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     

Differentiation of Inflammatory From Fibrotic Ileal Strictures among Patients with Crohn's Disease Based on Visual Analysis: Feasibility Study Combining Conventional B-Mode Ultrasound,Contrast-Enhanced Ultrasound and Strain Elastography

The aim of this pilot study was to assess prospectively the feasibility of conventional B-mode ultrasound (US) and contrast-enhanced ultrasound (CEUS) combined with real-time strain elastography (SE) in the differentiation of inflammatory from fibrotic ileal strictures among patients with Crohn's disease (CD) based on visual analysis. Twenty non-consecutive patients (15 male and 5 female; mean age?±?standard deviation, 40.2?±?10.22 y) with CD and stricture of the terminal ileal loop were scanned by conventional B-mode US and CEUS and, subsequently, by real-time SE. Two independent readers visually classified each bowel stricture as fibrotic or inflammatory based on conventional B-mode US, CEUS, SE, individually and then for all techniques combined. All techniques combined had a higher (p?<0.05) sensitivity (reader 1, 9/20 [45%]; reader 2, 7/20 [35%]), specificity (reader 1, 5/20 [25%]; reader 2, 8/20 [40%]) and diagnostic accuracy (reader 1, 14/20 [70%]; reader 2, 15/20 [75%]) and higher (p?<0.05) area under the receiver operating characteristic curve (reader 1, 0.953; reader 2, 0.921) than individual techniques. Inter-reader agreement was fair for conventional B-mode US (k?=?0.46) and CEUS (k?=?0.39), moderate for SE (k?=?0.6) and fair for all techniques combined (k?=?0.38). Conventional B-mode US and CEUS, in combination with SE, may improve differentiation of inflammatory from fibrotic ileal strictures among patients with CD based on visual analysis.     

Outcome of Urethral Strictures Managed by General Surgeons in a Rural Setting of India

In resource limited settings victims of urethral strictures often seek healthcare,when the strictures are far advanced. For a surgeon, management is indeed a challenging task, given the severity and extent of disease, lack of expertise, enough skills and equipment in the healthcare facility. This study was conducted at a rural teaching hospital in central India. All patients were assessed for the extent and severity of strictures and to rule out other causes of lower urinary obstruction. Outcome of all patients was assessed with American Urological Association Urinary Symptom Score and Urinary Flow Rate (ml/sec) before procedure, post procedure and at 6–12 months. Between 2007 and 2009, 110 patients, between 18–75 years of age were enrolled in this study which showed that a third of patients treated with urethral dilatation and optical internal urethrotomy required another intervention. It is conclude that urethral dilatation and internal optical dilatation result in short term improvement in urine flow rates and symptoms. Urethroplasty, the current gold standard of therapy for urethral strictures, results in outcomes that are clinically meaningful and more cost effective for a patient. The Americal Urological Association (AUA) symptom score and Urinarry Flow Ratemay be used to objectively assess outcome following surgical management of urethral strictures.     

Toxic catheters and urethral strictures: A concern about types of catheters used in resource-poor countries

Various reports in the literature have confirmed urethral toxicity caused by the use of catheters, mostly latex catheters and their coated versions, resulting in long-segment urethral strictures or strictures located in multiple areas of the urethra. Most catheters used in resource-poor countries, such as Nigeria, are latex catheters with various coatings, such as silicone. The reasons for the widespread use of these potentially toxic catheters are mainly non-availability and/or the high cost of less toxic catheters. We report three cases of urethral strictures following the use of siliconized latex catheters in order to highlight the potential urethral toxicity associated with the use of latex catheters and to draw the authorities’ attention to the need to regulate the types of catheters used in the country.     

Effect of spasmolytic drugs on esophageal foreign bodies

Muscle spasm has been proposed as the cause for esophageal food impaction. The aim was therefore to treat esophageal foreign bodies with spasmolytic drugs influencing both striated and smooth muscles of the esophagus. A multicenter, placebo-controlled, doubleblind study of glucagon and diazepam was undertaken in 43 patients. The foreign body disimpacted in 9 of 24 patients given active substances and in 6 of 19 patients given placebo; there was no significant difference between these two groups. Almost all disimpactions occurred several hours after injection of the drugs. The hypothesis of muscle spasm as an important cause of esophageal obstruction was rejected. Medical therapies for food disimpaction other than spasmolytic drugs have to be investigated.     

输尿管镜下铥激光治疗尿道狭窄65例临床分析

目的 探讨输尿管镜下结合铥激光技术尿道内切开治疗尿道狭窄及闭锁中的效果.方法 本院于2005年1月～2010年12月期间对65例尿道狭窄或闭锁的患者在输尿管镜下行铥激光尿道狭窄处内切开术,切除局部纤维瘢痕组织,修整尿道黏膜面,使管腔光滑;尿道闭锁者先行4号尿道探子经耻骨上膀胱造瘘口,沿膀胱前壁滑入尿道内口,然后经尿道置入输尿管镜与尿道探子对接.找到尿道后,将4号输尿管导管经输尿管镜插入膀胱内,输尿管镜随后穿越狭窄段进入膀胱内.铥激光放射状切开尿道狭窄环,并切除、修整尿道内面瘢痕组织,使管腔光滑,直至顺利通过20号尿道探子.结果 所有患者手术过程均顺利,55例一次手术治愈,4例经多次尿道扩张后治愈,4例在术后3个月至1年再次尿道狭窄,行铥激光内切开后治愈,2例3次铥激光内切开手术后治愈.术后前尿道瘘1例,持续导尿后自愈.术后3个月、6个月平均最大尿流率分别为(22.3±3.3)ml/s,(20.1 ±2.5)ml/s.结论 输尿管镜结合铥激光行尿道内切开加瘢痕切除术是治疗尿道狭窄及闭锁安全、创伤小、并发症少,疗效显著,有效的治疗方法.