镍钛记忆合金支架治疗复杂性尿道狭窄10例报告

尿道狭窄及闭塞治疗较为困难。我们在实验研究取得满意效果的基础上,自1991年8月开始,采用镍钛记忆合金螺旋管状支架治疗10例复杂性尿道狭窄(其中2例尿道闭锁),现报告如下。1 资料与方法1．1 临床资料本组10例均为男性:年龄20~58岁,平均27岁。     

镍钛记忆合金网状支架在输尿管狭窄中的应用

1994年 11月～ 1998年 12月 ,采用镍钛记忆合金网状支架治疗输尿管狭窄10例 ,疗效满意 ,报告如下。资料与方法　本组 10例。男 8例 ,女 2例。年龄 2 5～ 5 5岁 ,平均 45岁。 5例为直肠癌术后复发所致双输尿管下段梗阻 ,双肾积水 ,均有轻重不等的肾功能不全 ;1例输尿管中段结石 ;2例肾盂输尿管连接部狭窄 ,第 1次术后出现再狭窄 ,再次手术输尿管长度受限 ;1例神经源性膀胱尿失禁 ,行回肠代膀胱术后 4年。血Ｃｒ 30 0～ 40 0ｍｍｏｌ/Ｌ ,大剂量ＩＶＵ均示双肾输尿管积水 ,输尿管回肠吻合口狭窄。 1例移植肾 3年尿量进行性减少 ,手术探查及造…     

镍钛记忆合金网状支架治疗前列腺增生的观察

我院从 1 996年 5月～ 1 998年 5月对 2 8例前列腺增生患者采用镍钛记忆合金网状支架置入治疗 ,取得一定的效果 ,现报告如下。1　资料与方法1 .1 　 临床资料本组 2 8例 ,年龄 70～ 88岁 ,平均 ( 80 .0± 3.7)岁。均有尿潴留病史。辅助检查排除膀胱、尿道及前列腺其他疾病。伴有严重高血压、心脏病者 2 3例 ,肺气肿 5例 ,脑梗塞或脑出血 4例 ,糖尿病 6例 ,肾功能不全 2例。1 .2 　 治疗方法网状支架由北京高忆公司提供。前列腺尿道长度采用尿道镜直视下测定 ,支架置入亦在尿道镜直视下进行。 1 0例配合膀胱造口。术后 1 0例患者继续给予保列…     

镍钛记忆合金支架治疗气管狭窄的麻醉处理

镍钛记忆合金支架治疗气管狭窄的麻醉处理贾天军＊宋运琴＊镍钛记忆合金支架（简称ＮＴ－支架）是治疗气管狭窄的一种新手段［１］。我科自１９９１年３月至今对ＮＴ－支架治疗６例气管狭窄患者手术施行了麻醉。术中经过顺利，取得了较好的效果。现报告如下。资料与方法成...     

镍钛记忆合金聚髌器在髌骨骨折中的临床应用

髌骨骨折是常见的关节内骨折,治疗方法多以手术为主,目的是恢复伸膝功能,避免继发性创伤性关节炎.目前各种髌骨骨折内固定方法疗效报道不一,优良率欠佳[1,2].笔者自2000年开始采用镍钛记忆合金聚髌器治疗髌骨骨折,现对2000年至2001年采用聚髌器治疗的43例病历资料进行随访分析报告如下.……     

镍钛记忆合金支架治疗癌性肺不张的护理

采用镍钛记忆合金支架治疗肺癌致肺不张１５例,经胸透示肺复张,表明镍钛记忆合金支架可作为癌性支气管闭塞再通的治疗手段。做好心理护理,严密监测呼吸、心率及ＳｐＯ２情况;术后平卧１２ｈ以上,以防止支架移位;注意勿食过热饮食,以免支架变形、脱落或气道损伤等并发症的发生,对支架治疗癌性肺不张起重要作用。     

钛镍记忆合金支架辅助姑息切除治疗胆管癌

目的：总结钛镍记忆合金支架辅助姑息性切除术治疗胆管癌的疗效。方法：对13例胆管癌患者,实施肿瘤姑息性切除术,采用钛镍记忆合金辅助胆肠吻合,并进行跟踪随访。结果：手术死亡1例。随访12例,现仍存活3例,平均生存期达13．5个月,其中最长达26个月。结论：对姑息治疗的中晚期胆管癌患者,姑息性切除同时应用钛镍记忆合金可以延长生存期,提高生活质量。     

心包加镍钛记忆合金支架气管置换术

我们应用心包加镍钛记忆合金支架人工气管治愈1例老年大段气管切除的病人，效果颇佳，现报道如下。     

钛镍记忆合金直肠支架治疗直肠恶性梗阻8例报告

钛镍记忆合金直肠支架治疗直肠恶性梗阻８例报告解放军第２５１医院普外科（张家口市，０７５０００）张振海，尚培中，王铁山，李龙涛我院自１９９２年１１月开始，采用自行设计的钛镍记忆合金直肠用扩张支架治疗中晚期直肠癌性肠梗阻８例，作为一种新的姑息性治疗手段，...     

镍钛记忆合金支架气管内植入术的麻醉处理

镍钛记忆合金支架(Ni-Tamemory allous stent，简称Ni-Ti支架)气管内植入术是近十多年来发展起来的气管外科技术，它能有效解除由于各种良、恶性疾病所引起的局限性气管狭窄症状。但其麻醉处理较为复杂。本文回顾性总结了本院自1996年1月～2003年8月间的32例Ni-Ti支架植入手术，旨在对其麻醉管理进行初步探讨。     

Controversies in urethral reconstruction

Urethral strictures are a frequent source of lower urinary tract symptoms in men. Open urethroplasty is regarded as the gold-standard treatment for urethral stricture disease. The treatment for urethral strictures is a continually evolving process and there is renewed controversy over the best approach to take in reconstructing the urethra, since the superiority of one approach over another has not yet been clearly defined. Anterior urethroplasty can be treated, with low morbidity, in an outpatient surgical setting, thus decreasing the impact of urethroplasty. In order to improve outcome in adult patients when the penile shaft is involved, reconstructive urethral surgeons have learned to apply the principles of delicate tissue handling, and the development of minimally invasive techniques. Genital or extra-genital skin has been used as a free graft or harvested as a flap for some time, thanks to its location, hairless skin and durability. Since the early 1990s, the use of oral mucosa was introduced in genital reconstructive surgery and has become popular for urethral reconstructions. Urethral reconstructive surgery is changing rapidly and this change has posed problems for surgeons who see the principles that previously defined their profession becoming obsolete or unworkable. New techniques and new engineered material are a part of our future.     

尿道修复重建进展

尿道修复重建始终由于其病情复杂、手术难度大、风险高、成功率低、并发症发生率高而面临困难甚至失败。近年来,尿道修复重建在临床与基础研究上取得了较大的进展。尿道重建的手术方式已经发生了显著的变化。组织工程学的突破性发展,为泌尿道的修复与重建带来了全新的概念。尿道内切开术适用于部分患者,尿道成形术仍旧是尿道狭窄治疗的金标准,组织工程管状化尿道可用于复杂性尿道重建。本文就尿道修复重建的临床治疗及组织工程学现状与进展综述如下。     

Female urethral reconstruction

A basic understanding of female urethral anatomy is necessary to approach urethral reconstruction from an anatomic standpoint. This article reviews the techniques of female urethral reconstruction based on these anatomic divisions: proximal and bladder neck, midurethra, and distal urethra.     

Posterior urethral reconstruction

Summary The posterior prostatomembranous urethral stricture or distraction defect has historically been the most formidable challenge of stricture surgery. This uncommon lesion occurs most often as the sequelae of pelvic fracture injuries, or straddle trauma, and is associated with serious urethral disruption and separation – an injury that is often complicted by inappropriate initial management using substitution skin flap techniques with the development of recurrent stenosis, irreversible impotence, and occasional incontinence. Management by endoscopic techniques may be possible in patients with short strictures or in those after prostatectomy, but they rarely play a role in resolving the complex obliterated urethra with a significant defect [1]. Resolution of post-traumatic posterior urethral distraction defects and other posterior urethral pathologic conditions has dramatically improved over the past two decades despite an inaccessible subpublic location involving exposed sphincter-active and erectile neurovascular anatomy. The contemporary, perineal, one-stage bulboprostatic anastomotic operation as popularized by Turner-Warwick [20] with selective scar excision is a versatile procedure with a high patent lumen success. Patients undergoing anastomotic urethroplasty have a substained patent urethral lumen success rate approaching 100 % versus those who have undergone urethral skin flap or patch repair, where the restricture rate in 5 and 10 years increases twofold to threefold [1, 20]. A patent urethra after an anastomotic urethroplasty at 6 months is free from further recurrent stricture and gives credence to Mr. Turner-Warwick's admonition that “urethra is the best substitute for urethra”.      

Comparison of nitinol urethral stent infections with indwelling catheter-associated urinary-tract infections

BACKGROUND AND PURPOSE: To determine the efficacy of intraurethral metal stents in preventing or eradicating urinary-tract infections (UTI) during the management of bladder outlet obstruction (BOO) by comparing the frequency and nature of the infections with indwelling-catheter-associated UTI. PATIENTS AND METHODS: The SAS relative-risk test was used to compare the risks of UTI in 76 patients with temporary urethral stents, 60 patients with BOO who had never been catheterized nor stented, and 34 patients with a permanent indwelling urethral catheter (PIUC). Infection was assessed 1 month after placement of the devices. Scanning electron microscopy (SEM) of the proximal and distal pieces of the stents removed from five patients with and five patients without UTI was carried out in a search for predisposing changes on the surfaces. RESULTS: After insertion of the catheter, UTI developed in 79.4% of the patients who originally had sterile urine. However, after insertion of the stent, UTI developed in only 40.9% of the patients with sterile urine. In 21 (44.6%) of the catheterized patients who had infected urine, UTI was eradicated after stent insertion. The SEM analysis of the stents showed that a thick organic layer had formed only on the infected devices but with no sign of erosion. CONCLUSION: Urinary infection is a significant problem in patients with PIUC but is significantly less frequent and less severe in patients with urethral stents. This advantage of stents over the conventional urethral catheter, in addition to their obvious convenience for the patient, make them good alternatives to reduce the risk of UTI.     

Post-traumatic female urethral reconstruction

Post-traumatic urethral damage resulting in urethrovaginal fistulas or strictures, though rare, should be suspected in patients who have unexpected urinary incontinence or lower urinary tract symptoms after pelvic surgery, pelvic fracture, a long-term indwelling urethral catheter, or pelvic radiation. Careful physical examination and cystourethroscopy are critical to diagnose and assess the extent of the fistula. A concomitant vesicovaginal or ureterovaginal fistula should also be ruled out. The two main indications for reconstruction are sphincteric incontinence and urethral obstruction. Surgical correction intends to create a continent urethra that permits volitional, painless, and unobstructed passage of urine. An autologous pubovaginal sling, with or without a Martius flap at time of reconstruction, should be considered. The three approaches to urethral reconstruction are anterior bladder flaps, posterior bladder flaps, and vaginal wall flaps. We believe vaginal flaps are usually the best option. Options for vaginal repair of fistula include primary closure, peninsula flaps, bilateral labial pedicle flaps, and labial island flaps. Outcomes are optimized by using exacting surgical principles during repair and careful postoperative management by an experienced reconstructive surgeon.     

Erectile function after urethral reconstruction

Advances in urogenital plastic surgical tissue transfer techniques have enabled urethral reconstruction surgery to become the new gold-standard for treatment of refractory urethral stricture disease. Questions remain, however, regarding the long-term implications on sexual function after major genital reconstructive surgery. In this article, we review the pathologic features of urethral stricture disease and urologic trauma that may affect erectile function （EF） and assess the impact of various specific contemporary urethroplasty surgical techniques on male sexual function.