腔内自制线状电针切开治疗输尿管狭窄、闭锁54例报告

目的总结54例腔内自制线状电针切开治疗输尿管狭窄、闭锁,讨论该技术治疗输尿管狭窄、闭锁的疗效和安全性。方法对54例输尿管狭、闭锁窄病人采用腔内用自制线状电针电切、电凝等技术治疗资料进行回顾性分析。结果腔内自制线状电针切开治疗输尿管狭窄47例,闭锁7例。均获得成功。结论利用腔内自制线状电针切开技术治疗输尿管狭窄、闭锁疗效好,创伤小,安全性高,费用低。自制线状电针取材方便,适合基层医院推广应用。     

腔内技术治疗输尿管狭窄、闭锁443例临床分析

目的探讨腔内泌尿外科技术治疗输尿管狭窄、闭锁的疗效和安全性。方法对443例采用腔内泌尿外科技术治疗的输尿管狭窄、闭锁患者资料进行回顾性分析。结果对443例患者全部采用不同的腔内输尿管腔内技术治疗,其中:输尿管镜下直视扩张218例,导管扩张63例,输尿管球囊扩张15例,采用钬激光或线状电针电凝输尿管炎症性息肉引起的狭窄33例,钬激光内切开25例,线状电刀内切开47例,输尿管镜下直视冷刀切开术35例,输尿管闭锁复通7例。所有病例均一次手术成功,成功率100%。术后有3例输尿管狭窄患者肾积水复发。结论利用腔内技术处理输尿管狭窄疗效好,创伤小,安全性高,费用低。钬激光及线状电切电凝对炎症和息肉引起的狭窄,疗效较好。输尿管镜直视下扩张术结合术,对较轻的输尿管狭窄疗效好;输尿管套管扩张输尿管下段狭窄,效果好。输尿管冷刀切开术对较长段的严重狭窄或闭锁疗效更好。以上腔内技术处理狭窄,术后结合放置双J管引流、慢性扩张效果更好。     

腔内泌尿外科技术治疗输尿管狭窄

目的 探讨腔内泌尿外科技术治疗输尿管狭窄的疗效.方法 选择我院从2011年1月-2012年1 月]收治的输尿管狭窄患者92例,对其采用腔内泌尿外科技术进行治疗,对于临床治疗资料采用回顾性分析的方法进行分析.结果 89例通过内腔镜找到了正确引导的方向.采用尿管狭窄电刀内切术35例,激光内切开术15例,输尿管镜镜体扩张术15例,导管扩张术22例,球囊扩张术5例.通过1年的随访发现有85例患者通过手术后得到了一次性治愈,27例患者出现了病情复发的情况,需要进行重复扩张、内切开术或金属网状支架植入术.结论 采用腔内泌尿外科技术治疗输尿管狭窄具有显著治疗效果,其具有创伤小、安全性高、操作简单、治疗效果好等优点,与其他治疗方法相比具有显著优越性,值得进行临床推广.     

输尿管狭窄的腔内治疗体会

我院从 1995年 1月～ 2 0 0 1年 10月应用腔内泌尿外科方法治疗输尿管狭窄 2 6例 ,取得较好的治疗效果。现报告如下。1　资料与方法1·1　临床资料　本组 2 6例 ,男 12例 ,女 14例 ,年龄2 0～ 6 5岁 ,平均年龄 36岁 ,狭窄部位 :UPJ狭窄 3例(左 2 ,右 1) ,输尿管上段狭窄 5例 (左 3,右 5 ) ,输尿管中段狭窄 10例 (左 4、右 6 ) ,输尿管下段狭窄 8例 (左3、右 5 )。输尿管狭窄长度为 0 .5～ 1.5cm ,其中 0 .5～1.0cm者 18例 ,1.0～ 1.5CM者 8例。 16例为输尿管切开取石术后 ,2例为UPJ狭窄整形术后 ,8例为息肉阻塞。 18例经IVU或逆行肾盂…     

输尿管狭窄应用腔内泌尿外科技术治疗的效果分析

目的:探究腔内泌尿外科技术对于治疗输尿管狭窄的临床疗效.方法:选取来我院收治的输尿管狭窄患者100例,采用腔内泌尿外科技术进行临床治疗,对治疗资料进行分析研究.结果:93例患者由内窥镜引导找到正确导引方向.采用采用输尿管狭窄电刀内切开术47例,球囊扩张术24例,输尿管镜镜体扩张术16例,导管扩张术13例.93例患者术后随访12个月,88例患者通过手术一次性治愈,治愈率达到88％,5例患者出现病情反复,需要进行额外治疗.结论:腔内泌尿外科治疗输尿管狭窄创伤小,操作便捷,安全性高,有助于提高患者的生存质量,可以在临床上进行大力推广.     

输尿管镜联合钬激光内切开及切除治疗尿道狭窄和闭锁

目的 总结输尿管镜联合钬激光内切开及切除治疗尿道狭窄和闭锁的可行性与疗效.方法 总结输尿管镜联合钬激光内切开及切除治疗尿道狭窄和闭锁48例.结果 45例患者手术一次成功,成功率93.7%（45/48）,3例手术治疗失败.结论 输尿管镜联合钬激光内切开及切除治疗尿道狭窄和闭锁是安全、可行、有效的.     

输尿管镜联合钬激光内切开及切除治疗尿道狭窄和闭锁

目的 总结输尿管镜联合钬激光内切开及切除治疗尿道狭窄和闭锁的可行性与疗效.方法 总结输尿管镜联合钬激光内切开及切除治疗尿道狭窄和闭锁48例.结果 45例患者手术一次成功,成功率93.7%(45/48),3例手术治疗失败.结论 输尿管镜联合钬激光内切开及切除治疗尿道狭窄和闭锁是安全、可行、有效的.     

输尿管镜钬激光内切开术治疗输尿管狭窄18例临床分析

目的探讨输尿管镜钬激光内切开术治疗输尿管狭窄的临床疗效。方法采用输尿管镜钬激光内切开术治疗输尿管狭窄18例,均采用连续硬膜外腔麻醉或腰麻＋硬外复合麻醉方式,取膀胱截石位。结果3、例失败中转开放手术,15例顺利完成手术,手术时间35～55min,平均44min,无严重并发症。随访4～21个月,平均11．3个月,14例效果满意,1例术后5个月复发。术后再狭窄的发生率为6．7％（1／15）,总有效率为77．8％（14／18）。结论输尿管镜钬激光内切开术治疗输尿管狭窄是一种安全、有效的微创手术,熟练掌握输尿管镜操作技术,严格掌握手术适应证,可取得良好的效果。     

颅眶联合入路显微切除眶内球后肿瘤

目的探讨俯卧位输尿管镜治疗移植肾输尿管梗阻的临床效果。方法收集移植肾输尿管梗阻施行俯卧位输尿管镜腔内治疗11例患者的临床资料，表现多为尿量减少和（或）血肌酐升高。结果9例手术效果好，其中5例行钬激光碎石，3例为末端狭窄，采用球囊扩张1例，钬激光内切开2例，感染引起的用异物钳夹取出异物1例，为细菌混合菌团，失败2例，均为移植肾输尿管膀胱吻合口狭窄段较长，后改开放手术治疗，成功率81．82％。结论俯卧位输尿管镜可作为腔内治疗移植肾输尿管梗阻的方法之一，手术成功率高、并发症少、创伤小、效果可靠。     

俯卧位输尿管镜治疗移植肾输尿管梗阻(附11例报告)

目的 探讨俯卧位输尿管镜治疗移植肾输尿管梗阻的临床效果.方法 收集移植肾输尿管梗阻施行俯卧位输尿管镜腔内治疗11例患者的临床资料,表现多为尿量减少和(或)血肌酐升高.结果 9例手术效果好,其中5例行钬激光碎石,3例为末端狭窄,采用球囊扩张1例,钬激光内切开2例,感染引起的用异物钳夹取出异物1例,为细菌混合菌团,失败2例,均为移植肾输尿管膀胱吻合口狭窄段较长,后改开放手术治疗,成功率81.82%.结论 俯卧位输尿管镜可作为腔内治疗移植肾输尿管梗阻的方法之一,手术成功率高、并发症少、创伤小、效果可靠.     

内镜下会师治疗尿道严重狭窄或闭锁（附17例报告）

目的探讨内镜下会师治疗尿道严重狭窄或闭锁的有效性与安全性。方法2002年3月-2006年12月经膀胱造瘘通道顺行与经尿道逆行内镜下会师，应用冷刀、电切镜或钬激光治疗尿道严重狭窄或闭锁17例，其中单纯尿道严重狭窄11例，合并闭锁6例。狭窄或闭锁位于后尿道12例，5例位于前尿道。尿道闭锁平均长度为1．2cm，尿道狭窄平均长度为2．3cm。结果17例患者均手术成功，6例在软膀胱镜下钬激光顺行切开尿道，11例逆行切开尿道。平均手术时间115min，留置导尿管4～6周，术后定期行尿道扩张，未见尿失禁病例，狭窄复发1例。结论内镜下会师治疗尿道狭窄或闭锁具有直观、安全、微创的特点，临床效果满意。     

Population-based study of small intestinal atresia and stenosis, Hawaii, 1986-2000

Atresia and stenosis are some of the most common birth defects affecting the small intestine. Few population-based studies have examined the epidemiology of small intestinal atresia/stenosis. Eighty-two cases of small intestinal atresia/stenosis were identified through a population-based birth defects registry in Hawaii during 1986-2000. The relationships of various clinical and demographic factors with small intestinal atresia/stenosis and duodenal atresia/stenosis were examined. The small intestinal atresia/stenosis and duodenal atresia/stenosis rates were 2.9 per 10,000 live births [95% confidence interval (CI) 2.3-3.6] and 1.3 per 10,000 live births (95% CI 1.0-1.9), respectively. No secular trend was observed (P = 0.067 and 0.090, respectively). Maternal age risk for small intestinal atresia/stenosis was U-shaped, while duodenal atresia/stenosis rates were highest with maternal age of 35 years or more. Small intestinal atresia/stenosis was substantially more common among Far East Asians than Caucasians [rate ratio (RR) 1.96, 95% CI 1.24-2.94]. Duodenal atresia/stenosis risk was higher in Hawaii County than in Honolulu County (RR 2.55, 95% CI 1.10-5.02). Small intestinal atresia/stenosis was also associated with low birth weight (RR 11.50, 95% CI 8.05-15.92), low gestational age (RR 8.60, 95% CI 6.34-11.41) and multiple births (RR 3.79, 95% CI 1.39-8.24). In conclusion, this study found associations between small intestinal atresia/stenosis and maternal age, maternal race/ethnicity, county of residence, birth weight, gestational age and plurality, but not delivery period. Many of the associations between small intestinal atresia/stenosis and other factors noted in this investigation were similar to those reported by other studies.     

内镜下黏膜切除术与内镜下黏膜剥离术对直径为2～3cm的早期食管癌及癌前病变的疗效分析

目的对内镜下黏膜切除术（EMR）与内镜下黏膜剥离术（ESD）治疗直径为2～3em的早期食管癌及癌前病变的效果进行评价。方法回顾性分析内镜下治疗的77例直径为2—3cm的早期食管癌及癌前病变患者临床资料。采用EMR治疗37例（EMR组）42处病灶,采用ESD治疗40例（ESD组）41个病灶。观察两组术中出血、穿孔发生情况,术后食管狭窄、复发情况。结果EMR组出血、穿孔发生率分别为7．1％（3／42）、0,均显著低于ESD组的24．4％（10／41）、17．1％（7／41）,差异有统计学意义（p〈0．05或〈0．01）。两组食管狭窄发生率比较差异无统计学意义（P〉0．05）。EMR组复发率为14．3％（6／42）,显著高于ESD组的0,差异有统计学意义（P〈0．05）。结论在治疗直径为2．3cm的早期食管癌及癌前病变的有效性方面ESD优于EMR,但ESD发生出血和穿孔的风险较高,二者在术后食管狭窄方面无显著差异。     

The use of lasers in the treatment of urolithiasis]

The treatment of calculi in the urinary tract has been subject to major changes over the last few years. Since extracorporeal shockwave lithotripsy (ESWL) is the first choice of treatment, there appears to be little need for endoscopic and surgical techniques. In case ESWL treatment is unsuccessful or inadequate, laser lithotripsy is a good alternative. In most cases, laser lithotripsy causes a good disintegration with use of very thin and flexible instrumentation. Hence, the risk of damage to the urinary tract is much less than with other endoscopic techniques such as ultrasonic and electrohydraulic lithotripsy. Our first results with 21 bladder and 18 ureter calculi in 25 patients were a successful disintegration of 84% of bladder calculi and a 70% success for ureter calculi. Only one complication of the ureteroscopic manipulation was observed. Disadvantages of laser lithotripsy are the high price of the equipment and the fact that not all calculi can be fragmented with one type of laser.     

Balloon dilatation of cervical anastomosis stricture after subtotal resection of the esophagus

AIMS: The stricture of the anastomosis is one of the most common complications of the subtotal esophageal resections. The authors present indications, technics and results of the endoscopic dilatation. PATIENTS AND METHODS: In a 10 year period 26 patients (22 male, 4 female, mean age of 53.7 years) with stricture of anastomosis between the esophagus and the neo-esophagus after subtotal esophageal resection were dilated endoscopically 82 times. The indication of the resection was tumour in 23 (88.5%) cases, congenital atresia in 2 (7.7%) cases and corrosive disease in one (3.8%) case. In 7 (31.8%) cases the stricture developed after anastomosis leakage. The mean time between the operation and the dilatation was 7.8 months. The cause of the stricture was cancer recurrency in 4 (15.4%) cases. RESULTS: There were no complications related to the dilatation. The mean number of the dilatation was 3.2 (1-9). There was no significant difference between the number of dilatation in patients with or without previously anastomotic leakage. The success rate of the dilatation for benign strictures was 95.5%. In only one patient (4.5%) was needed operative intervention. In the 4 patients with tumour recurrency a stent was also implanted in the stenosis. CONCLUSIONS: The endoscopic dilatation for the treatment of the cervical anastomosis stricture after subtotal esophageal resection is a successful method with a low rate of complications. In cases of tumour recurrency a stent implantation is suggested.     

经尿道输尿管扩张术治疗输尿管下段狭窄112例临床分析

目的探讨经尿道输尿管扩张治疗输尿管下段狭窄的临床效果。方法采用经尿道输尿管扩张治疗输尿管下段狭窄112例,其中男65例,女47例,平均年龄38岁。狭窄段长度0．5～0．2cm。结果112例均顺利通过输尿管扩张导丝,狭窄段扩张成功。随访6～30个月,平均13个月。一次扩张成功96例（85．7％）,B超提示肾盂积水均消失或明显减轻,CTU示狭窄段通畅;其中2例先天性巨输尿管症术后取支架后狭窄复发,肾盂积水无明显改善,经再次扩张和置人双“J”管后,肾积水减轻,狭窄段较前通畅;所有手术无输尿管穿孔、脱套、撕裂等严重并发症发生。结论经尿道输尿管扩张治疗输尿管下段狭窄具有操作简单、效果可靠、并发症少、体表无伤口、可重复治疗及住院时间短等优点。     

内镜下治疗消化道良恶性狭窄120例分析

目的?探讨经内镜治疗消化道狭窄临床疗效.方法?收集该院在2010年3月—2012年3月期间收治的120位消化道狭窄患者的临床资料,针对患者在内镜下不同的治疗方法,包括支架放置术、高频电凝电切除术、探条扩张法、球囊扩张法等,进行系统回顾分析.结果?在120位消化道狭窄患者的治疗中,有59位患者选择高频电治疗法,有37位患者选择内镜下支架放置术,有11位患者选择探条扩张法,有13位患者选择内镜球囊扩张法.其中107例一次性对症治疗成功,有13例在治疗多次(<3次)后对症治疗成功.结论?内镜下治疗消化道狭窄有简单、安全、创伤小等优点,疗效显著.     

输尿管镜气压弹道碎石治疗输尿管中下段结石临床疗效分析

目的 分析输尿管镜与气压弹道碎石联合治疗技术在输尿管中下段的结石治疗中的疗效.方法 选取100例输尿管中下段的结石患者,60例（研究组）采用输尿管镜与气压弹道碎石联合技术治疗,40例（对照组）采用传统开放性取石方式治疗,对比两组手术情况、一次性取石成功率和并发症情况.结果 研究组在手术时间、术后下床时间及住院时间上均更短;研究组一次取石成功率90.0％,并发症发生率6.7％;对照组一次取石成功率82.5％,并发症发生率12.5％;研究组效果相对更佳（P＜0.05）.结论 输尿管镜与气压弹道碎石联合治疗技术在输尿管中下段的结石治疗中效果显著,安全可靠,临床可广泛应用.     

Experience with ESWL treatment of giant kidney and ureteral calculi (based on 1400 cases)

On the basis of the treatment of 1400 patients who suffered from kidney and ureter stones we may conclude that 80-82% of the extractable stones can be treated with ESWL monotherapy. ESWL proved to be successful in almost every case where there were 2 or 3 cm large--or larger--kidney stones or stones at almost any part of the ureter. The extraction of the larger kidney stones can be helped with stent put up previously, nephrostome or repeated ESWL. We apply other invasive methods more and more rarely. The aiming and treatment of ureter stones which can be found at different parts of the ureter is better with adjuvant laying and diagnostic methods. In the case of staghorn calculi ESWL can be combined with percutaneous operations. In the case of large staghorn calculi traditional operations seem to be the most successful methods after which percutaneous treatment or ESWL can be performed if there are fragments left behind.