微创经皮肾镜碎石术治疗输尿管上段结石

目的 探讨和评价开展微创经皮肾镜碎石术治疗输尿管上段结石的疗效及临床经验.方法 采用微创经皮肾镜气压弹道碎石术治疗89例输尿管上段结石并进行回顾分析和临床随访.结果 微创经皮肾镜气压弹道碎石术治疗输尿管上段结石89例,成功88例,结石清除率98.9%.术后住院平均(3.13±1.07)d,无一例发生严重的术中、术后并发症.结论 微创经皮肾镜碎石术治疗输尿管上段结石安全、可靠、有效、微创.     

经皮肾镜气压弹道联合超声碎石治疗上尿路感染性结石

目的探讨经皮肾镜治疗输尿管上段结石及肾结石并感染的疗效。方法对肾、输尿上段结石并感染较轻者,经控制感染后I期行经皮肾镜气压弹道联合超声碎石术37例;合并较严重感染者先期行经皮肾造瘘、Ⅱ期经皮肾镜气压弹道联合超声碎石术17例。结果 I期行经皮肾镜气压弹道联合超声碎石术37例中,4例术后出现高热(>39℃),7例术后体温在38℃～39℃,其余26例术后体温<38℃。Ⅱ期经皮肾镜气压弹道联合超声碎石术17例,所有病例Ⅱ期经瘘道碎石取石术后体温均<38℃。结论对于输尿管上段及肾结石并感染患者,经抗炎治疗后复查,血象、体温正常,无腰痛,估计手术时间较短者,选择I期经皮肾镜碎石取石术;否则,选择Ⅱ期经皮肾镜术。     

经皮肾镜气压弹道联合超声碎石治疗上尿路感染性结石

目的探讨经皮肾镜治疗输尿管上段结石及肾结石并感染的疗效。方法对肾、输尿上段结石并感染较轻者,经控制感染后I期行经皮肾镜气压弹道联合超声碎石术37例;合并较严重感染者先期行经皮肾造瘘、Ⅱ期经皮肾镜气压弹道联合超声碎石术17例。结果 I期行经皮肾镜气压弹道联合超声碎石术37例中,4例术后出现高热(>39℃),7例术后体温在38℃～39℃,其余26例术后体温<38℃。Ⅱ期经皮肾镜气压弹道联合超声碎石术17例,所有病例Ⅱ期经瘘道碎石取石术后体温均<38℃。结论对于输尿管上段及肾结石并感染患者,经抗炎治疗后复查,血象、体温正常,无腰痛,估计手术时间较短者,选择I期经皮肾镜碎石取石术;否则,选择Ⅱ期经皮肾镜术。     

输尿管镜气压弹道碎石治疗输尿管结石所致急性肾衰竭

目的 探讨输尿管镜气压弹道碎石治疗输尿管结石所致急性肾衰竭的疗效、安全性和可行性.方法 回顾性分析18例输尿管结石所致急性肾衰竭急诊行输尿管镜气压弹道碎石术患者的病历资料.结果 16例行输尿管镜气压弹道碎石术成功,并放置双“J”管内引流.2例失败者行经皮肾穿刺造瘘引流术引流尿液.4例术后有肉眼血尿,3例合并尿路感染,经止血、抗炎等治疗后治愈.随访3～6个月,无输尿管狭窄等并发症发生,肾积水消失.结论 输尿管结石所致急性肾衰竭急诊行输尿管镜气压弹道碎石术是安全可行、有效的方法.     

输尿管镜气压弹道碎石术治疗输尿管结石疗效分析

目的分析临床应用输尿管镜气压弹道碎石术（URSL）治疗输尿管结石疗效及安全性。方法将2011-09/2013-06收治的93例输尿管结石患者行输尿管镜气压弹道碎石术的临床资料进行回顾性分析。结果 93例输尿管结石患者,手术时间17～116 min,平均（41.8±3.2）min,一次性碎石取出88例,成功率为94.6%,其中上段结石12例,成功率为75.0%（9/12）,中段结石26例,成功率96.2%（25/26）,下段结石55例,成功率98.2%（54/55）;3例输尿管上段结石上移至肾盂内,留置双J管术后行ESWL治疗,2例输尿管中下段结石因息肉致输尿管狭窄置镜失败,改行开放手术。平均住院时间（5.2±1.3）d,术后随访2～6个月,31例轻中度肾积水消失,8例重度肾积水转为轻度肾积水,腹部平片（KUB）、静脉肾盂造影（IVP）显示无结石残留及输尿管狭窄。结论输尿管镜下气压弹道碎石术（URSL）治疗输尿管结石具有创伤小、安全、高效、净石率高等优点,是治疗输尿管中、下段结石的首选方法,可有效解除或减轻重度肾积水,同时双侧结石也可处理,一次性碎石取石成功率高,对于输尿管上段结石联合体外冲击波碎石术（ESWL）疗效更好。     

微创经皮肾输尿管镜气压弹道碎石术治疗上尿路结石疗效观察

目的探讨微创经皮肾输尿管镜气压弹道碎石治疗肾脏与输尿管上段结石的方法与疗效。方法采用微创经皮肾输尿管镜下气压弹道碎石上尿路结石45例。结果2004年6月~2006年3月,采用Ⅰ期、Ⅱ期或分步微创经皮肾输尿管镜手术成功处理45例上尿路结石,其中包括鹿角型结石、多发性肾结石、ESWL治疗失败、孤立肾结石、开放取石手术后复发、输尿管上段结石。肾结石清除率为91.7%,输尿管结石清除率为88.9%。随访2~12个月,无严重手术并发症发生。结论微创经皮肾输尿管镜气压弹道碎石术治疗上尿路结石具有微创损伤、恢复快、并发症少、安全高效、结石清除率高的优点。     

MPCNL钬激光与气压弹道治疗输尿管结石的疗效比较

目的:探讨微通道经皮肾镜钬激光及气压弹道碎石取石对治疗输尿管上段结石的疗效.方法:选取60例输尿管上段结石患者,分成两组,每组30例,A组碎石能量使用钬激光,B组使用气压弹道.分析两组手术时间、住院时间、结石清除率、术后并发症上的区别.结果:钬激光组的平均手术时间明显小于气压弹道组(P<0.05),其术后留置肾造瘘管时间短于气压弹道组,术后住院时间和术后残石率上两种手术方式差异无统计学意义(P>0.05).钬激光组有3例发生术后发热,而气压弹道组有11例术后发热,差异有统计学意义.总体而言钬激光组在手术时间、术后留置肾造瘘管时间及术后感染等方面优于气压弹道组.结论:微通道经皮肾镜钬激光与气压弹道碎石取石术均为治疗肾结石及输尿管上段结石的有效方法,在某些指标上钬激光具有优势,应根据实际情况选择不同手术方式.     

输尿管镜下气压弹道碎石术治疗输尿管结石366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临床效果.方法 对366例行输尿管镜下气压弹道碎石术的患者进行回顾性分析.结果 366例患者中治疗成功315例,一次碎石成功率为86.1%(其中上段为81.8%,中下段为93.4%);31例患者放置内支架管后再行体外冲击波治疗(ESWL);12例患者因输尿管狭窄,扭曲而改为开放手术.结论 输尿管镜下气压弹道碎石术治疗输尿管结石安全,效果确切,损伤小,术后恢复快,是治疗输尿管结石较为满意的手术方法,而且中、下段结石疗效明显优于上段结石.     

顺行软镜在硬镜失败的输尿管中下段结石并发肾结石中的应用

目的:探讨顺行输尿管软镜在处理输尿管镜失败的输尿管中下段结石同时合并肾结石的可行性及优势。方法:回顾分析我院2015年4月~2017年2月6例输尿管下段结石并发同侧肾结石行逆行输尿管镜治疗失败患者,术前行KUB+IVP,CT等检查明确诊断为输尿管中下段结石同时合并肾结石,输尿管结石直径7~12mm,肾结石直径6~14mm,多发,其中左侧4例,右侧2例,患者年龄26~42岁,平均37岁。其中3例肾中度积水合并医源性输尿管开口损伤无法进镜,1例合并输尿管开口严重狭窄,1例输尿管下段严重扭曲,1例合并结石周围息肉组织包裹,输尿管镜失败后改行经皮肾穿刺,先行经皮肾输尿管镜钬激光处理肾结石,完成后行顺行输尿管软镜成功处理输尿管中下段结石及病变,碎石冲洗入膀胱,输尿管内留置斑马导丝或超滑导丝,确认进入膀胱后置入D-J管2~4周,留置肾造瘘管复查无结石残留后5~6天拔管。结果:所有患者均手术成功,术后4~6天复查KUB或CT未见结石残留,D-J管顺利置入膀胱,手术时间35~55min,平均42min,未出现发热、严重感染及出血等严重并发症,随访3~6月未出现输尿管狭窄。结论:目前输尿管镜碎石取石术是处理需要手术干预的输尿管中下段结石首选方法。但由于各种原因导致逆行输尿管镜碎石失败,这时采用经皮肾微通道输尿管镜钬激光先处理肾结石,再行顺行输尿管软镜处理输尿管中下段结石是一种安全,高效,一举两得的治疗手段,值得推广。     

输尿管镜下气压弹道碎石治疗350例输尿管结石的临床分析

目的 分析输尿管镜下气压弹道碎石治疗输尿管结石的临床效果.方法 总结350例输尿管中下段结石患者接受输尿管镜下气压弹道碎石术的手术时间、术后住院日、并发症及处理方法.结果 350例输尿管镜下气压弹道碎石术治疗输尿管结石平均手术时间为42.66分钟,术后平均住院日约5.36天,发生严重并发症例数共8例(2.2％),其中因输尿管狭窄无法进镜2例(0.5％),中转开放手术,术后恢复良好.术中输尿管穿孔 1例(0.2％),术后予拔出双J管,给予止血对症治疗后恢复良好.术中输尿管结石逃逸至肾脏1例(0.2％),后患者出院未随访.术后出现肾脏包膜下血肿1例(0.2％),给予腹带加压、输血等对症保守治疗后1月出院.术后严重尿路感染症状2例(0.5％),均予比阿培南针抗炎治疗1周后症状好转,后顺利出院.术后双J管位置欠佳引起严重肾绞痛1例(0.2％),给予膀胱镜下调整双J管位置后患者肾绞痛症状消失.结论 输尿管镜下气压弹道碎石是治疗中下段输尿管结石的理想方法,手术时间短,术后恢复快,其严重并发症较少见,大多数可保守治疗.     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Qualitative research with people with intellectual disability

Qualitative research methods are gaining popularity in disability research, in particular as a way to explore the personal experience of disability. However, using these methods can be problematic with people traditionally regarded as vulnerable in the research relationship. People with intellectual disability are often so regarded. This paper discusses ethical concerns and issues of research credibility in qualitative research with this group of disabled people. An ethnographic study about the parenting experience of parents with intellectual disability is used to illustrate strategies to achieve credibility in qualitative studies in intellectual disability research.