气压弹道碎石术治疗输尿管结石

目的 探讨输尿管镜下气压弹道碎石术治疗输尿管结石的效果。方法 应用输尿管镜下气压弹道碎石治疗输尿管结石180例。男127例，女53例，年龄14～62岁，平均38岁。输尿管上段结石18例，中段64例，下段98例。结石直径0．5～2．3cm，平均0．7cm。合并患侧肾积水89例，其中1例女性双侧输尿管下段结石并梗阻、双肾积水，肾功能不全。结果 180例输尿管结石粉碎率98．3％(177例)，1次彻底清除率91．7％(165例)，3例结石移至肾盂者未完成手术，12例术终输尿管壁残留结石粉末，术后4周IVU复查，残石已排空。67例(37．0％)术后有肉眼或镜下血尿，多于1～2d内消失。180例均无穿孔、感染等并发症。结论 输尿管镜直视下气压弹道碎石术治疗输尿管结石确切、安全、组织损伤小，清除彻底、并发症少，可作为输尿管中段和下段结石的首选治疗方法。     

输尿管镜治疗急性输尿管梗阻

目的探讨输尿管镜在急性输尿管梗阻的诊断及处理中的优势。方法回顾分析54例急性输尿管梗阻经过输尿管镜技术治疗的临床资料。结果52例经过输尿管镜技术成功解除梗阻。结石性梗阻50例,其中双侧输尿管结石3例,孤肾1例;息肉及狭窄各1例。2例因置镜失败经过手术解除梗阻,术后证实为结石。结论输尿管镜技术对急性输尿管梗阻性疾病具有诊断及治疗双重作用,对于持续性肾绞痛及急性肾后性肾功能不全等需急诊处理者更为适宜。     

输尿管阴性结石的影像学分析

目的 探讨输尿管阴性结石的影象学诊断价值。方法 对78例输尿管阴性结石的常规B超、利尿性B超、逆行尿路造影、经皮肾穿刺造影、CT检查结果进行比较分析。结果 五种检查方法中CT诊断符合率最高(96．42％)，其次是利尿性B超(85．29％)，经统计学处理有显著性差异(P＜0．01)。结论 CT诊断输尿管阴性结石优于其它方法，并不受年龄和部位的限制，B超先确定梗阻部位是关键。     

输尿管镜治疗输尿管结石86例报告

目的 探讨输尿管镜技术治疗输尿管结石的方法。方法 回顾性分析应用输尿管镜技术治疗86例输尿管结石的临床资料。结果 输尿管上段结石碎石成功率为75％(9／12)，中段结石碎石90％(18／20)，下段结石98．1％(53／54)。输尿管结石碎石后排净率为98．7％(79／肋)，其中上段结石为88．8％(8／9)，中、下段结石均为100％(71／71)。结论 输尿管镜气压弹道碎石是治疗输尿管中下段结石的首先方法。对输尿管上段结石宜配合体外震波碎石术。     

输尿管镜气压弹道碎石术治疗输尿管结石梗阻并发急性肾功能衰竭——附18例报告

目的探讨输尿管镜气压弹道碎石术治疗输尿管结石梗阻并发急性肾功能衰竭的临床疗效。方法分析应用气压弹道碎石术治疗输尿管结石梗阻并发急性肾功能衰竭18例的临床资料。结果18例33侧结石均一次性解除梗阻，成功率100％，1周内结石排净率84.5％(28／33)。5侧结石残留，均为上段结石占15．5％。其中3例体外行震波碎石术(ESWL)、1例经皮肾镜取石术(PCL)、1例溶石治愈。并发症：输尿管穿孔2例，占6．7％，经保守治愈。结论气压弹道碎石术具有适应症广、损伤小、见效快、并发症少的特点；能有效清除结石，解除梗阻，挽救肾功能。     

986例输尿管结石的超声诊断体会

目的探讨应用超声诊断仪诊断输尿管结石的方法及体会。方法回顾性分析超声科就诊的986例输尿管结石病人资料。结果B超诊断符合970例（98．4％），输尿管上端结石420例（43.3％），中段结石186例（19.2％），下段结石364例（37．5％），左侧530例（54．6％），右侧440例（45.4％），双侧输尿管结石20例（2．1％）。结石大小为3-20mm。其中796例（82．1％）有不同程度的肾盂积水及输尿管扩张，无明显肾积水者部分也可见肾盂管壁回声改变。其中70例（7．2％）可见肾周积液。结论超声诊断仪确诊输尿管结石为临床首选，其方便，无痛苦．可重复性检查，是目前诊断输尿管结石的一种良好方法。     

腹腔镜输尿管切开取石术治疗合并输尿管狭窄的输尿管上段结石临床分析

目的 对腹腔镜输尿管切开取石术(LUL)治疗合并输尿管狭窄的输尿管上段结石的安全性和有效性进行临床分析.方法 回顾性分析2010年1月至2011年12月本中心收治的14例合并输尿管狭窄的输尿管上段结石患者,其中合并单纯输尿管狭窄5例(35.7％),合并肾孟输尿管连接部梗阻(UPJO)9例(64.3％),均采用LUL及输尿管狭窄切除吻合术或肾盂离断成形术治疗.结果 所有患者均顺利完成手术,结石长径为1.5 ～2.1 cm,手术时间100～150分钟,无术中输血病例,术中无严重并发症发生,无中转开放病例.术后留置腹腔引流管8～11天,住院天数10～19天,无漏尿及其它并发症发生.术后2个月复查KUB或B超,示1例患者肾内小结石残留,给予口服排石药物治疗,结石清除率为92.85％(13/14).结论 腹腔镜输尿管切开取石术治疗输尿管上段结石安全、有效,可以同时治疗输尿管狭窄及肾盂连接部梗阻,以期更有效的预防结石复发.建议该手术方法作为治疗合并单纯输尿管狭窄及肾盂输尿管连接部梗阻的输尿管上段结石的首选治疗措施.     

输尿管镜下气压弹道碎石术治疗输尿管结石54例

目的 探讨输尿管镜下气压弹道碎石术治疗输尿管结石的疗效。方法 总结采用输尿管镜下气压弹道碎石术治疗输尿管结石的54例的临床资料。结果 一次性碎石成功率90．7％(49／54)。平均结石排净时间26(7～54)d，平均手术时间42(30～70)min．平均术后住院4．8(3～9)d，并发症发生率为7．5％(4／54)。其中输尿管穿孔1例，置镜失败1例，输尿管结石冲入肾盂2例。另1例结石下方输尿管狭窄．改行开放手术治疗。结论 输尿管镜下气压弹道碎石方法安全，疗效确切。     

经尿道输尿管软镜钬激光治疗肾和输尿管上段结石

目的探讨输尿管软镜下钬激光治疗肾和输尿管上段结石的疗效及安全性。方法回顾性分析了56例采用输尿管软镜下钬激光治疗肾和输尿管上段结石的临床资料,术前均经过超声、CT或静脉肾盂造影诊断为。肾或输尿管上段结石,分析该术式的手术时间、术后并发症,术后结石清除率等。结果单次输尿管软镜进镜成功率92．9％（52／56）,平均碎石时间为（55．3±6．5）min,总体碎石成功率98．1％（53／54）,术后4周复查超声或KUB提示结石排净率90．7％（49／54）,所有患者均未出现严重并发症。结论输尿管软镜下钬激光碎石术治疗肾和输尿管上段结石安全、可靠、成功率高。     

经输尿管镜钬激光碎石治疗输尿管结石

目的探讨输尿管镜钬激光碎石术治疗输尿管结石的有效性和安全性。方法回顾性分析59例采用输尿管镜钬激光碎石治疗输尿管结石的患者资料。男37例，女22例，平均54．3岁。结石位于输尿管上段16例，中段13例，下段30例。结石直径0．7—1．8cm，平均1．05cm。结果单次碎石成功率为90％（53／59），其中上段结石单次碎石成功率为69％（11／16），中、下段为98％（42／43）。平均手术时间32．2min，术中无输尿管穿孔等并发症发生，平均住院2．9天。57例随访1-3个月，结石排净率98％（56／57），无输尿管狭窄发生。结论输尿管镜钬激光碎石治疗输尿管结石创伤少，成功率高，可作为输尿管结石特别是中、下段结石首选的治疗方法。     

小儿输尿管疾病的超声诊断

采用经腹壁超声方法，对４０６例输尿管疾病检查诊断，其中肾盂输尿管囊肿６９例、异位开口４８例、双输尿管畸形７例、结石２６例、肾盂输尿管连接处狭窄１４２例、输尿管扩张和巨输尿管症１１４例。小儿输尿管疾病以先天性畸形为主，多需手术治疗。超声诊断能为治疗提供确切依据，符合率较高，该法简便、重复性强、刺激性小，非常适宜小儿检查。     

输尿管疾病的超声诊断

采用超声检查方法诊断１４４１例输尿管疾病。其中，输尿管结石１３３２例，肾盂输尿管连结部狭窄４６例，输尿管开口囊肿２６例，重复肾盂和重复输尿管合并输尿管开口异位１６例，巨输管阁下 ９例，腔静脉后输尿管３例，输尿管息肉３例，输尿管癌６例。超声检查与手术和其它Ｘ线检查对照组结果表明，超声诊断输尿管疾病的符合率为９８．５％。本组病例中没有假阳性。     

中老年人输尿管梗阻导致肾积水的病因及诊断分析

目的　提高中老年人输尿管梗阻的病因诊断水平。　方法　回顾性分析了近 10年来收治的 141例中老年人肾积水的病因及诊断方法。　结果　在本组病例中 ,输尿管结石 5 9例 ,输尿管癌 5 1例 ;输尿管结核 11例 ;肾盂输尿管交界处狭窄 9例 ;输尿管囊肿 6例 ;输尿管息肉 5例。　结论　输尿管结石和肿瘤是导致中老年人输尿管梗阻的主要病因 ,对于这些病因的诊断 ,尤其伴有血尿的患者 ,B超应作为诊断及定期复查的首选检查手段。     

产前超声诊断对新生儿消化道梗阻性疾病手术治疗价值的观察

目的探讨产前超声早期诊断出消化道梗阻性疾病对患儿出生后手术前瞻性指导和改善预后的意义。方法 新生儿消化道梗阻并手术治疗的患儿138例。92例产前超声已确诊消化道梗阻的患儿为观察组,46例出生后确诊为消化道梗阻的患儿为对照组。观察组患儿经多学科会诊(multi-disciplinary team,MDT)后进行围手术期处理,产后早期手术。对照组患儿经MDT后择期手术。观察记录两组患儿术后恢复自主呼吸比率、治愈率、住院时间和预后情况。结果观察组患儿较对照组术前准备明显更为充分,手术并发症较少,术后恢复自主呼吸而不必使用呼吸机比率较高分别为83.7%和67.4%,P0.05,住院时间分别为(12±4.1)天和(14±4.3)天,P0.05,门诊随访预后较好。结论产前超声检查是早期确诊小儿消化道梗阻性疾病的重要手段。超声确诊后早期干预,可以提前完善术前准备,提高手术成功率和治愈率。     

Dynamics of the urinary tract in longterm vesico-ureteral reflux with infravesical obstruction and infection in pigs; V

In a study of the dynamic function of the urinary tract in infravesically obstructed pigs with vesicoureteric reflux, 5 pigs with 6 refluxing ureters evidenced urinary tract infection after 8 and 10 weeks of obstruction. Examination showed that the median ureteric baseline activity had decreased to 0.0 A.P./min (action potentials/min). During bladder filling, no increase in activity was seen, although there was pressure equilibration between the bladder and the renal pelvis, when the reflux producing bladder pressure was reached. Only a few episodes of retrograde activity were recorded during the bladder filling. 46% of the ureteric contractions were incomplete and stopped in the mid-third of ureter. The study showed the severe, irreversible impairment of ureteric function when subjected to not only reflux and obstruction but also infection.     

Urological complications following renal transplantation

A total of 1016 consecutive renal transplants performed between 1976 and 1990 were analysed retrospectively to determine the incidence of urological complìcations and possible predisposing factors. Some 189 episodes of ureteric obstruction and/or urinary leak occurred in 143 patients (overall incidence 14.1 %). The median annual rate of urinary leak was 5.1%; that of ureteric obstruction was 4.5% pre-1986 and 16.1% post-1986. Sixty-three episodes of urinary leak occurred in 54 patients from 1 day to 3 months post-transplant and 60% involved the distal ureter. Thirty were treated primarily by reconstructive surgery, ten required nephrectomy and three died of associated sepsis. A total of 126 episodes of ureteric obstruction occurred in 104 patients from 1 day to 12 years post-transplant and 86% involved the distal ureter. Prior to 1986, 10/11 patients with ureteric obstruction were treated by reconstructive surgery, but since then 88 (95%) have been treated by percutaneous nephrostomy, with or without stenting, with only one graft lost and no deaths. Children had a significantly increased incidence of ureteric obstruction (P<0.001) whilst male recipients had an increased incidence of urinary leak (P=0.04). More patients with ureteric obstruction than those without had two or more episodes of rejection (P=0.03). No single cause for the increased incidence of ureteric obstruction since 1986 has been identified. Continued attention to technical detail and further study of this trend is warranted.     

Urological complications in 119 consecutive renal transplants.

One hundred and nine patients undergoing 119 transplants have been followed up from 8 months to 9 years. Urological complications occurred in 16 transplants, an incidence of 13.4%. Ureteroneocystostomy was performed primarily in all cases; in 98 by the conventional Politano-Leadbetter technique with 9 (9.2%) urological complications and in 32 by an extravesical technique with 7 (21.8%) urological complications. One patient died as a result of ureteric obstruction, without operation. In 3 patients with lower ureteric obstruction, transurethral ureteric meatotomy was successful in 2 cases and resulted in no change in renal function in the third. Two patients with urinary fistulae were managed successfully by continuous drainage with indwelling urethral catheters. The remaining 10 patients required 12 open surgical procedures for relief of ureteric obstruction, with improvement in function in 7 patients.     

�Ź����ȹܳ���������׵��ܹܽ�ʯ����ϼ�ֵ

目的 评价腹腔镜胆囊切除术(LC)前磁共振胆硬管成像(MRCP)对无征兆肛总管结石(ACBDS)的诊断价值。方法 对2002年1月至6月419例慢性结石性胆囊炎病人比前常规行MRCP，对检查结果进行分析。并统计有无黄疸或胆源性胰腺炎病史、B超提示胆总管扩张及入院后肝功能异常等胆总管结石(CBDS)危险因素，计算相关指标。结果 MRCP敏感性为100％(35／35)，特异度99．5％(382／384)，正确率为99．5％(417／419)。ACBDS的发生率为1．0％(4／419)，占CBDS的11．4％(4／35)。结论 MRCP对ACBDS有很高的诊断价值，可以降低比后胆总管残余结石的发生率，应作为比前常规检查。     

Pelvi-ureteric junction obstruction in duplex kidneys

OBJECTIVE

To report our experience of 11 children with pelvi‐ureteric junction obstruction (PUJO) in a duplex kidney and to review previous reports.

PATIENTS AND METHODS

From 1995 to 2005 the second author (G.H.H.S.) performed 145 pyeloplasties in single‐system kidneys and in 11 children with PUJO in a duplex kidney. Upper and lower pole obstructions were found in both complete and incomplete duplicated systems. Investigations included renal ultrasonography, renal scintigraphy, micturating cystography, cystoscopy and retrograde pyelography. Ten patients had surgery (eight dismembered pyeloplasties, one upper‐pole heminephrectomy, one pyelo‐ureterostomy).

RESULTS

Three children had obstruction of the upper moiety and eight had obstruction of the lower moiety. Upper and lower pole obstructions were found in both complete and incomplete duplicated systems.

CONCLUSION

Upper‐pole obstruction in a duplex kidney is rare; the present series suggests that it is more common than previously reported.     

常用乳腺影像诊断方法的比较研究

目的 比较彩色多普勒超声、钼靶和近红外线在乳腺癌及乳腺良性疾病诊断中的作用。方法 以术后病理结果为金标准，比较术前3种检查方法的诊断准确性。结果 共计565例乳腺疾病患者接受检查，其中乳腺癌274例，良性乳腺疾病291例。对乳腺癌彩超、钼靶和近红外线检查的灵敏度分别为83．7％（200／239）、84．2％（64／76）和76．9％（100／130），特异度分别为88．6％（226／255）、93．2％（69／74）和82．6％（114／138），诊断符合率分别为86．2％（426／494）、88．7％（133／150）和79．9％（214／268），其中彩超和钼靶检查的诊断符合率优于近红外线（P〈0．05），尤其对≤2cm的乳腺癌，近红外线对其诊断有较高的假阴性率（48．8％，21／43）。对乳腺炎性病变和导管瘤，彩超的检出率分别为58．8％（10／17）和69．2％（18／26），高于近红外线的检出率[分别为0和23．5％（4／17），P〈0．05和P〈0．01]。对乳腺癌在无查体配合诊断情况下行近红外线检查，其灵敏度和诊断符合率明显下降[灵敏度从76．9％（100／130）降到56．9％（74／130），P〈0．01；诊断符合率从79．9％（214／298）降到61．9％（166／268），P〈0．01]。结论 彩色多普勒超声和钼靶是有价值的常用乳腺影像诊断方法。