输尿管镜治疗输尿管膀胱壁段结石52例

目的：探讨经输尿管镜气压弹道碎石术治疗输尿管膀胱壁段结石。方法：总结1999-06/2001-06应用输尿管镜气压弹道碎石术治疗的输尿管膀胱壁段结石52例。结果：52例中治愈49例，术中结石完全排出的30例，其余病例3日内完全排出。治愈率94.2％。结论：经输尿管镜气压弹道碎石术治疗输尿管膀胱壁段结石完全有效，并发症少，是一种满意的方法。     

输尿管镜治疗输尿管上段结石合并感染疗效观察

目的分析输尿管镜联合钬激光治疗输尿管上段结石合并感染的效果。方法对56例输尿管上段结石合并感染者予以输尿管镜联合钬激光治疗。结果本组患者中53例(94.46%)患者成功碎石,手术时间(38.50±4.10)min,住院时间(7.03±1.48)d,体温恢复正常时间(1.98±0.52)d,白细胞计数恢复正常时间(3.87±1.06)d。术后并发症2例,发生率3.57%。3例中2例因输尿管扩张扭曲所致,1例因脓液过多、视野不清致无法有效碎石,后均改开放手术取石。结论输尿管镜联合钬激光治疗输尿管上段结石合并感染,疗效确切、安全性高。     

输尿管镜治疗输尿管下段结石的体会

临床上常见的输尿管下段结石患者，常伴有明显的肾绞痛发作，在治疗时常以对症解痉为主。因一般下段结石较小，多在0．8cm以下，因此多用排石治疗。我院从2003年9月～2005年10月治疗输尿管下段结石患者43例，现报告如下。     

输尿管上段结石治疗首选输尿管软镜？

随着微创技术的飞速发展及其在泌尿外科领域中的广泛应用,输尿管结石的治疗发生了根本性的变化—微创手术已基本取代了传统开放手术。目前治疗输尿管上段结石常用的微创外科治疗方法主要有体外冲击波碎石术（extracorporealshock—wavelithotripsy,ESWL）、经皮肾镜碎石取石术（percuta—neousnephrolithotomy,PCNL）及输尿管镜碎石术（ureteroscopiclithotripsy,URL）。     

ESWL与输尿管镜治疗输尿管下段结石的比较

目的：比较体外冲击波碎石术（ＥＳＷＬ）与输尿管治疗输尿管下段结石的结石排净率和并发症。方法：治疗输尿管下段结石患者３９０例,其中用ＥＳＷＬ治疗２１０例,输尿管镜治疗１８０例。结果：两组患者术后１个月的结石排净率分别为７８．１％和９３．３％（Ｐ〈０．０５）;ＥＳＷＬ组的主要并发症为再次治疗率高（１１．９％）,而输尿管镜组的主要并发症为输尿管穿孔（３．３％）。结论：输尿管镜治疗输尿管下段结石的疗效优于     

远端输尿管镜治疗中,下段输尿管结石

应用远端输尿管镜摘取骶髂关节上缘以下的输尿管结石51例,取石成功41例(80.4%),失败10例(19.6%)。讨论了远端输尿管取石术的应用价值、并发症及手术时机和注意事项,认为:此术操作简易,便于掌握,成功率高,损伤小而恢复快,可作为治疗中、下段输尿管结石的首选方法。     

输尿管软镜技术治疗输尿管上段结石手术技巧探讨

目的 探讨输尿管软镜技术治疗输尿管上段结石的手术技巧.方法 96例输尿管上段结石患者接受一期输尿管软镜钬激光碎石治疗,先以Wolf 8.0 ～ 9.8F输尿管镜在镍钛导丝引导下直接扩张输尿管开口进入输尿管,沿导丝放置一次性导引鞘,遇到输尿管节段性狭窄时,在硬镜下直接置入输尿管球囊进行扩张,扩张后再置入输尿管导引鞘,引入输尿管软镜钬激光碎石,并使用套石篮套取出较大的结石碎片.结果 94例患者一期成功置鞘碎石,2例因输尿管狭窄难以置入输尿管软镜鞘.手术时间30～75 min,平均45 min.术后9例患者寒战发热,无其他严重并发症.术后1个月拔除D-J管,复查CT/KUB,结石清除率94.79％ (91/96).结论 输尿管软镜钬激光碎石技术是处理输尿管上段结石的有效手段,熟练掌握手术技巧及灵活采用辅助手段,能够显著提高一期输尿管软镜手术的置管成功率.     

微通道经皮肾镜联合输尿管镜治疗输尿管中上段结石体会

目的观察和分析经皮肾镜联合输尿管镜治疗输尿管中上段结石的效果,总结临床治疗经验、降低结石残留率。方法将75例输尿管中上段结石患者予经皮肾镜联合输尿管镜手术治疗,观察手术时间、术中出血量、术后下床活动时间、住院时间、Ⅰ期结石取净率及并发症等指标。结果 75例中Ⅰ期结石取净71例(94.67%),4例(5.33%)存在残留结石。Ⅰ期结石取净者手术时间(45.40±10.00)min,术中失血量(80.00±15.00)m L,术后下床活动时间(5.30±1.20)d,住院时间(12.00±1.00)d。71例Ⅰ期结石取净者出现5例并发症,其中发热4例,血尿1例,无肠管及血管损伤情况发生。结论经皮肾镜联合输尿管镜治疗输尿管中上段结石扬一次性清除率高、并发症少,临床效果满意。     

微输尿管镜治疗女性输尿管下段结石合并输尿管狭窄一例

病人,女,54岁.因左侧输尿管支架管置入术后3 周余入院.3 周余前因左侧腰腹部疼痛于当地医院行泌尿系彩超提示左侧输尿管下段结石并肾积水,行经尿道左侧输尿管镜激光碎石术,术中发现左侧输尿管下段狭窄,术中留置 F 4.8双J管一根,本次入院前泌尿系统CT检查提示左侧输尿管支架管置入术后、左侧输尿管下段结石并肾积水(图1、...     

封堵器联合输尿管硬镜和输尿管软镜在输尿管上段结石治疗中的对比分析

目的:探讨封堵器联合输尿管硬镜和输尿管软镜在输尿管上段结石治疗中的安全性及有效性。方法:对安徽医科大学附属巢湖医院2021年1月-2023年1月收治的43例上段输尿管结石患者进行回顾性分析,根据手术方式分为A、B 2组。A组使用一次性内镜下取石导管作为封堵器联合输尿管硬镜碎石,共23例;B组为未封堵或封堵失败,Ⅰ期或者Ⅱ期使用输尿管软镜碎石,共20例。统计2组患者的结石清除率、手术时间、住院时间、总花费、术后并发症发生率。结果:A组手术时间为(40.87±17.23)min, B组为(111.85±31.57)min; A组住院费用为(11 603.08±1 013.68)元,低于B组的(22 033.63±3 268.94)元。A组住院天数为(4.04±0.77)d, B组为(8.95±2.74)d。以上指标均差异有统计学意义(P<0.05)。A组术后1个月结石清除率为91.30%,B组为95.00%,差异无统计学意义(P>0.05)。2组的术后并发症发生率差异无统计学意义(P>0.05)。结论:一次性内镜下取石导管作为封堵器用于治疗输尿管上段结石疗效确切,安全性较...     

Nitroxergic innervation of the human ureterovesical junction

Nitric oxide synthase (NOS) immunohistochemistry and nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d) histochemistry were used to investigate the distribution of nitroxergic, i.e., nitric oxide-synthesizing, neuronal perikarya and processes in the human ureterovesical junction (UVJ). Tissue specimens obtained from two cadaver kidney donors and two patients undergoing radical cystectomy for bladder cancer were examined. Clusters of NOS-immunoreactive neurons were localized in extramural ureterovesical ganglia. NOS-containing nerve fibers traveled within large extramural nerve trunks and marched among smooth muscle bundles. Extramural and intramural blood vessels were encircled by varicose NOS-positive axonal processes. The distribution of NOS immunoreactivity paralleled the staining pattern for NADPH-d activity. Urothelium stained strongly for NADPH-d activity but showed no NOS immunolabeling. Specimens from all four patients investigated showed similar staining patterns. Our results suggest that nitric oxide, a potent smooth-muscle-relaxing neurotransmitter in the autonomic nervous system, plays a physiologic role in opening the human UVJ.     

输尿管膀胱连接部狭窄诊治体会

目的　探讨输尿管膀胱连接部狭窄的诊治方法。　方法　回顾性分析 18例输尿管膀胱连接部狭窄的临床资料。男 6例 ,女 12例。平均年龄 4 3岁。左侧 5例 ,右侧 6例 ,双侧 7例。膀胱壁内段狭窄 12例 18侧 ,膀胱前 7例 7侧 (含 1例双侧者 1侧 )。输尿管膀胱再植 7例 7侧 ;经膀胱镜或术中输尿管扩张后 ,留置双J管或细硅胶导尿管 6例 6侧 ;狭窄段纵行切开带蒂膀胱黏膜条翻转输尿管末段成形术 7例 12侧。　结果　 18例术后随访 2个月～ 2 3年 ,全组无输尿管狭窄 ,治愈率78% ,好转率 2 2 %。其中输尿管扩张后 ,留置双J管或细硅胶导尿管治愈率 6 7% (4/ 6 ) ;狭窄段纵行切开带蒂膀胱黏膜条翻转输尿管末段成形术 7例均治愈。输尿管再植术 3例和输尿管末段成形术 5例 ,膀胱造影无膀胱输尿管返流。　结论　经膀胱镜或术中输尿管扩张后留置双J管和狭窄段纵行切开带蒂膀胱黏膜条翻转输尿管末段成形术治疗输尿管膀胱连接部狭窄创伤小 ,疗效满意。     

腹腔镜输尿管膀胱再植术(附17例报告)

目的　探讨腹腔镜输尿管膀胱再植术的可行性及其临床意义。　方法　男 5例 ,女 12例。左侧 7例 ,右侧 10例。 10例为单纯先天性输尿管出口狭窄 ;1例右侧输尿管出口结石和息肉形成 ;2例为开放输尿管膀胱再植术后再发输尿管出口狭窄 ,其中 1例并发输尿管下端 2枚结石 ;1例为重复肾输尿管上单位输尿管出口狭窄并发 2枚结石 ;2例为输尿管出口狭窄作经尿道钬激光切开再次狭窄 ;1例为泌尿系结核左肾切除术后右侧输尿管出口狭窄。重度肾积水 12例 ,中度肾积水 5例。均应用腹腔镜输尿管膀胱再植术治疗 ,其中输尿管膀胱黏膜吻合术 15例 ,膀胱壁袢法 2例。　结果　 17例均获得成功。手术耗时 90～ 16 0min ,平均 112min ,术中出血 6 0～ 10 0ml。术后 1～ 3d拔除膀胱外引流管 ,无 1例尿漏 ,术后 1周拔除导尿管 ,术后 1个月拔除双J管。 1例因上尿路结石下移至输尿管膀胱吻合口再次形成梗阻 ,行体外冲击波碎石 (ESWL)治疗 ,无吻合口狭窄。术后半年膀胱造影Ⅲ°输尿管返流 6例 ,Ⅰ°～Ⅱ°输尿管返流 5例 ,无输尿管返流 6例 ;术后 1年Ⅲ°输尿管返流 3例 ,Ⅰ°～Ⅱ°输尿管返流 4例。随访 3～ 2 4个月 ,B超和IVU复查中度肾积水 4例 ,轻度肾积水 5例 ,无明显肾积水 8例。　结论　腹腔镜输尿管膀胱再植术可行 ,输尿管膀     

经尿道输尿管镜联合体外震波碎石治疗输尿管结石256报告

目的探讨输尿管镜联合体外震波碎石（extracorporeal shock wave lithotripsy，ESWL）治疗输尿管结石的价值。方法2005年10月-2007年6月采用输尿管镜联合ESWL治疗输尿管结石256例，中段（56例）及下段（170例）结石用输尿管镜取石，上段（30例）结石用ESWL碎石，输尿管镜取石失败或结石残留联合ESWL治疗。结果输尿管下段结石一期结石清除率98．2％（167／170），中段结石一期结石清除率89．2％（50／56），上段结石一期结石清除率73．3％（22／30）。输尿管穿孔3例，输尿管黏膜撕脱1例，结石远端输尿管扭曲进镜致使尿管穿孔改切开取石1例，输尿管镜取石失败或结石残留联合ESWL治疗二期结石清除率91．7％（11／12）。结论输尿管镜治疗输尿管下段及中段结石成功率高，输尿管镜取石失败或结石残留联合ESWL可提高二期结石清除率。     

输尿管镜诊治输尿管疾病92例体会

目的 探讨提高输尿管镜诊治输尿管疾病水平的方法。方法回顾分析92例输尿管疾病经输尿管镜诊治的临床资料。结果输尿管镜检与手术治疗成功率92．4％(85／92)。手术并发假道形成2例，无1例严重并发症。结论在输尿管导管或导丝引导下，采用手控间断灌注扩张法直接或旋转上挑进镜，安全可靠，手术成功率高。利用输尿管导管或套石篮固定结石及间断低流灌注可提高碎石率。     

Ureterovesical junction obstruction causes increment in smooth muscle contractility,and cholinergic and adrenergic activity in distal ureter of rabbits

Background/Purpose

The controversy in management of primary obstructed megaureter necessitates further elucidation of the underlying pathophysiology. We evaluated smooth muscle contractility, and cholinergic, adrenergic and serotonergic activity of rabbit distal ureters after ureterovesical junction (UVJ) obstruction.

Methods

Sham (SH) operation, partial obstruction (PO) and complete obstruction (CO) of the right UVJ were performed in rabbits. Three weeks later, distal ureters were isolated; spontaneous contractions (SC), contractile responses to electrical field stimulation (EFS), high KCl, carbachol, phenylephrine and serotonin were recorded.

Results

SC amplitudes increased in CO compared to PO and SH (p < 0.001). SC frequency was higher in CO (p < 0.05). EFS-induced contraction amplitudes were greater in CO than other groups (p < 0.05). High KCl-induced contractions were greater in CO (p < 0.001) and PO (p < 0.01). Carbachol-induced contractility was enhanced in CO and PO (p < 0.05). Contractile response to phenylephrine was greater in CO than other groups (p < 0.05). Serotonin induced contractile responses in CO and PO, greater in CO (p < 0.05). UVJ obstruction also increased spontaneous contractility in contralateral PO and CO ureters.

Conclusions

UVJ obstruction increased spontaneous and neurotransmitter-induced contractions in an obstruction grade-dependent manner. Obstruction also altered contractility of the contralateral ureters. Our findings may serve to provide further understanding of the pathophysiology of megaureter.     

顺行和逆行输尿管镜联合会师治疗肾盂输尿管连接部闭锁

目的：探讨顺行和逆行输尿管镜联合会师治疗肾盂输尿管连接部(UPJ)闭锁的方法和疗效。方法：采用经皮肾顺行和经尿道逆行输尿管镜联合操作,在C臂X线机辅助定位下会师,治疗16例因复杂肾结石行肾盂切开取石术后致UPJ闭锁的患者。在复通导丝引导下,4例辅以输尿管镜直视下硬性扩张,10例辅以直视下冷刀切开,2例辅以直视下钬激光切割。结果：14例UPJ闭锁经双输尿管硬镜会师治疗复通成功;2例因输尿管狭窄及扭曲而会师治疗失败,加用经尿道逆行输尿管软镜联合操作而复通成功。14例术后放置两条F6双J支架管,2例放置记忆金属网状支架。结论：对UPJ闭锁的患者,采用顺行和逆行输尿管硬镜联合会师治疗安全,创伤少,疗效满意;对同侧有输尿管狭窄及扭曲的UPJ闭锁,采用输尿管软镜逆行联合操作可以增加UPJ复通的成功率。     

Hydronephrosis and renal deterioration in the elderly due to abnormalities of the lower urinary tract and ureterovesical junction

The geriatric population presents a unique challenge to the health care provider. The incidence of common lower urinary tract disorders, such as benign prostatic hypertrophy (BPH), prostate cancer and incontinence increase dramatically with aging. In their more severe forms, these disorders may predispose to hydronephrosis and ultimately to renal deterioration. This review of lower urinary tract and ureterovesical junction (UVJ) physiology and pathophysiology, will focus on: (1) anatomic UVJ obstruction from prostate cancer, or severe bladder hypertrophy, (2) functional obstruction from compression or stretching of the UVJ during bladder distention from urinary retention, and (3) bladder decompensation in the female. We will present a diagnostic and treatment algorithm and discuss future trends in the geriatric population. Clearly, the geriatric health care provider always must considerthe lower urinary tract when confronted with acuterenal deterioration, because prompt diagnosis and treatment of significant, lower-urinary-tract disease can maximize recovery of renal function. This revised version was published online in August 2006 with corrections to the Cover Date.     

局麻下输尿管镜气压弹道碎石治疗输尿管中下段结石(附136例报告)

目的:探讨输尿管腔内局部麻醉下使用输尿管镜气压弹道碎石治疗输尿管中下段结石可行性.方法:输尿管腔内注入局麻药物配合术前辅助用药,进行输尿管镜下气压弹道碎石治疗输尿管中下段结石136例,对疼痛评分,手术耐受性及手术成功率进行分析.结果:本组136例患者中,一次手术成功130例,占95.6%;麻醉耐受132例,占98%.结论:输尿管腔内局麻配合术前辅助用药,方法简便、安全、可行.