针式腹腔镜在泌尿外科的应用现况

针式腹腔镜是新近出现的直径只有2 mm的腹腔镜设备,目前已用于普通外科、妇产科等一些疾病的治疗上.在泌尿外科方面,针式腹腔镜在肾上腺切除术、小儿隐睾固定术等手术上也得到了应用.虽然对针式腹腔镜手术的定义仍存在争议,目前2 mm的器械也尚有局限性,但其相对于传统腹腔镜有明显的优点,如损伤比传统腹腔镜手术更小、美观性更好、住院时间更短、恢复更快.针式腹腔镜将是常规腹腔镜发展的必然结果.     

尿道发育不良性阴茎弯曲的手术矫治

目的临床研究尿道发育不良性阴茎弯曲27例的手术方式和疗效。方法皮肤切口绕过菲薄尿道,脱蜕尿道表面阴茎皮肤,切断阴茎腹侧之深浅筋膜,伸直阴茎,手术不伤及尿道。结果27例阴茎下弯得以伸直,其中1例因留置橡胶导尿管导致阴茎部尿道狭窄,经尿扩治疗2年余,排尿尚通畅。结论采取保护菲薄尿道的切口脱蜕阴茎皮肤,切断增厚的阴茎筋膜能伸直Ⅰ型弯曲的阴茎。     

泌尿系先天性异常的X线诊断（附36例分析）

本文报告经我院１９８５～１９９２年间放射科肾盂分泌性造影证实的泌尿系先天性异常３６例，着重讨论常见畸形的种类及Ｘ线诊断，强调常规Ｘ线造影检查仍是有效且较经济的手段，讨论分析发病机制与Ｘ线影象的关系。     

Consequences of fluid absorption during transurethral resection of the prostate using distilled water or glycine 1.5 per cent

This prospective and randomized study compared the consequences of two irrigating fluids, distilled water and glycine for transurethral prostatectomy. Forty-nine consecutive unselected patients undergoing transurethral resection of the prostate with spinal anaesthesia were investigated. The irrigating fluid was either distilled water (group A, 24 patients) or glycine 1.5 per cent (group B, 25 patients). The absorption of irrigating fluid was measured, all surgical events and any clinical signs of TURP syndrome during and after surgery were recorded. Early signs of TURP syndrome were observed in one patient in group A and in four in group B without further consequence. From all the biological variables, only plasma protein concentration, haematocrit, free plasma haemoglobin and free bilirubin concentrations were found to have changed. Plasma protein concentration and haematocrit decreased significantly during and after surgery in the two groups. Free plasma haemoglobin increased significantly with time: a significantly higher concentration was observed in group A than group B. Free bilirubin concentration increased with time in the two groups and was statistically greater in group A. With the two irrigating fluids, we observed a significant amount of haemolysis and haemodilution without clinical consequences. A low irrigating fluid pressure, a short resection time, and the use of spinal anaesthesia seems to us to be essential. Close observation of patients following transurethral prostatectomy is needed but the choice of the irrigating fluid does not seem to be important. Cette étude prospective et randomisée a comparé les conséquences de deux liquides d’irrigation, l’eau distillée et le glycocolle au cours de la chirurgie prostatique par voie basse. Quarante-neuf patients consécutifs, non sélectionnés, bénéficiant d’une résection transuréthrale de prostate sous rachianesthésie, sont étudiés. Le liquide d’irrigation est soil l’eau distillée (groupe A, 24 patients), soit le glycocolle à 1.5 pour cent (groupe B, 25 patients). L’absorption des liquides d’irrigation, les incidents chirurgicaux et les signes cliniques du syndrome de réabsorption sont systématiquement notés. Des signes caractéristiques du syndrome de réabsorption sont observés dans un cas dans le groupe A et dans quatre cos dans le groupe B sans conséquence ultérieure. Seuls la protidémie, l’hématocrite, l’hémoglobine plasmatique libre et la bilirubine libre changent significativement. L’hémoglobine plasmatique libre augmente significativement dans les deux groupes, avec un taux plasmatique significativement plus élevé dans le groupe A. Avec les deux liquides d’irrigation, on observe une hémolyse et une hémodilution sans conséquence clinique. Un temps de résection court, un faible niveau de pression d’irrigation, l’utilisation de l’anesthésie rachidienne nous semblent trés importants. Une surveillance clinique et biologique attentive pendant et après la résection transuréthrale de prostate sont nécessaires; en revanche, le choix du liquide d’irrigation ne semble pas l’élément essentiel.     

小儿复杂性尿道下裂的处理

目的 :为探讨复杂性尿道下裂手术疗效。方法 :对近 5年间收治的复杂性尿道下裂 2 9例进行回顾性研究 ,全部病例再次手术 ,术式为带蒂包皮或阴茎皮管转移尿道成形、原位阴茎阴囊皮管尿道成形、阴囊皮管和包皮皮管转移联合形成尿道等术式重建尿道。结果 :除 1例经原位阴茎皮管尿道成形术后遗留 2个尿瘘外 ,余 2 8例均获成功 ,成功率 96 .5 %。结论 :术前仔细评估 ,选择合适的手术方式是获得成功的关键。     

膀胱颈部电切术治疗膀胱颈梗阻

目的：探讨经尿道电切术治疗膀胱颈梗阻的方法和治疗效果。方法:根据14例膀胱颈部挛缩的情况,分别采用膀胱颈口切沟术,膀胱颈口号下半环切除加12点切沟术。结果：12例排尿通畅,肾脏、输尿管、膀胱的功能形成恢复正常;2例合并糖尿病者排尿困难症状改善,残余悄量明显减少。未出现尿失禁症状。结论：经尿道膀胱颈口电切术治疗膀胱梗阻是安全有效的治疗方法,根据颈部狭窄程度的不同,选择不同的电切方法,可以提高手术治疗效果。     

Independent risk factors for early urologic complications after kidney transplantation

Urologic complications are the most frequent technical adverse events following kidney transplantation (KTX). We evaluated traditional and novel potential risk factors for urologic complications following KTX. Consecutive KTX recipients between December 1, 2006 and December 31, 2010 with at least six‐month follow‐up (n = 635) were evaluated for overall urologic complications accounting for donor, recipient, and transplant characteristics using univariate and multivariate logistic regression. Urologic complications occurred in 29 cases (4.6%) at a median of 40 d (range 1–999) post‐transplantation and included 17 ureteral strictures (2.6%), five (0.8%) ureteral obstructions due to donor‐derived stones or intraluminal thrombus, and seven urine leaks (1.1%). All except two complications occurred within the first year of transplantation. Risk factors for urologic complications on univariate analysis were dual KTX (p = 0.04) and renal artery multiplicity (p = 0.02). On multivariate analysis, only renal artery multiplicity remained significant (aHR 2.4, 95% confidence interval 1.1, 5.1, p = 0.02). Donation after cardiac death, non‐mandatory national share kidneys, donor peak serum creatinine > 1.5 mg/dL or creatinine phosphokinase > 1000 IU/L, and donor down time were not associated with urologic complications. Our data suggest that donor artery multiplicity is an independent risk factor for urologic complications following KTX.     

泌尿外科腔镜术后尿源性脓毒血症的预后影响因素分析

目的:探讨影响泌尿外科腔镜手术后尿源性脓毒血症的预后因素,改善尿源性脓毒血症的预后.方法:回顾性分析57例泌尿外科腔镜手术后尿源性脓毒血症的患者资料,并按照严重程度分为低危组和高危组,比较按照临床资料特征、化验结果的区别.结果:在57例脓毒血症患者中,高危组24例,低危组33例,在性别构成(男/女)、术前尿路感染方面,高危组明显高于低危组,两组间差异有统计学意义.在手术方式方面,高危组患者中输尿管镜手术比例明显高于低危级,而经皮肾镜比例明显低于低危组,两组间差异有统计学意义.手术时间方面,高危组明显长于低危组,两组间差异有统计学意义.术后血白细胞、中性粒细胞、C反应蛋白、多脏器功能障碍发生率、血培养阳性率方面,高危组高于低危组,而术后至出现脓毒血症症状时间间隔(手术-感染时间)、血小板、血红蛋白、纤维蛋白原方面低于低危组,两组间差异有统计学意义.结论:男性、术前存在尿路感染、合并糖尿病、输尿管镜手术、手术时间过长是尿源性脓毒血症预后不良的因素;术后血中性粒细胞比例明显升高、C反应蛋白升高、发生多脏器功能障碍、血培养阳性、手术-感染时间短、血小板下降、血红蛋白下降、纤维蛋白原降低是预后不良的指标.