腔内治疗小儿肾盂输尿管连接部梗阻的手术配合

目的 探讨腔内技术治疗小儿肾盂输尿管连接部梗阻(UPJO)的手术配合方法.方法 对2004年3月-2005年4月收治的22例小儿UPJO施行腔内治疗手术,并对配合过程进行总结分析.结果 21例患儿腔内手术顺利,1例中转行开放手术,所有手术均在护士及时有效的手术配合护理下顺利完成.结论 针对不同的腔内治疗手段采用灵活的手术配合,是保证小儿UPJO腔内治疗手术顺利完成的关键.     

小儿尿路结石腔内微创治疗的手术配合

目的探讨小儿尿路结石腔内微创治疗的手术配合要点。方法对187例尿路结石症患儿施行腔内微创手术治疗,分析总结术中护理方法和经验。结果187例患儿手术均获成功,术中配合顺利,术中、术后无严重不良反应发生。结论掌握小儿尿路结石症的相关知识,做好术前准备,熟悉手术步骤,熟练配合手术,有利于手术顺利完成。     

小儿尿路结石腔内微创治疗的手术配合

目的 探讨小儿尿路结石腔内微创治疗的手术配合要点.方法 对187例尿路结石症患儿施行腔内微创手术治疗,分析总结术中护理方法和经验.结果 187例患儿手术均获成功,术中配合顺利,术中、术后无严重不良反应发生.结论 掌握小儿尿路结石症的相关知识,做好术前准备,熟悉手术步骤,熟练配合手术,有利于手术顺利完成.     

后腹腔镜肾盂成形术在肾盂输尿管连接部梗阻的应用

目的探讨后腹腔镜手术治疗肾盂输尿管连接部梗阻（ureteropeluic junction obstruction,UPJO）的手术技巧和临床效果。方法回顾性分析2006年7月2009年10月59例采用后腹腔镜手术治疗UPJO患者的临床资料。后腹腔镜下行UPJO周围压迫组织松解术18例,Y-V成形术25例,离断成形术16例。结果术后随访3～36个月。所有患者手术均顺利完成。静脉肾盂造影均提示造影剂通过良好,肾积水均得到明显改善。结论后腹腔镜治疗UPJO创伤小,患者术后痛苦小、恢复快、住院时间短、疗效显著,可作为UPJO治疗的首选治疗方法 。     

腹腔镜下疝囊高位结扎日间手术治小儿腹股沟疝的疗效

目的 探讨腹腔镜下疝囊高位结扎日间手术在治疗小儿腹股沟疝中的可行性和注意事项.方法 对洛阳市第六人民医院2008年2月至2011年2月收治的228例小儿腹股沟疝患者采用腹腔镜下疝囊高位结扎日间手术治疗.结果 228例患者均顺利完成手术,所有病例24 h内出院,随访1年,复发1例,无其他并发症发生.结论 应用腔镜下疝囊高位结扎日间手术治疗小儿腹股沟疝疗效确切,安全可行,值得推广.     

钬激光腔内治疗输尿管肾盂连接处狭窄

目的探讨钬激光腔内治疗肾盂输尿管交界处狭窄（UPJO）的方法及疗效。方法对14例UPJO患者采用钬激光腔内治疗，于狭窄段后外侧全层切开输尿管壁直至肾周脂肪，术后留置双J管6～8周。全部患者获得随访，平均随访10．5个月（4～27个月）。结果手术时间30～60min，术后平均住院3d（2～6d）。临床症状改善明显，影像学显示内切开段造影剂通过良好12例，2例治疗失败者再次给予钬激光腔内切开．1例随访8个月显示治疗成功，1例随访4个月，目前临床症状改善。结论钬激光腔内切开治疗UPJO具有微创、住院时间短、疗效可靠、可重复进行等特点，可作为对部分UPJO病人进行微创治疗的首选。     

主动脉夹层动脉瘤腔内隔绝术的介入手术护理与配合

目的:总结主动脉夹层动脉瘤腔内隔绝术的介入手术护理及配合经验.方法:在导管室对108例患者进行主动脉夹层动脉瘤腔内隔绝术,加强术中护理及与血管外科、介入医师、麻醉医师的配合.结果:108例患者均顺利完成了腔内隔绝术.结论:腔内隔绝术属于新兴的微创治疗手术,且在导管室内进行,术中护理配合有新颖性及特殊性,须进一步总结完善,形成规范.     

肾盂输尿管连接处狭窄的微创治疗探讨

目的 探讨微创治疗肾孟输尿管交界处狭窄(UPJO)的适应证选择、手术技巧及临床应用价值.方法 回顾性分析钬激光顺逆行腔内切开、后腹腔镜肾盂成形术治疗52例UPJO的临床资料.腔内逆行治疗组14例,顺行治疗组25例,后腹腔镜肾孟成形组13例.结果 逆行腔内治疗组:手术时间30～60min,术后平均住院3 d(2～6)d;临床治愈12例,2例治疗失败者再次给予钬激光内腔内切开,1例随访8个月显示治疗成功,1例随访4个月,目前临床症状改善.顺行腔内治疗组:手术时间60～90 min,术后平均住院6(5～7)d;临床治愈21例,4例治疗失败者再次给予经皮肾微造瘘钬激光腔内切开,1例随访13个月显示治疗成功,3例分别随访4、6和9个月,目前临床症状改善.后腹腔镜治疗组:13例手术均获成功,手术时间120～200 mia,平均175min;出血量60～110mL,平均75mL.术后平均住院时间75 d(5～8 d).围手术期无并发症.随访3～19个月,UPJ吻合口无狭窄,肾积水、肾功能均得到改善.结论 只要适应证选择得当,微创治疗UPJO具有重要的临床价值.     

腔内后装治疗宫颈癌大出血患者的观察与护理

目的 探讨宫颈癌大出血后装治疗的配合和护理。方法 采用高剂量率单次大剂量腔内后装治疗宫颈癌大出血患者14例,对患者加强心理护理,病情观察,密切配合医生进行后装治疗操作。结果 14例患者顺利完成腔内后装治疗,其中13例患者治疗后出血减少或停止,1例患者治疗后仍出血量多,采取髂内动脉栓塞术止血。结论 腔内后装治疗是有效控制宫颈癌大出血的方法,高质量的护理是患者顺利完成治疗的保证。     

腔镜联合鼻内镜手术治疗Graves眼病的护理配合

[目的]探讨腔镜联合鼻内镜治疗甲状腺相关性眼病的手术护理配合。[方法]对37例(40眼)腔镜联合鼻内镜治疗甲状腺相关眼病病人的手术护理配合进行分析与总结。[结果]37例病人(40眼)手术均顺利完成,无中转开放手术,术中平均出血量5mL。病人术后无皮下积液感染,颜面部未留下任何与该手术相关瘢痕,对美容效果满意。[结论]加强腔镜联合鼻内镜手术治疗Graves眼病的护理配合是手术成功的保证。     

超声对肾盂输尿管连接部梗阻的定位及病因分析

目的评价超声对肾盂输尿管连接部梗阻的诊断价值。方法采用空腹饮水膀胱充盈法对68例肾盂输尿管连接部梗阻进行超声检查。结果最后确诊为肾盂输尿管连接部结石37例、狭窄19例、肿瘤5例、因周围肿瘤压迫3例、结核和肾门部囊肿压迫各2例。超声显像诊断肾盂输尿管连接部梗阻位置的符合率为97·1%,诊断梗阻病因的符合率为91·2%。结论超声显像对肾盂输尿管连接部的诊断具有重要价值。     

离断性肾盂成形术治疗肾盂输尿管连接部梗阻60例

目的总结离断性肾盂成形术治疗肾孟输尿管连接部梗阻（UPJO）的诊治体会。方法分析60例UPJO患者的临床资料。其中肾孟输尿管连接部狭窄40例,肾孟输尿管高位连接12例,迷走血管压迫5例,纤维条索压迫3例。均采用Anderson-Hynes术。结果术后随访6～36个月,分别行B超、静脉肾孟造影检查、MRI检查,有58例（96.7%）肾积水消失或明显减轻,1例（1.7%）无明显变化,1例（1.7%）肾积水加重。结论离断性肾孟成形术治疗UPJO疗效显著。     

Endopyeloureterotomy via the transpelvic extra-ureteral approach

We have developed a new procedure – endopyeloureterotomy via the transpelvic extra-ureteral approach. From September 1988 to March 1994, we have treated 72 patients with ureteropelvic junction obstruction in 73 procedures and had a success rate of 89%. Causes were primary obstruction in 60 cases, post-operative scars in four, scars from inflammation of renal calculi in four, failure of previous endopyelotomy in three and scars from tuberculosis in two. The length of the stenotic segment ranged from 0.2 to 6.5cm (mean: 1.8cm) Follow-up ranged from 6 to 69 months (mean: 24 months). It showed that 21 of 73 procedures (28.8%) had completely removed the ureteropelvic junction obstruction, 44 procedures (60.3%) had reduced the obstruction, and eight procedures had failed to bring about a decrease in obstruction. Long-term follow-up of 50 patients for 1 year or more showed that there was no recurrence of stenosis at all after the examination at 6 months after operation. Our new technique has proven etficacious in treating ureteropelvic junction obstruction.     

超声显像对肾盂输尿管连接部梗阻的定位及病因诊断

目的评价超声显像对肾盂输尿管连接部（盂管口）梗阻的诊断价值。方法采取空腹饮水膀胱充盈法对７４例（８１侧）盂管口梗阻进行超声显像检查。结果最后确诊为盂管口结石３０例（３４侧）、狭窄２３例（２６侧）、肿瘤６例、周围肿瘤压迫４例、结核和肾门部囊肿压迫各３例、异位血管、输尿管瓣膜、迂曲等共５例。超声显像诊断盂管口梗阻位置的符合率为９６．３％（７８／８１）,诊断梗阻病因的符合率为８８．９％（７２／８１）。结论超声显像对盂管口梗阻的诊断具有重要价值,而对输尿管息肉、瓣膜、异位血管等诊断困难     

Hydronephrosis in children: Narrowing the differential diagnosis with ultrasound

Twenty patients with hydronephrosis in whom examination with ultrasound was helpful in defining the extent of dilation of the collecting system are presented. Thirteen patients had hydronephrosis due to obstruction at the ureteropelvic junction, six had obstruction of the ureterovesical junction from various causes, and one had massive bilateral vesicoureteral reflux. The diagnosis of high ureteral obstruction as opposed to obstruction or reflux at the ureterovesical junction was based on visualizing a dilated ureter in the latter two groups.     

肾迷走血管引起肾盂输尿管连接部梗阻

目的:分析12例肾迷走血管造成的肾盂输尿管连接部梗阻的X线表现,讨论肾迷走血管的起源及其致病机理,提高肾盂输尿管连接部梗阻的鉴别诊断。材料与方法:以静脉肾盂造影为首选检查方法,对不显影者可作逆行肾盂造影检查。结果:肾盂输尿管连接部带状压迫截断征和输尿管屈曲扭转征是本病典型征象,还可见患侧不同程度的肾积水,肾功能减低或可伴肾结石。结论:肾下极的迷走血管很少见,而经肾盂输尿管连接部前方入肾下极者是造成该处梗阻的病因。部分的肾迷走动脉可伴有迷走静脉。     

Management of congenital hydronephrosis with ureteropelvic junction obstruction: The Vienna AKH experience 1986–2001

One of the most common causes of congenital hydronephrosis is obstruction of the ureteropelvic junction. The obstruction can be detected with prenatal ultrasonography screening and treated before renal function is reduced; the obstruction may also resolve spontaneously. Currently, there is no test for predicting the outcome of this obstruction. Management guidelines for neonates with asymptomatic obstruction of the ureteropelvic junction are based on expert opinions, but not on evidence-based data. In our retrospective study, we evaluated management and outcome of 26 renal units in 23 infants (15 boys, 8 girls) with congenital obstruction of the ureteropelvic junction treated in our institution between 1986 and 2001. These infants had isolated hydronephrosis on prenatal and postnatal sonography, showed an obstructive curve pattern in the postnatal diuretic nephrogram and had at least one follow-up nephrogram during a follow-up period of at least 1.5 years. Of these renal units, 16 demonstrated normal function (Group I), five moderate function (Group II) and five severely reduced function (Group III). In group I, 6 of 12 primarily conservatively managed kidneys resolved spontaneously and remained normal in function. In group II, all infants were operated and 83% improved their kidney function. In group III, all infants were operated but none demonstrated relevant improvement. These data support the current expert opinion of the Arbeitsgemeinschaft P?diatrische Nephrologie (APN), that ureteropelvic junction obstruction in neonates with normal renal function can be managed primarily conservatively with close monitoring. In neonates with moderately--but not with severely--reduced renal function, early surgery is effective in the prevention of deterioration.     

磁共振尿路成像在小儿尿路梗阻诊断中的应用

目的:探讨磁共振尿路成像(MRU)在小儿尿路梗阻诊断中的价值。方法:31例尿路梗阻患儿分别作静脉尿路造影(IVP)、腹部超声(BUS)和磁共振尿路成像(MRU)检查,对照手术结果,观察MRU尿路梗阻的表现。结果:31例尿路梗阻患儿中经MRU诊断为肾盂输尿管连接部狭窄24例,输尿管口囊肿3例,壁段狭窄2例,原发性巨输尿管症2例。诊断正确率100%。结论:MRU具有无创,诊断准确率高的优点,非常适合用于小儿尿路梗阻疾病的诊断。     

后腹腔镜精准辅助小切口离断肾盂成形术治疗小儿肾盂输尿管连接部梗阻（附22例报告）

目的探讨后腹腔镜精准辅助小切口离断肾盂成形术治疗小儿肾盂输尿管连接部梗阻(UPJO)的手术技巧和临床价值。方法 22例小儿UPJO行后腹腔镜精准辅助小切口离断肾盂成形术。其中,男15例,女7例,年龄6个月~8岁,平均3.5岁;左侧13例,右侧7例,双侧肾积水2例。结果辅助小切口长度1.5~4.0 cm,平均2.6 cm,手术时间42~95 min,平均63 min,术中出血量5~30 ml,平均15 ml,术后住院时间5~12 d,平均6.6 d。围手术期尿漏1例,因术后护理不当夹闭导尿管导致,术后延长伤口引流管留置时间后治愈。术后随访3~24个月,复查B超及尿路造影(CTU)显示肾积水及肾功能均得到改善,尿常规正常。结论对于部分小儿UPJO,后腹腔镜精准辅助小切口离断肾盂成形术是一种微创、安全而有效的手术治疗方法。     

Ureteropelvic junction obstruction in children

Infants with ureteropelvic junction obstruction usually present with an abdominal mass or a urinary tract infection, which generally leads to prompt diagnosis. In children over age six, the diagnosis is often delayed because they frequently present with poorly localized abdominal pain simulating functional or gastrointestinal illness. Children with unexplained abdominal pain should undergo urologic evaluation, even if urinalysis and urine culture are negative. Ultrasonography is useful for detecting hydronephrosis.