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51.
腔内冷刀切开及瘢痕电切治疗后尿道狭窄 总被引:1,自引:0,他引:1
目的探讨腔内冷刀切开及瘢痕电切治疗后尿道狭窄,提高后尿道狭窄腔内手术成功率.材料与方法回顾分析76例外伤性后尿道狭窄行尿道内切开及尿道瘢痕电切术治疗.后尿道狭窄长度0.3~2.5cm,平均1.7cm.结果72例(94.7%)手术成功,其中68例一次成功,4例因狭窄复发而行2次腔内手术成功;4例失败原因均为术中尿道出血多视野不清晰而改为开放手术治疗.患者术后均定期行尿道扩张,术后6~12月复查尿流率,最大尿流率16~34(21.2±8.9)ml/s,平均尿流率10~25(14.1±5.6)ml/s.结论腔内冷刀切开及瘢痕电切治疗后尿道狭窄,方法简单、安全、疗效好、可反复治疗、费用低、创伤小,我们认为腔内冷刀切开及瘢痕电切术是后尿道狭窄的最佳选择. 相似文献
52.
目的:探讨男性尿道狭窄超声管腔形态与最大尿流率的相关性,以丰富尿道狭窄诊断和术后疗效评价的信息。方法:80例尿道狭窄患者(除外尿道外口狭窄),超声测量尿道狭窄段内径(D)、狭窄段近侧10mm处尿道扩张段内径(PD)、狭窄内径比率(Rd,Rd=D/PD)和狭窄长度(L)。将超声形态学量与最大尿流率(MFR)进行相关分析。结果:≤50岁组和>50岁组中的D与MFR的相关系数r分别为0.80、0.60、Rd与MFR的相关系数r分别为0.87和0.69。将狭窄内径比率等于0.67、0.79分别定为≤50岁组和>50岁组的临界狭窄组,并结合MFR对尿流率测定时排尿量大于200ml患者设施了初步的分型方法。结论:尿道狭窄超声和 尿流率的联合研究,能同时提供功能和 形态的信息,弥补了各自的局限性,有助于全面、准确地反映患者的排尿功能,对于指导临床进一步处理和术后疗效评价具有重要的临床实际意义。 相似文献
53.
Benjamin Tharian Grant Caddy Tony CK Tham 《World journal of gastrointestinal endoscopy》2013,5(10):476-486
Crohn’s disease (CD) is a chronic inflammatory condition of the gastrointestinal tract resulting in inflammation, stricturing and fistulae secondary to transmural inflammation. Diagnosis relies on clinical history, abnormal laboratory parameters, characteristic radiologic and endoscopic changes within the gastrointestinal tract and most importantly a supportive histology. The article is intended mainly for the general gastroenterologist and for other interested physicians. Management of small bowel CD has been suboptimal and limited due to the inaccessibility of the small bowel. Enteroscopy has had a significant renaissance recently, thereby extending the reach of the endoscopist, aiding diagnosis and enabling therapeutic interventions in the small bowel. Radiologic imaging is used as the first line modality to visualise the small bowel. If the clinical suspicion is high, wireless capsule endoscopy (WCE) is used to rule out superficial and early disease, despite the above investigations being normal. This is followed by push enteroscopy or device assisted enteroscopy (DAE) as is appropriate. This approach has been found to be the most cost effective and least invasive. DAE includes balloon-assisted enteroscopy, [double balloon enteroscopy (DBE), single balloon enteroscopy (SBE) and more recently spiral enteroscopy (SE)]. This review is not going to cover the various other indications of enteroscopy, radiological small bowel investigations nor WCE and limited only to enteroscopy in small bowel Crohn’s. These excluded topics already have comprehensive reviews. Evidence available from randomized controlled trials comparing the various modalities is limited and at best regarded as Grade C or D (based on expert opinion). The evidence suggests that all three DAE modalities have comparable insertion depths, diagnostic and therapeutic efficacies and complication rates, though most favour DBE due to higher rates of total enteroscopy. SE is quicker than DBE, but lower complete enteroscopy rates. SBE has quicker procedural times and is evolving but the least available DAE today. Larger prospective randomised controlled trial’s in the future could help us understand some unanswered areas including the role of BAE in small bowel screening and comparative studies between the main types of enteroscopy in small bowel CD. 相似文献
54.
Paul A Fraser N Chhabra S Yardley IE Davies BW Singh SJ 《Pediatric surgery international》2007,23(12):1187-1190
The Soave endorectal pullthrough is a commonly performed procedure for the definitive management of children with Hirschsprung’s
disease (HD). Anastomotic stricture is a recognised complication of this procedure [1–5]. There are multiple causes for these strictures, circular anastomosis being one of them. There are techniques described
which alter the shape of the anastomosis of the pulled through bowel to decrease the incidence of strictures. These are oblique
[6] and heart-shaped [7] anastomoses. We describe a new technique of oblique anastomosis where the pulled through bowel is anastomosed posteriorly
0.5 cm from the dentate line, and anteriorly 1.5 cm above this point. This oblique anastomosis is designed to lower the stricture
rate. If a stricture does occur, an anastomosis near the anocutaneous junction on the posterior aspect also faciltates Y–V
anoplasty. We present our experience using this technique. Seventeen consecutive children underwent the procedure at our institution
between 2003 and 2006. Only one child developed an anastomotic stricture requiring anal dilatation. 相似文献
55.
Background
Urethral stricture may disturb both micturition and semen emission. Urethroplasty, despite the restoration of a proper urethral patency, may not eliminate the accompanying ejaculatory dysfunction (EjD).Aim
To investigate the relationship among urethral stricture, urethroplasty, and ejaculatory function.Methods
For the systematic review, the authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Internet-based bibliographic databases (PubMed and Scopus) were searched to access studies that examined the influence of urethral stricture and urethroplasty on ejaculatory function.Outcomes
EjD accompanying urethral stricture, before and after urethroplasty, was evaluated.Results
20 Studies were included in the final analysis. In total, these studies comprised a population of 1,913 patients, aged between 11–86 years, 1,823 with an anterior urethral stricture and 90 with a posterior one. No randomized trials regarding the topic were found. Patients with urethral stricture typically report poor force of ejaculation, reduced ejaculatory volume, reduced pleasure, or complete failure to ejaculate. The prevalence of pre-operative disorders depends on patients’ age and is more severe in the older population. The pre-operative stricture length, location, and type of surgery have no statistically significant influence on post-operative EjD. In some patients, despite a successful urethral reconstruction, problems with ejaculation persist. The improvement in ejaculation after urethroplasty is observed only in younger men. The available data are inconclusive whether the separation of the bulbospongiosus muscle during urethroplasty impairs its later functionality.Clinical Implications
Analyzing the available literature on the subject, this review provides knowledge about the possible influence of urethroplasty on ejaculatory function, which may be useful both in the pre-operative patient consultation and in the choice of treatment method.Strengths & Limitations
The evidence is sufficient to determine effects on health outcomes. However, the strength of evidence is limited by the lack of randomized trials and differences in terms of methodology and analyzed populations, preclusive of conducting the meta-analysis.Conclusion
It has not been unequivocally determined which factors related to the stricture or surgery are decisive for post-operative ejaculatory function. The improvement in ejaculation after urethroplasty is observed only in younger men.Kaluzny A, Gibas A, Matuszewski M. Ejaculatory Disorders in Men With Urethral Stricture and Impact of Urethroplasty on the Ejaculatory Function: A Systematic Review. J Sex Med 2018;15:974–981. 相似文献56.
输尿管镜钬激光与冷刀内切开治疗男性尿道狭窄疗效比较 总被引:2,自引:0,他引:2
目的评价输尿管镜联合钬激光与冷刀内切开治疗男性尿道狭窄的临床疗效。方法回顾性分析46例输尿管镜联合钬激光治疗患者(A组)和72例经尿道冷刀内切开治疗患者(B组)的临床资料。结果A组36例获访4~12个月,术后平均最大尿流率(16.8±3.2)ml/s,再次手术者5例(13.8%);B组51例获访8~25个月,术后平均最大尿流率(10.2±2.5)ml/s,再次手术者18例(35.2%)。结论输尿管镜联合钬激光治疗男性尿道狭窄视野清晰、切割精确,治疗效果优于经尿道冷刀内切开。 相似文献
57.
目的评估透视下球囊扩张治疗良性放射性食管狭窄的安全性和长期疗效。方法从1997年6月至2008年12月,我科共对12例良性放射性食管狭窄行透视下球囊扩张治疗。最大球囊直径为15mm(n=19),20mm(n=5),25mm(n=2)。对此治疗的技术成功率、临床成功率、吞咽困难复发和并发症分别进行评估。结果12例患者共接受了26次球囊扩张(平均2.2次),技术成功率为100%,临床成功率为75%,5例患者仅行1次扩张。7例患者在首次扩张后出现复发,随后进行了重复扩张。1例患者出现Ⅰ型食管穿孔,无严重并发症出现。结论尽管球囊扩张的复发率高,透视下球囊扩张仍然是简单、安全治疗良性放射性食管狭窄首选方法。 相似文献
58.
59.
目的总结肝外胆管狭窄医源性损伤的修复经验。方法回顾性分析18例医源性胆管狭窄病人的临床资料。结果本组治愈17例,死亡1例,16例获随访,随访时间1~5年,效果良好。结论杜绝胆管损伤是每位普外科医生所必须重视的问题。一旦发生胆管损伤应视损伤程度和范围拟定合理的修复方案,不可草率从事。对于术中发现的胆管损伤做到细致的胆管无张力吻合,无漏胆,及术后长时间的胆管内支撑是预防医源性肝外胆管狭窄的关键。 相似文献
60.
中南地区正常成人上呼吸道的MRI测量及其临床价值 总被引:2,自引:0,他引:2
目的:测量中南地区正常成人上呼吸道MR扫描后各层面径线长度、咽壁厚度及横截面积等指标,为临床诊断该区域病变提供客观指标。方法:对182例健康成人行MR上呼吸道扫描,并测量软腭后区、悬雍垂区、舌后区和会厌后区气道各径线长度、咽壁厚度和横截面积等指标,以单侧95%可信区间确定各测量指标的参考值。结果:在气道各个扫描平面中,绝大多数冠状径大于矢状径,男子组和女子组间比较,除软腭后区外,大多数测量指标差异显著,并指定了男、女各测量指标的正常值范围。结论:成人上呼吸道MRI测量及正常值的确定,为临床判断该区有否占位性病变及阻塞性睡眠呼吸暂停综合征(OSAS)患者气道解剖性狭窄部位的确定提供了客观指标。 相似文献