经皮肾微造瘘钬激光腔内切开治疗肾盏狭窄及闭锁

目的 破坏小,肾功能受损轻)、住院时间短、疗效可靠、可重复进行等特点,可作为肾盏狭窄及闭锁患者微创治疗的首选. 管6～8周. 结果手术时间80～120 min,平均90 min.术后平均住院8(7～9)d.42例患者获随访,平均随访9(4～ 6)个月.临床症状改善明显、IVU显示内切开段造影剂通过良好,肾积水减轻38例;4例治疗失败者再次行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、9个月,临床症状改善. 结论 经皮肾微造瘘钬激光治疗肾盏狭窄及闭锁具有微创(术中出血少,肾集合系统破坏小,肾功能受损轻)、住院时间短、疗效可靠、可重复进行等特点,可作为肾盏狭窄及闭锁患者微创治疗的首选. 管6～8周. 结果手术时间80～120 min,平均90 min.术后平均住院8(7～9)d.42例患者获随访,平均随访9(4～ 6)个月.临床症状改善明显、IVU显示内切开段造影剂通过良好,肾积水减     

顺行经皮肾微造瘘与逆行经输尿管镜钬激光肾盂内切开术治疗肾盂输尿管连接部狭窄疗效比较

目的比较顺行经皮肾微造瘘(antegrade mini-invasive percutaneous nephrostomy,MPCN)和逆行经输尿管镜(retrograde ureteroscopy,RUS)行钬激光肾盂内切开术治疗肾盂输尿管连接部狭窄(ureteropelvic junction obstruction,UPJO)的疗效。方法48例UPJO患者按照治疗方法分为MPCN组(28例)和RUS组(20例)。结果MPCN组无一例中转开放,平均手术时间(52.3±12.7)min、术中出血量(32.1±17.9)ml、术后住院时间(6.3±1.3)d、恢复工作时间(43.2±5.2)d、并发症发生率17.9%(5/28),随访治疗有效率为89.3%(25/28)。RUS组有4例中转开放或顺行腔内手术,平均手术时间(36.2±7.8)min、术中出血量(9.4±7.3)ml、术后住院时间(4.0±1.3)d、恢复工作时间(37.7±5.3)d、并发症发生率18.7%(3/16),随访治疗有效率56.2%(9/16)。两组并发症发生率比较差异无统计学意义(P>0.05),但手术时间、术中出血量、术后住院时...     

经皮肾镜钬激光碎石术治疗输尿管结石的研究

目的 探讨微创经皮肾镜钬激光碎石术对输尿管上段结石治疗的疗效分析.方法 将2011年3月到2013年3月在本院泌尿外科治疗的60例输尿管上段结石的患者,按随机数字分组法分为观察组(采用微创经皮肾镜钬激光碎石术)及对照组(采用开放手术治疗)各30例,通过对比两组患者手术中耗费时间、术中出血量、住院时间、术后并发症情况及随访3个月后结石的排净率和患者的满意度.结果 ①两组患者在手术时间方面比较无显著性差异(t=1.5598,P＞0.05);观察组患者的术中出血量明显少于对照组[(76.4 ±9.65)mL vs (128.3±10.32) mL],其住院时间也短于对照组[(5.86 ±1.47)d vs(7.95±1.53)d],差异均有统计学意义(P＜0.01);②观察组患者术后并发症发生率低于对照组(6.67％ vs 30％),差异有统计学意义(x2 =5.4546,P＜0.05);③随访3个月后,观察组患者与对照组的结石排净率(96.7％ vs73.3％)及满意度(100％ vs 80％)比较,差异具有统计学意义(P＜0.05).结论 输尿管上段结石采用微创经皮肾镜钬激光碎石术治疗的疗效确切,具有创伤小、结石排净率高、并发症发生率低等优势,能获得患者的满意,值得临床广泛推广.     

经皮肾微造瘘输尿管镜下治疗肾盂输尿管连接部狭窄32例

目的探讨应用微刨技术治疗肾盂输尿管连接部狭窄的可行性与临床疗效。方法对32例肾盂输尿管连接部狭窄的患者行经皮肾微造瘘输尿管镜下电切并置内外支架管治疗，其中行输尿管镜下电切并内置两条双J管术20例，电切并置一条双J管12例，狭窄合并肾结石一次手术28例，狭窄合并息肉者2例，单纯连接部狭窄2例。砖果32例肾盂输尿管连接部狭窄的患者行经皮肾微造瘘输尿管镜下电切扩张术一次性成功达25例，6例行二次扩张取得成功，1例患者因为先天性狭窄行两次电切并置内外支架管术后疗效不佳改为输尿管连接部开放整形术。20例合并肾结石者结石均一次取净，8例患者经二次取石均取净，31例随访8个月～3年，均治愈。砖论应用微创技术治疗肾盂输尿管连接部狭窄的临床疗效佳、创伤小、恢复快、安全、值得推广。     

经皮肾镜超声气压弹道碎石联合钬激光内切开治疗肾输尿管上段结石伴狭窄

目的:探讨经皮肾镜超声气压弹道碎石联合钬激光内切开治疗肾输尿管上段结石伴狭窄的安全性及疗效。方法:对31例患者采用标准通道经皮肾镜超声气压弹道碎石联合钬激光内切开治疗。31例患者为医源性输尿管上段狭窄伴结石23例,先天性肾盂输尿管交界处狭窄伴结石8例;并发输尿管上段结石11例,肾结石20例。结果:31例无一例中转开放,平均手术时间(62.6±8.6)min,恢复进食时间(32±6)h,下床活动时间(3.2±1.2)d。合并输尿管结石患者均予结石取净,肾结石患者2例下盏残留8mm结石,结石取净率为93.5%(29/31)。术后并发症4例,并发症发生率12.9%,术后并发出血1例,予超选择肾动脉栓塞止血治愈,感染2例,予敏感抗菌素控制,双J管移位1例,予输尿管下调整位置。术后3～6个月复查,肾积水改善总有效率87.1%(27/31),4例肾积水无明显变化。随访6～36个月,2例出现腰部酸胀、积水加重症状,予逆行输尿管镜下钬激光内切开+球囊扩张后好转,1例反复感染肾积水加重予肾切除。结论:经皮肾镜超声气压弹道碎石联合钬激光内切开治疗肾输尿管上段结石伴狭窄结石清除率高、创伤小、手术安全有效。     

经皮肾造瘘大功率钬激光碎石术治疗复杂性肾结石35例报告

目的探讨经皮肾造瘘大功率钬激光碎石术治疗复杂性肾结行的疗效。方法采用经皮肾造瘘大功率（40～60W）钬激光碎石术治疗35例复杂性肾结石。伴肾盂输尿管连接部狭窄（UPJO）的5例同时行钬激光内切开。结果35例手术均成功,平均碎石时间65min。29例（82．9％）单次碎石后排净结仃,残余结石6例,经ESWL1～3次治疗后结石排净。34例随诊半年,无结石残留或复发。UPJO者尿流通畅,无再狭窄发生。结论经皮肾造瘘大功率钬激光碎石术具有创伤小,碎石快,安全可靠等优点,术后残石可经ESWL后排出,是治疗复杂性肾结石的有效方法。     

经皮肾穿刺造瘘后输尿管镜钬激光碎石肾盂内压力变化及临床意义

目的 探讨经皮肾穿刺造瘘后输尿管镜钬激光碎石术术中肾盂内压力变化及对术后并发症的影响.方法 回顾性分析输尿管镜碎石术治疗上尿路结石64例的临床资料,其中术前行肾脏穿刺造瘘28例(实验组);术前未行肾脏穿刺造瘘36例(对照组).采用压力传感器实时测量行输尿管镜碎石术的患者肾盂内压力,统计术后发热、疼痛指数及肾功能等相关临床指标.结果实验组术中平均肾盂压力(17.4±3.5)mm Hg(1mm Hg=0.133kPa),对照组为(22.3±5.7)mm Hg.实验组术后发热、早期一过性肾功能减退发生率及肾区疼痛均明显低于对照组,差异有统计学意义.结论 术前肾造瘘能够降低输尿管镜钬激光碎石术中的肾盂压力及术后的并发症.     

输尿管镜下钬激光碎石与微创经皮肾镜取石术治疗上段输尿管结石的疗效比较

目的 观察对比上段输尿管结石患者采取输尿管镜下钬激光碎石(URS)与微创经皮肾镜取石术(MPCNL)治疗的临床效果.方法 选取2012年9月至2015年1月于本院诊治的上段输尿管结石患者共200例进行研究,随机原则分为研究组(n=103)和对照组(n=97),对照组实施MPCNL治疗、研究组行URS治疗.比较两组手术时间、手术成功率、术后血红蛋白下降值、术后1d疼痛情况、结石清除率、术后并发症、住院时间、治疗费用.结果 研究组的手术时间较对照组稍长,初始结石清除率低于对照组(P＜0.05),但其术后1d疼痛、住院时间、治疗费用均优于对照组(P＜0.05);两组的手术成功率、术后血红蛋白下降值、术后1个月结石清除率、并发症发生率对比无明显差异(P＞0.05).结论 URS和MPCNL治疗上段输尿管结石的结石清除率相当,URS术后患者疼痛轻、恢复快、费用低.     

经皮肾镜钬激光碎石术分期治疗结石性脓肾的临床分析

目的 探讨经皮肾镜钬激光碎石术分期治疗结石性脓肾的临床效果.方法 采取回顾性分析方法对本院2012年1月～2013年12月间70例结石性脓肾患者的临床资料进行分析,其中Ⅰ期经皮肾镜钬激光碎石术治疗的30例患者为A组,Ⅰ期穿刺后Ⅱ期经皮肾镜钬激光碎石术治疗的40例患者为B组,观察两组的临床效果.结果 A组结石清除率为76.7％,B组结石清除率为80.0％,差异比较无统计学意义(P＞0.05);A组住院时间、造痿管留置时间、住院费用均明显低于B组,差异有统计学意义(P＜0.05);A组手术时间高于B组,差异有统计学意义;A组术后感染性并发症发生率为20.0％,B组术后感染性并发症发生率为25.0％,差异无统计学意义(P＞0.05).结论 临床中对于结石性脓肾患者采取Ⅰ期经皮肾镜钬激光碎石术治疗效果优于Ⅱ期手术,能够缩短患者住院时间,降低住院费用,值得临床应用.     

经皮肾微造瘘输尿管镜碎石术失血因素分析

目的 探讨经皮肾微造瘘输尿管镜碎石术(MPCNL)的失血影响因素. 方法 收集2002年7月至2006年10月885例1156次MPCNL术患者临床资料.以术后失血量作为应变量,以失血可能相关因素作为自变量,进行多元线性回归分析. 结果 MPCNL术后平均血红蛋白降低(14.2±8.3)g/L.输血患者17例(1.5%),行超选择性血管栓塞止血7例(0.6%).与失血量可能相关的因素有术中并发症(6=0.496,P＜0.001)、通道大小(6=0.405,P＜0.001)、通道成熟度(6=0.377,P＜0.001)、通道数量(6=0.326,P=0.005)、结石大小(6=0.210,P=0.015)、手术时间(6=0.139,P=0.27)、肾实质厚度(6=0.128,P=0.035)、既往结石干预史(6=-0.121,P=0.038)、糖尿病(6=0.110,P=0.051)、尿培养(6=-0.095,P=0.058).与失血量可能无关因素有年龄、性别、侧别、肥胖、高血压、肾功能,手术医师、麻醉方式、穿刺盏、尝试穿刺次数、穿刺出尿液颜色. 结论 为减少MPCNL术失血量,术中操作应精准,尽可能地减少术中并发症、减少手术时间.在兼顾结石划、、类型的前提下,通道应尽可能小、通道数量应尽可能少.对于结石较大、术中出现并发症、需要多通道或大通道、存在潜在出血因素的患者,分期MPCNL是明智的选择.     

Percutaneous endopyelotomy for ureteropelvic junction obstruction

Percutaneous endopyelotomy was performed 13 times on 11 patients with primary and secondary UPJ obstruction between 1994 and 2002. Excretory urogram revealed improvement in ten of eleven patients. One of the ten successfully treated patients required repeated endopyelotomy. Endopyelotomy failed in one patient, who had secondary UPJ obstruction that had been stenosed by granuloma caused by a ureteral stone. As the patient had UPJ obstruction of high insertion type with thinned renal parenchyma, nephrectomy was performed after repeated endopyelotomy. Compared with open pyeloplasty, percutaneous endopyelotomy is less invasive and is cosmetically advantageous.     

钬激光内切开术治疗输尿管肾盂连接部狭窄的疗效观察(附24例报告)

目的：探讨输尿管镜下钬激光(Ho：YAG激光)内切术开治疗肾盂输尿管连接部狭窄的疗效。方法：采用经输尿管镜Ho：YAG激光内切开术治疗24例肾盂输尿管连接部狭窄患者，术后平均留置双J管6周，每间隔3—6个月行超声、排泄性尿路造影及肾图检查。结果：平均随访10个月，20例临床症状缓解，影像学检查提示内切开段造影剂通过良好，治疗成功；4例治疗失败者再次行Ho：YAG激光内切开术，其中2例获得满意结果；无一例发生手术并发症。结论：输尿管镜下Ho：YAG激光内切开术对于原发性和继发性输尿管肾盂连接部狭窄是一种安全、有效、微创的治疗方法。     

经皮肾镜内切开术联合碎石术治疗UPJO并肾结石25例报告

目的:观察经皮肾镜内切开术联合碎石取石术治疗UPJO并肾结石的可行性、疗效及临床应用价值。方法:对25例UPJO并肾结石的患者采用经皮肾镜肾盂内切开术加碎石取石术进行治疗。结果:平均手术时间80min,术中出血量100～500ml,平均住院11.2d。23例患者一次完成手术,2例行Ⅱ期手术处理残石。其中单通道治疗19例,双通道治疗6例,清石率为88%。无大出血等严重并发症发生。随访6个月～3年,UPJO有效率为92%,2例患者术后出现再狭窄,两次内切开无效后改为开放性离断肾盂成形术。结论:经皮肾镜肾盂内切开术联合碎石取石术创伤小,恢复快,疗效确切,是一种治疗UPJO并肾结石的有效方法。     

Percutaneous pyeloplasty (endopyelotomy) for congenital ureteropelvic junction obstruction.

Endopyelotomy was performed in 30 patients with congenital primary ureteropelvic junction obstruction; 4 patients had high insertion of the ureter and 8 patients had caliceal stones. Clinical and radiologic success was achieved in 25 patients. There were five failures, all of whom subsequently had successful open pyeloplasty. The theoretical and experimental foundations of the procedure and fine points of the operative technique are presented. Endopyelotomy appears to be valuable for primary ureteropelvic junction obstruction just as it is for secondary obstruction.     

Percutaneous endopyelotomy for secondary ureteropelvic junction obstruction: prognostic factors affecting late recurrence

OBJECTIVE: To determine prognostic variables which influence late recurrence after initially successful percutaneous endopyelotomy for secondary ureteropelvic junction obstruction (UPJO). MATERIAL AND METHODS: Between July 1987 and March 2002, 67 patients with secondary UPJO were treated with percutaneous endopyelotomy at our center. Long-term follow-up data were available for 50 patients with initially successful results (42 after a single treatment and eight after repeated endopyelotomy). Follow-up excretory urography and diuretic renal scans were performed for objective evaluation. Late recurrence was diagnosed if obstruction developed after > 1 year of follow-up. Univariate (Kaplan-Meier method) and multivariate (Cox regression model) analyses of pre-, peri- and postoperative factors were carried out for detection of significant variables affecting the late recurrence rate. RESULTS: The follow-up period ranged from 1.27 to 13.85 years (mean 6 +/- 4.3 years). Late recurrence of UPJO was observed in seven cases (14%): 4/42 initially successful cases (9.5%) and 3/8 cases of repeated endopyelotomy (37.5%). In univariate analysis, the significant factors were severity of stenosis at the UPJ (p = 0.04), preoperative serum creatinine (p = 0.04), repetition of endopyelotomy (p = 0.03) and development of postoperative complications (p = 0.02). In multivariate analysis, all of the above factors, with the exception of severity of stenosis at the UPJ, were independent significant factors affecting late recurrence. CONCLUSIONS: As late recurrence was observed in 14% of cases after percutaneous endopyelotomy, long-term follow-up is needed, especially in patients with elevated preoperative serum creatinine, those in whom postoperative complications developed and those in whom a first attempt at endopyelotomy failed.     

Collagen changes in the ureteropelvic junction after failed antegrade endopyelotomy

PURPOSE: We evaluated the collagen content and differentiation of the ureteropelvic junction (UPJ) of patients who underwent Anderson-Hynes dismembered pyeloplasty after failure of antegrade endopyelotomy. MATERIALS AND METHODS: A total of 12 UPJ obstructions were examined more than 12 months after endopyelotomy with both histochemical staining to analyze total collagen content and immunohistochemical staining to analyze collagen types I and III. The specimens were compared with 12 primary UPJ obstructions and 6 normal UPJs. Statistical analysis was performed using Fisher's test and Wilcoxon matched-pairs signed-rank test. RESULTS: Immunohistochemical staining revealed that collagen type I was located in the interfascicular space and collagen type III in the intrafascicular space in all UPJs. We found more collagen in obstructed than in normal UPJs. Collagen type III was more abundant in secondary than in primary UPJ obstructions (P < 0.01). In obstruction after endopyelotomy, the staining intensity of collagen type III was greater than the intensity of collagen type I (P < 0.01). CONCLUSION: Our results suggest that the success of antegrade endopyelotomy was impaired by an inflammatory process. This condition determined a shift of collagen differentiation toward type III, which is more fibrous than type I.     

经皮顺行腔内切开术治疗肾盂输尿管连接部梗阻

目的:探讨应用经皮顺行腔内切开术(PAE)治疗肾盂输尿管连接部梗阻(UPJO)的适应症、疗效及技巧。方法:UPJO患者75例,其中肾盂输尿管连接部(UPJ)闭锁26例(34.7%)。男38例,女37例,平均年龄35(21～68)岁。左侧31例,右侧44例。原发性UPJO 39例(合并结石37例),开放UPJO成形术后8例,腹腔镜UPJO成形术后4例,开放手术取石术后14例,PCNL术后10例。均经B超、KUB、IVU、CT、逆行肾盂造影检查确诊。结果:Ⅰ期成功内切开69例(92.0%),4例(5.3%)间隔1周后Ⅱ期手术成功,2例放弃Ⅱ期治疗。单一应用PAE 59例(80.8%),PAE联合输尿管镜逆行内切开14例(19.2%)。术后3～6个月拔除输尿管支架管,随访6个月时,62例(84.9%)无复发,复发患者11例(15.1%)中包括UPJ闭锁患者10例。随访12个月时,55例(75.3%)无复发,24个月时52例(71.2%)无复发。21例复发患者中,9例行第二次PAE手术治愈,2例行第三次PAE手术后治愈,1例行开放肾盂成形术,9例每3～6个月更换双J管或动态观察。结论:PAE可以作为原发性UPJO的一线治疗。继发性UPJO或其他成形术后再狭窄的UPJO复发率高,但是PAE适用范围广,可重复性好,仍然是微创腔内治疗的有效手段。     

Percutaneous surgery for ureteropelvic junction obstruction (endopyelotomy): technique and early results

We incised ureteropelvic junction obstruction in 31 patients with a cold knife direct-vision urethrotome inserted through a percutaneous nephrostomy tract. In 12 patients renal calculi were removed endourologically during the same session. There were no immediate complications and nephrostograms showed adequate drainage in all cases. Of these patients 8 had previously undergone open pyeloplasty without success. The longest followup is almost 2 years. There have been 4 failures and, thus, the success rate is 87.1 per cent.