新型胆囊镜的研发与应用

目的：为取石（息肉）保胆手术提供设备支持。 方法：2007年6月至2012年9月,结合胆囊的生理解剖、胆囊疾病的特点、人体工程学及工业设计于一体,研发出新型胆囊镜。 结果：在国家中医药管理局指定的两家医院进行了临床试验,完成取石（息肉）保胆手术120例,并申报国家专利102项,获得国家专利授权82项,获SFAD注册。 结论：研发的取石/息肉保胆手术专用的新型胆囊镜是安全、可靠、有效的取石（息肉）保胆手术器械,为胆囊病的研究提供了新的设备支持。     

经皮肾镜联合输尿管镜气压弹道碎石治疗输尿管石街

目的探讨经皮肾镜取石术（percutaneous nephrolithotripsy,PCNL）联合经尿道输尿管镜气压弹道碎石治疗输尿管石街的可行性。方法 2008年3月～2011年10月对27例经B超、KUB、泌尿系CT三维重建等检查确诊的输尿管石街,在输尿管镜下气压弹道加水冲将石街推至肾盂或输尿管上段,再行PCNL。结果 23例1次取石成功,3例2次取石成功,1例因输尿管下端闭锁无法进镜,仅行经皮肾造瘘置管引流术。19例随访3～12个月,平均6个月,8例积水完全消失,7例轻度积水,4例中度积水,无出血、输尿管梗阻、结石复发。结论 PCNL联合输尿管镜气压弹道治疗输尿管石街,疗效确切、安全。     

后腹腔镜联合经尿道输尿管口电切治疗上尿路尿路上皮癌

目的探讨后腹腔镜联合经尿道输尿管口电切行上尿路尿路上皮癌（upper urinary tract urothelial carcinoma,UUT—UC）根治性切除术的疗效。方法2009年4月～2012年1月,对21例UUT—UC采用后腹腔镜联合经尿道输尿管口电切行肾、输尿管、膀胱袖状切除术。先经尿道行输尿管口电切使输尿管与膀胱完全脱离,后腹腔镜下行肾及上段输尿管的游离和切除,取标本同时游离中下段输尿管以完成全程输尿管的切除。结果21例手术均成功,手术时间80～150min,平均110min,术中出血量60～180ml,平均100ml;无严重并发症发生。术后住院8～14d,平均9．5d。病理检查均为UUT—UC,其中肾盂癌15例,输尿管癌6例,20例T1-2N0M0,1例T3N0M0。21例随访4～36个月,平均20个月,均未见肿瘤复发及转移。结论后腹腔镜手术联合经尿道输尿管口电切治疗低级别肾盂癌和上段输尿管癌安全、有效。     

饮食结构调整对预防泌尿系结石复发的影响

目的研究根据结石成分分析结果调整饮食结构与结石复发的关系。方法 290例泌尿系结石患者进行结石成分分析,并随机分为2组,一组根据结石成分分析结果调整饮食,另一组则按传统方法嘱患者多饮水等,不进行特别的饮食结构调整。观察2组的复发率。结果饮食结构调整组复发11例（7.5%）,对照组复发23例（16.1%）,饮食结构调整组结石复发率明显低于对照组（χ2=5.181,P=0.023）,差异有统计学意义。结论根据患者代谢及结石成分分析结果进行调整饮食结构,可有效预防泌尿系结石的复发。     

急诊输尿管镜治疗输尿管结石并首次肾绞痛的疗效观察

目的 评价急诊输尿管镜治疗输尿管结石并首次肾绞痛的疗效.方法 本院2010年7月至2011年7月期间收治的140例输尿管结石患者纳入本研究范畴,其中60例输尿管结石患者首次肾绞痛时就诊,急诊行输尿管镜钬激光碎石,纳入第一组;80例患者对症处理后立即入院或肾绞痛再次发作入院并常规检查后再行输尿管镜钬激光碎石,纳入第2组.对两组患者的碎石效果、辅助治疗及相关并发症等指标进行比较,行统计学分析,得出结论.结果 140例患者均经输尿管镜检查,第1组结石大小0.80±0.31 cm,结石一次性清除率96.67％,无患者因结石疼痛再次就诊;第2组结石大小0.75±0.35 cm,结石一次性清除率95.00％,因结石疼痛再次就诊次数2.03±1.85,两组患者无严重并发症发生.结论 急诊输尿管镜治疗输尿管结石并首次肾绞痛安全可行,能及时解除疼痛.     

经皮肾镜联合球囊扩张治疗复发性肾结石合并输尿管上段狭窄18例报告

目的 探讨经皮肾镜联合球囊扩张治疗复发性肾结石合并输尿管上段狭窄的方法与疗效. 方法 回顾性分析2008年6月至2011年6月收治18例有肾及输尿管上段开放手术史、术后残留或复发肾结石合并输尿管上段狭窄患者的资料.男8例,女10例.年龄27～48岁.其中合并肾积水2～4 cm者14例,5～6 cm者3例,＞6 cm者1例.合并结石＜1 cm者15例,1～～3 cm者2例,＞3 cm者1例.应用经皮肾镜超声气压弹道碎石取石,联合使用球囊扩张治疗.统计分析结石清除率、肾积水变化情况及并发症,对比手术前后IVU造影及CTU检查结果情况. 结果 18例均成功建立通道,无中转开放手术病例.术后第3天肾出血1例(6％),予超选择肾动脉栓塞止血成功;双J管位置不佳1例,予内镜下调整.结石完全清除16例(89％),1例肾下盏残留结石＜5 mm未予处理,1例残留肾结石合并感染,反复治疗无效者行脓肾切除术.术后随访6～ 36个月,平均12个月,肾积水明显减少14例;肾积水无明显变化3例,再狭窄行球囊扩张后好转,术后患者IVU或CTU肾显影改善. 结论 经皮肾镜超声气压弹道联合球囊扩张是治疗复发性肾结石合并输尿管上段狭窄安全有效的方法.     

盆腔恶性肿瘤致肾后性肾衰竭的双介入治疗

目的探讨经皮穿刺顺行输尿管支架置放术结合区域性动脉化疗对盆腔原发或转移性肿瘤合并急性肾衰竭的临床价值及安全性。方法对18例盆腔恶性肿瘤伴双侧输尿管梗阻致肾后性肾功能不全的患者,行一侧经皮穿刺顺行放置输尿管支架,肾功能恢复后3～5d行区域性动脉插管化疗。结果17例输尿管支架置放术一次手术获成功,1例患者左侧肾造瘘失败且发生肾周血肿,后经导管节段性动脉栓塞止血,5d后经右肾造瘘成功。无其他严重并发症。术前血肌酐175.40～1040.70μmol/L,6例存在出血倾向,所有患者肾造瘘2～7d后肾功能恢复正常,随后进行3～8次动脉常规剂量化疗。随访时间3～15个月,平均7个月。结论经皮穿刺顺行输尿管支架置放术结合区域性动脉化疗,治疗盆腔原发或转移性肿瘤合并急性肾衰竭安全、可行、并发症少,可延长患者生存期。     

腹腔镜超声在经腹腔镜输尿管上段切开取石术中的应用

目的 探讨腹腔镜超声(LUS)在腹腔镜输尿管上段切开取石术中的应用价值。方法 对7例输尿管上段结石患者在腹腔镜输尿管上段切开取石术中应用LUS对输尿管和结石定位。结果 7例LUS检查输尿管均显像，超声引导下顺利游离出输尿管；7例结石均获得准确定位，5例用无损伤钳顺利取出结石，2例按LUS定位切开输尿管后取出结石。LUS检查时间9-20min，平均14min。结论 LUS在腹腔镜输尿管上段切开取石术中有实际应用价值。     

小儿输尿管开口异位的诊断和治疗(附22例报告)

目的 提高小儿输尿管开口异位的诊治效果。方法 总结22例输尿管开口异位患儿临床资料。男1例，女21例。年龄1个月～12岁，平均4岁。单侧17例，双侧5例。21例女童中，有正常分次排尿伴异常漏尿18例，完全持续性漏尿3例；1例男童有上尿路梗阻及泌尿系感染。异位开口于阴道14例、尿道4例、前庭3例、膀胱颈1例。结果 手术治疗20例，其中肾切除者11例、半肾切除者7例，术后漏尿症状消失，3例合并输尿管残端综合征；1例双输尿管膀胱再植术后仍有尿失禁；1例直肠化膀胱术无漏尿症状。结论 明确诊断，选择合理手术是小儿异位输尿管口治疗成功的关键。     

Reduced renal function and benefits of treatment in cystinuria vs other forms of nephrolithiasis

A significant study from the USA compares cystine stone formers and routine stone formers; the former group had a higher requirement for therapeutic procedures, but this was less if they took chelating agents, although remaining higher than in the latter group. Other interesting findings are also presented. OBJECTIVE: First, to compare two types of stone formers (SF), those with cystinuria and those without, for effects of treatments for stones, as cystinuria leads to recurrent stones that are difficult to fragment with shock-wave lithotripsy, and there is disagreement about the efficacy of current treatments. Second, to compare these two groups with respect to blood pressure (BP) and renal function, as cystine stones may be associated with more morbidity than are routine stones. PATIENTS AND METHODS: Fifty-two cystinuric patients (cystine SF) entering our programme since 1970 were compared with 3215 SF without cystinuria (routine SF), of whom 114 had a single functioning kidney (routine SF + nephrectomy). All patients had three 24-h urine and blood samples taken to determine the risk of stones before their first clinic visit; these studies were repeated after therapy was initiated, and at regular intervals to monitor therapy. Cystine was measured in the urine samples of the cystine SF. All stone-related procedures were recorded, and BP measured at clinic visits. Creatinine clearances (CCr) were calculated from each set of serum and urine values. Cystine supersaturation (SS) was directly measured in 16 urine samples collected before treatment and 13 afterward. RESULTS: Patients were treated with increased fluid intake, potassium alkali and chelating agents such as alpha-mercapto-propionyl-glycine, as needed. The mean (sd) CCr, corrected for age and gender, was significantly lower at entry in cystine SF than in routine SF, at 91 (6) vs 160 (1) L/day, respectively (P < 0.001), and remained so at the last CCr. Neither systolic nor diastolic BP, similarly corrected, differed between the groups, but cystine SF had significantly more procedures, corrected for time at risk, before treatment than did routine SF, at 4.0 (0.4) vs 1.86 (0.06), respectively (P < 0.001); time-adjusted procedures decreased significantly in both groups during treatment, but remained higher in cystine SF, at 0.88 (0.14) vs 0.23 (0.02), respectively, (P < 0.001). Urine volume and pH were significantly higher in cystine SF than in routine SF, both before and during treatment. Cystine SS decreased during treatment, consistent with the increase in urine volume and decline in procedure rates during treatment. CONCLUSION: Cystine SF have significantly higher procedure rates than routine SF, but procedure rates decline during therapy, although they remain higher than in routine SF. The lower CCr in cystinurics suggests that treatment to prevent stone recurrence and the need for procedures is particularly important, and emphasizes the need for a close follow-up. Use of cystine SS measurements may allow closer monitoring of the effect of treatment on the risk of stone recurrence.