目的 探讨输尿管镜气压弹道碎石治疗胆总管下段嵌顿性结石的方法及疗效。方法 传统方法取石失败病例改用输尿管镜置入胆总管直视见到胆总管下段嵌顿性结石，气压弹道碎石，盐水冲洗出或钳夹出结石，并探查下段是否通畅。结果 清除结石时间5~10 min，成功率100%（19/19），术后2~4周拔T管，无切口感染、无胆道感染、无残留结石。结论 输尿管镜气压弹道碎石治疗胆总管下段嵌顿性结石，高效、安全，值得临床推广应用。
目的:探讨B超监测下输尿管镜治疗输尿管结石的临床疗效及可行性。方法:2007年12月~2008年12月采用B超监测下输尿管镜治疗输尿管结石患者34例,结石位于上段4例,中段11例,下段19例。结果:一次性碎石治愈者33例,一次性碎石成功率97%,手术时间(40±15)min,术后2~7天排尽结石,术后住院平均时间3.5(2～5)天。结论:B超监测下输尿管镜治疗输尿管结石对于手术操作者易于随时动态观察结石情况,对于大于0.4 cm的碎石块无遗漏,增加术中一次碎石成功率,可行性高。
ObjectiveTo assess the efficacy and safety of percutaneous nephrolithotomy (PCNL) versus ureteroscopic lithotripsy (URL) in the treatment of impacted proximal ureteral stones>1 cm. MethodsWe electronically searched PubMed, Cochrane library, Embase, WanFang, Chinese National Knowledge Infrastructure and VIP database (by the end of July 2015) to collect randomized controlled trials involving PCNL vs. URL for the treatment of impacted proximal ureteral stones> 1 cm. The quality of those trials were assessed. Data were extracted and analyzed with RevMan 5.3 software. ResultsSix randomized controlled trials were finally obtained after screening. A total of 487 patients were included for a Meta-analysis. The results showed that, as compared with the control group (URL), the patients in the trial group (PCNL) had the following features: ① There was a remarkable improvement of stone clearance rate [RR=1.20, 95% CI (1.09, 1.33), P=0.000 3].② There was no statistical difference in postoperative fever rates, urinary tract perforation rates [RR=1.73, 95%CI (0.43, 7.00), P=0.45; RR=1.02, 95%CI (0.11, 9.37), P=0.99], but the incidence of hematuria was higher [RR=1.99, 95%CI (1.09, 3.62), P=0.03], and the mean operative duration was longer [WMD=30.03 minutes, 95%CI (10.04, 50.02) minuntes, P=0.003].③ The mean hospitalization stay was delayed by an average of 3.73 days [WMD=3.73 days, 95%CI (3.02, 4.44) days, P<0.000 01]. ConclusionPCNL is better than URL in the stone clearance rate, while patients in the PCNL group have to stay in the hospital much longer, and should bear longer mean operative duration.
目的:探讨输尿管镜技术在泌尿外科疾病诊治中的临床应用价值。方法: 2002年9月至2008年9月应用经尿道输尿管镜技术诊断和治疗泌尿系疾病患者1333例。其中行输尿管镜治疗者1200例, 包括输尿管结石1010例,其中上段结石146例、中段344例、下段520例;输尿管狭窄18例;医源性双J管滞留38例;男性尿道狭窄38例;膀胱尿道结石41例;肾盂结石8例;输尿管阴道漏5例;小儿逆行输尿管插管20例;内支架管置入22例。其中用于诊断的患者133例。结果:治疗1010例输尿管结石,成功865例,成功率为85.6%,其中治疗输尿管上、中、下段结石的成功率分别为68.5%、81.7%及93.1%;输尿管狭窄、尿道狭窄、膀胱尿道结石、输尿管阴道漏及小儿逆行输尿管插管均疗效满意。用于诊断的133例患者中,发现肿瘤4例,阴性结石48例,息肉8例,输尿管结核9例,输尿管狭窄30例,无阳性发现34例。手术失败24例。发生严重手术并发症37例,其中死亡1例,感染性休克2例,黏膜撕脱4例,穿孔15例、假道12例,严重出血3例。结论:输尿管镜技术由于其适应于泌尿系统腔道的独特特点,可应用于泌尿外科的许多疾病的诊治,尤其对输尿管下段结石可作为首选治疗措施;只要仔细操作,随着经验的积累,并发症发生率会越来越低。
Objective To evaluate the clinical value of ureteroscope in cholelithiasis treated by laparoscopic surgery. Methods The clinical data of 36 patients admitted because of hepatolithus with ureteroscope combination in laparoscopic surgery from February 2007 to September 2009 in Guidong People’s Hospital of Guangxi were analyzed retrospectively. Results In 33 cases, stones were removed once by ureteroscope in laparoscopic surgery with residual stones (in 3 cases residual stone were removed secondarily through T tube) and the other 3 cases were transferred to laparotomy forcedly due to bleeding of biliary duct and vessels of porta hepatis and tearing of bile duct. During operation, blood loss was 30-280 (94.51±54.70) ml; operation time was 110-260 (147.22±48.45) min; recovery time of bowel movement was 1-3 (2.03±0.76) d; postoperative hospitalization time was 6-13 (7.12±1.65) d (some discharged with T tube); the time of patients of T tubes pulled out was 28-45 (38.92±6.52) d. Bile leakage happened in 1 case and infection of biliary tract in 1 case, no complications such as biliary stricture or bile duct bleeding were found after operation. Conclusions Treatment of intrahepatic bile duct or a single extra-hepatic sand-like stones with ureteroscopy usage in laparoscopic surgery is feasible and less invasive. It is a minimally invasive treatment for intra- or extra-hepatic stones due to rapidly postoperative rehabilitation.
目的:探讨经尿道输尿管镜腔内气压弹道碎石治疗肾盂结石的疗效。方法:回顾分析7例肾盂结石经尿道输尿管镜腔内气压弹道碎石术式治疗的临床资料。结果:5例术后复查出现大小不等上尿路残余结石,分别予经皮肾镜碎石,经尿道输尿管镜碎石,体外振波碎石治疗后复查无残余结石。结论:肾盂结石经尿道输尿管镜腔内气压弹道碎石治疗需要根据结石的大小、形态及位置严格掌握适应症。
目的 总结应用输尿管镜治疗结石梗阻性肾积脓手术配合的经验。 方法 对2003年4月-2007年12月因输尿管结石引起梗阻性肾积脓的27例患者行输尿管镜检查、气压弹道碎石、取石及留置双J管治疗的临床资料及手术配合进行回顾性分析。 结果 27例患者中，1次取净结石24例；术后2周经体外震波碎石治愈2例；改行开放手术1例，术中无明显并发症。 结论 手术护士应熟悉操作步骤，密切配合医生手术。应用输尿管镜治疗结石梗阻性肾积脓具有疗效好、创伤小、安全可靠等优点。
目的 探讨4种输尿管镜入镜方法的成功率及对输尿管口的损伤。 方法 回顾性分析2008年7月－2011年3月间行输尿管镜手术的患者共553例，按其入镜方法分为4组，分别采用球囊扩张法、灌注泵加压灌注入镜法、内旋法及倒入法进行输尿管镜操作。分析其成功率及对输尿管口的损伤。 结果 气囊扩张法成功率为95%，但对输尿管口的损伤率为100%；灌注泵加压法成功率为67.5%，输尿管口损伤率为87.0%；内旋法的成功率为87.9%，损伤率为50.0%；倒入法成功率91.0%，对输尿管口损伤率为22.2%。4种方法中，灌注泵加压法一次性成功率最低，与其余3种方法比较，差异均有统计学意义（P＜0.008）；其余3种方法间一次性成功率差异无统计学意义（P＞0.008）。对输尿管口的损伤率，4种方法组间两两比较的差异均有统计学意义（P＜0.008），其中气囊扩张法损伤率最高，倒入法最低。 结论 倒入法是4种方法中成功率较高且损伤小的一种方法。