for eradicating a staghorn stone in 1 patient. Hypothermia developed in 2 patients in whom operative time exceeded 150 minutes. No blood transfusions were required. CONCLUSIONS: Percutaneous nephrolithotomy is safe and effective in children, and should be considered a viable management option. However, staghorn calculi may require alternative management, particularly in the setting of underlying anatomical abnormalities. Children with renal calculi should undergo a complete anatomical and metabolic assessment with the institution of medical therapy, as appropriate.     

亚甲蓝在胰岛素瘤手术中的定位作用

本文对12例胰岛素瘤的诊断和治疗进行临床分析。认为Whipple三联症及胰岛素测定可作为定性诊断的主要依据;其治疗困难在于定位诊断,术中应用经胰十二指肠上、下动脉注入亚甲蓝,使肿瘤呈深蓝色改变的定位方法有助于术中寻找瘤体。作者应用此法行12例手术,无1例肿瘤遗漏。     

MEDPOR生物材料在颅颌面畸形整复中的应用

目的：介绍Medpor生物材料在颌面畸形整复中的应用。方法：对6例不同原因所致颌面部畸形采用Medpor生物材料或Medpor复合软组织瓣整复畸形。结果：6例手术均获得满意效果，无感染等并发症，外形恢复好。结论：Medpor生物材料克服了组织移植特别是骨移植所存在的组织吸收的缺点，具有创伤小、可塑性强，并可与软组织移植复合整复颌面部畸形的特点。     

THE BIOAVAILABILITY OF OXALATE FROM OCA (OXALIS TUBEROSA)

PURPOSE: It is believed that soluble oxalate has higher bioavailability than insoluble oxalate. Oca (Oxalis tuberosa) is moderately high in oxalate and contains oxalate in soluble form only. We estimated the bioavailability of oxalate in oca based on the urinary excretion of oxalate after oxalate loading with oca to estimate the bioavailability of oxalate in oca. We also clarified whether bioavailability differs in various oxalate loads from the same food source and studied the effect of an additional calcium source on the bioavailability of oxalate from oca. MATERIALS AND METHODS: Four men and 4 women ingested 50, 100 and 150 gm. oca as well as 100 gm. oca with 100 gm. sour cream. Oxalate was measured in a 6-hour urine sample from each volunteer. RESULTS: The mean bioavailability of oxalate from oca plus or minus standard deviation was 1.44% +/- 1.31% during the 6-hour period after intake. There was no significant difference in oxalate bioavailability among oxalate intake levels in this study, although oca consumption with sour cream significantly decreased the uptake of oxalate (p <0.01). The variation in bioavailability among individuals was high in our study. CONCLUSIONS: The bioavailability of oxalate in oca appears to be similar to that in spinach. However, bioavailability varies among individuals and depends on other constituents of a combined meal.     

腹股沟直疝治疗体会(附88例报告)

作者统计了1972～1996年手术治疗88例腹股沟直疝的临床资料。其中右侧46例(52.3％),左侧24例(27.3％),双侧18例(20.4％),骑跨疝4例(4.5％);修补方法采用McVay法59例(63.4％),Bassini法18例(19.3％),Halsted法12例(12.9％),改良McVay法2例(2.2％),疝成形2例(2.2％)。随访58例(65.9％),2例复发(2.3％)。文内对腹股沟直疝的特点及术式选择进行了讨论,提出术中应注意识别骑跨疝的存在,旨在提高腹股沟直疝手术的疗效。