Ureteral catheter placement for prevention of ureteral injury during laparoscopic hysterectomy

AIM: Ureteral injury is among the most devastating complications of gynecologic surgery. Estimated incidence of ureteral injury during laparoscopic hysterectomy is 2.6-35 times (0.2-6.0%) that in abdominal hysterectomy. We investigated preoperative ureteral catheter (UC) placement as a way to prevent ureteral injury in laparoscopic hysterectomy. METHODS: Clinical records of 94 women who underwent laparoscopic hysterectomy between February 2006 and January 2007 in Yazaki Hospital, Kanagawa, Japan, were reviewed retrospectively. Thirty-four patients between February and June 2006 underwent the surgery without ureteral catheterization and 60 patients between July 2006 and January 2007 underwent surgery with ureteral catheterization. Clinical outcomes were statistically compared between the two groups. RESULTS: The average time required for catheter insertion was 9.35 min. The ureter in which the catheter was placed was visualized clearly. In one patient, whose left ureter was deviated by a massive myoma, catheter insertion was not possible. No complications arose from catheter placement except for minor complaints including low back pain, urinary discomfort, and transient hematuria. While one injury occurred in a patient without ureteral catheterization (1/34), no ureteral injury occurred in any patient with ureteral catheterization (0/60). Operative time, total blood loss, and hospital stay were not significantly different between the two groups. CONCLUSIONS: UC placement is simple, helping to prevent ureteral injury during laparoscopic hysterectomy and enhancing safety of this procedure.     

Multiple bladder calculi: a rare cause of irreducible uterine prolapse

Background A vesical calculus in a prolapsed cystocele is rare. Objective To highlight bladder calculi as a cause of irreducible uterine prolapse. Case Report A case of irreducible total uterine prolapse caused by multiple vesical calculi is presented. Bladder stones were removed through vaginal cystolithotomy followed by vaginal hysterectomy. Conclusion In cases of acute irreducible pelvic organ prolapse, the possibility of bladder stones should be kept in mind and X-ray pelvis including the prolapsed mass should be done to confirm the diagnosis.     

探讨腹腔镜联合胆道镜治疗胆结石合并肝外胆管结石效果及对免疫功能的影响

目的:探讨腹腔镜联合胆道镜治疗胆结石合并肝外胆管结石的效果及对免疫功能的影响。方法:回顾性分析2018年8月至2020年8月长治市第三人民医院普外科收治的105例胆结石合并肝外胆管结石患者的临床资料,男55例,女50例,年龄(60.25±2.65)岁,年龄范围为53～72岁。按照不同手术方法分为传统组( n...     

腔内钬激光碎石术治疗输尿管上段结石的体会(附121例报告)

目的探讨腔内钬激光碎石术治疗上段输尿管结石的技巧与方法。方法回顾性分析121例应用硬性输尿管肾镜和钬激光碎石术治疗上段输尿管结石患者资料。结果单次碎石成功率为95%(115/121)。术后随访2周~6个月,除6例失败者外,结石排净率98%(113/115),I VU示肾盂积水由术前(3.5±0.8)cm降至(1.5±0.4)cm(P<0.01),无输尿管狭窄发生。结论腔内钬激光碎石术治疗上段输尿管结石,尤其是结石直径>1cm同时合并输尿管息肉及狭窄者有明显优势,熟练掌握输尿管镜的技巧和方法是保证手术成功的重要因素之一。     

ERK1/2信号蛋白在单侧尿路梗阻大鼠肾组织中的表达

目的:探讨单侧尿路梗阻(UUO)模型大鼠肾组织细胞外信号调节激酶(ERK1/2)的表达及意义。方法:42只SD大鼠随机分为模型组和假手术组。模型组采用UUO术,术后1,3,7,14,21 d和28 d处死动物取肾组织,观察肾组织病理改变;用免疫组化法测定肾组织TGF-β1、磷酸化ERK1/2和CollagenⅠ表达。结果:病理结果显示,UUO 3 d肾小管上皮细胞肿胀、肾间质炎症细胞浸润;UUO 14 d肾组织大量炎症细胞浸润和纤维组织增生,28 d肾小管结构基本破坏,纤维组织弥漫增生。免疫组化显示,正常肾组织有基础TGF-β1、磷酸化ERK1/2和CollagenⅠ的表达。UUO3 d TGF-β1增加明显,7 d达高峰,此后表达减少;磷酸化ERK1/2的表达在UUO术后3 d明显增加,并持续增加到第7 d,此后表达减少;而UUO术后3 d肾组织CollagenⅠ表达亦明显升高,并持续增加到28 d。模型组肾组织TGF-β1、磷酸化ERK1/2的表达时相一致并呈明显正相关,并与肾间质CollagenⅠ的积聚密切相关。结论:磷酸化ERK1/2信号蛋白在单侧尿路梗阻大鼠肾组织中的表达明显增高,可能在梗阻性肾病肾间质纤维化过程中起重要作用。     

钬激光碎石术与体外冲击波碎石术治疗输尿管结石的疗效比较

目的：比较钬激光碎石术与体外冲击波碎石术治疗输尿管结石的疗效。方法回顾性分析2012年1月-2014年1月在我院行钬激光碎石术治疗的50例输尿管结石患者的临床资料,设立为观察组,结石单发40例,多发10例。左侧27例,右侧21例,双侧2例。结石大小0.3-2.1 cm。另选择同期行体外冲击波碎石术治疗的50例输尿管结石患者作为对照组,结石单发41例,多发9例。左侧25例,右侧22例,双侧3例。结石大小0.4-2.2cm。比较两组患者的手术时间、3个月的结石排净率及并发症情况。采用SPSS12.0统计学软件对数据进行分析,其中结石排净率等计数资料组间比较采用卡方检验,手术时间等计量资料组间比较采用t检验。结果观察组输尿管结石患者的平均手术时间明显短于对照组,差异有统计学意义（P＜0.05）。观察组结石≥1 cm的输尿管结石患者3个月结石排净率明显高于对照组,差异有统计学意义（P＜0.05）。结论钬激光碎石术较体外冲击波碎石术治疗输尿管结石具有手术时间短、排石成功率高、并发症少等优点,值得广泛推广和应用。     

输尿管镜钬激光和体外冲击波碎石术对输尿管上段结石的疗效比较

目的比较输尿管镜钬激光和体外冲击波碎石术治疗输尿管上段结石的疗效。方法观察组38例采用输尿管镜钬激光治疗,对照组38例采用体外冲击波碎石术。结果观察组的手术时间明显短于对照组,观察组住院时间少于对照组,观察组一次碎石成功率明显高于对照组,术后随访3个月,观察组术后3个月结石排净率明显高于对照组,两组比较差异有统计学意义（P〈0．05）。观察组的并发症明显少于对照组,两组比较差异有统计学意义（P〈0．05）。结论输尿管镜钬激光手术效果明显好于体外冲击波碎石术,具有手术时间短、并发症少、排石率高等优点．值得广泛推广和应用。     

MSCT曲面重建技术对中下段输尿管结石的诊断价值简

目的探讨多层螺旋CT（MSCT）曲面重建技术对输尿管结石的诊断价值。方法回顾2011年7月-2013年9月期间,120例中下段输尿管结石患者行MSCT扫描,分析CT轴位图像及曲面重建图像,并对两者的结石检出率进行分析比较。结朵120例输尿管结石曲面重建图像诊断的准确率100％,轴位像为73％。结论多排螺旋CT曲面重建图像较单纯轴位图像对输尿管结石有更高的诊断价值。     

TURP联合气压弹道碎石术治疗高危老年人BPH合并膀胱结石

目的评价70岁及以上高危老年人良性前列腺增生症(BPH)合并膀胱结石腔内手术治疗的效果及安全性。方法回顾性分析96例70～92岁患者经尿道前列腺切除术(TURP),同时行气压弹道碎石术的临床资料和随访结果。结果所有患者均一次处理成功,平均手术时间80.5min,平均术中出血108mL,术中和术后无膀胱穿孔、水中毒和危及生命的并发症发生。随访2年,未见结石复发及尿失禁、尿道狭窄等并发症。结论70岁及以上高危老年人同期施行TURP和气压弹道碎石术安全、有效,值得临床推广。