盐酸坦索罗辛预防上尿路手术后双J管综合征效果观察

目的：观察盐酸坦索罗辛预防上尿路手术后双J管综合征的临床效果。方法：选择行上尿路手术后留置双J管78例,随机分为观察组38例和对照组40例。观察组术后口服盐酸坦索罗辛,对照组不服用盐酸坦索罗辛。观察比较两组尿频尿急、血尿及肋腹区疼痛发生情况。结果：观察组尿频尿急、血尿及肋腹区疼痛无、轻度发生率均显著高于对照组（P〈0.05）,中、重度发生率显著低于对照组（P〈0.05）。结论：盐酸坦索罗辛可有效预防上尿路手术后双J管综合征。     

上尿路取石术中两种引流效果对比

1996～ 2 0 0 1年 ,我院收治上尿路结石行开放手术取石 6 7例 ,术中分别置双J管和外支架引流。经对两种引流术后恢复时间、并发症发生情况分析对比 ,发现双J管引流效果较好。1　对象和方法1 1　对象　置双J管引流组 32例 (32次 ) ,男 2 4例 ,女 8例 ;年龄 2 3～ 5 2岁 ,平均 37 5岁。外支架引流组 35例 (35次 ) ,男 2 8例 ,女 7例 ;年龄 2 2～ 5 5岁 ,平均 38 5岁。1 2　方法　肾盂切开取石 2 0例 ,输尿管上段取石术 5例 ,输尿管中段取石术 5例 ,输尿管下段取石术2例 ,取石后于输尿管内置入双J管。肾实质切开取石 2例 ,肾盂切开取石 2 4例…     

《解放军医学杂志》稿约

随着我国人口老龄化程度日益加重,老年人输尿管结石等输尿管阻塞性疾病的发生率逐年升高[1],且老年患者多合并高血压、高血脂、冠心病等心血管疾病,治疗难度和风险增大.近些年,微创手术在临床中应用广泛,腹腔镜在输尿管结石、输尿管阻塞性疾病等的尿路手术也日益成熟.双J管配合腹腔镜手术不仅可以进行封闭式引流,还可以起到内支架的作用,能减少感染的发生[2],有研究表明术前放置双J管可有效减少输尿管损伤[3-4].2013年9月-2015年8月我们对32例行后腹腔镜尿路手术的窦性心动过缓患者术前预留置输尿管双J管,取得了满意效果,现报告如下.     

输尿管手术放置双J管366例分析

目的探讨输尿管手术放置双J管的适用范围,留置时间及注意事项等有关临床问题。方法对366例因不同原因行输尿管手术患者均留置双J管,肾盂、输尿管交界处的手术,将导丝从双J管的肾端侧孔插入;输尿管手术,将导丝从双J管中部侧孔插入;为证实导管是否插入膀胱,在膀胱内注入亚甲兰300～500ml。结果360例术后切口全部Ⅰ期愈合;带管时间20～60d;360例顺利从膀胱拔管,5例置管失败,双J管残留于输尿管(3例经输尿管镜取出,2例再次行手术取管),1例留置时间超过6个月,双J管尿盐沉积,采用开放性手术取出。结论任何原因引起的输尿管梗阻、狭窄均可使用双J管作支架内引流,留置时间视具体病情而定,一般应控制在20～40d之间。     

上尿路梗阻并发肾功能不全的处理（附83例报告）

目的 总结上尿路梗阻并发肾功能不全的治疗效果。方法对75例尿路结石、8例肿瘤所致上尿路梗阻并发肾功能不全的患，采用手术和观J管引流辉除梗阻后肾功能的恢复情况进行随访观察，并自身对照。结果75例结石患中58例采后肾功能恢复正常，17例肾功能明显改善，8例肿瘤患经置双J管和造瘘后6例肾功能降至正常，2例轻度异常。结论 上尿路梗阻并发肾功能不全，在处理上，应尽快充分解除梗阻，观侧上尿路结石应争取同期双侧取石术，肿瘤所致的梗阻留置双J管内引流，是一种较为理想的治行方法。     

上尿路梗阻并发肾功能不全的处理——(附83例报告)

目的 总结上尿路梗阻并发肾功能不全的治疗效果。方法 对75例尿路结石、8例肿瘤所致上尿路梗阻并发肾功能不全的患者,采用手术和双J管引流解除梗阻后肾功能的恢复情况进行随访观察,并自身对照。结果 75例结石患者中58例术后肾功能恢复正常,17例肾功能明显改善,8例肿瘤患者经置双J管和造瘘后6例肾功能降至正常,2例轻度异常。结论 上尿路梗阻并发肾功能不全,在处理上,应尽快充分解除梗阻,双侧上尿路结石应争取同期双侧取石术,肿瘤所致的梗阻留置双J管内引流,是一种较为理想的治疗方法。     

输尿管双J支架管置入术后再次梗阻因素分析

目的 探讨输尿管双J支架管置入术后再次梗阻的影响因素.方法 回顾性分析121例肿瘤性肾盂积水置入输尿管双J管的临床资料,对肿瘤进展、尿盐结垢、肾小球滤过功能、每日尿量、尿路感染、留管时间、下尿路功能及双J管内径等因素总结,分析输尿管再次梗阻的原因及预防方法.结果 12I例患者48例再梗阻,其中肿瘤进展、尿盐结垢、尿路感染、留置时间是主要影响因素,占87.5％;肾小球滤过功能、每日尿量及下尿路功能也是重要因素,占12.5％.另外,双J管内径也是影响再梗阻的因素.通过局部控制肿瘤、改善饮用水及按时换双J管等相应措施,44例未再梗阻,4例因肿瘤进展再梗阻改外引流.结论 输尿管双J管置入后,积极抗肿瘤治疗、降低饮用水硬度、改善肾功能、多饮水排尿、预防尿路感染、缩短留管时间、纠正下尿路功能障碍能有效地延缓或预防双J管再次梗阻.     

单J管在肾移植手术中的应用(附118例报告)

目的探讨肾移植术中放置单J管对降低输尿管并发症的作用。方法分析172例次同种异体肾移植手术,在行尿路重建时均采用膀胱外法作输尿管膀胱吻合,其中118例在尿路重建时留置单J管者,作为置管组;54例未留置单J管者,作为未置管组。随访3月,观察术后输尿管并发症的发生情况。结果置管组无一例发生输尿管梗阻,发生尿漏1例;未置管组发生输尿管梗阻2例,尿漏3例,置管组输尿管并发症总发生率明显低于未置管组(P<0.01)。结论肾移植术中放置单J管可以明显减少术后输尿管梗阻和尿漏等输尿管并发症的发生。     

介入法逆行置入双"J"管治疗输尿管狭窄

目的 评价采用介入法逆行置入双“Ｊ”管治疗输尿管狭窄的疗效。方法 对２０例不同部位、不同病因的输尿管狭窄患者采用介入法逆行置入双“Ｊ”管进行治疗。结果 分部病例采用介入法逆行置入双“Ｊ”管均获得成功,置管成功率为１００％。治愈率为９０％。疼痛、尿漏、伤口感染和出血等并发症显著减少,针对置管后对上尿路的影响,置管的适应证,置管引流的时间和并发症进行了讨论。结论 采用介入法逆行置入双“Ｊ”管治疗输尿管     

双J管滞留5年并发结石1例

双J管在肾盂、输尿管手术中应用广泛,起支撑和内引流作用,能明显减少术后并发症;但如果长期滞留,给患者带来许多不必要的麻烦.笔者结合文献对本院1例双J管滞留5年的病例的临床诊治经过做一回顾性分析,以提高对双J管长期滞留这一现象的认识.     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.