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。
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 systematically review the effectiveness and safety of transurethral ureteroscopy lithotripsy in the treatment of upper ureteral calculi. MethodsWe electronically searched The Cochrane Library (Issue 3, 2013), PubMed (1966 to 2013.8), EMbase (1990 to 2013.8), CNKI (1949 to 2013.9), CBM (1978 to 2013.9), VIP (1989 to 2013.8) and WanFang Data (1990 to 2013.8) for the randomized controlled studies (RCTs) related to retroperitoneoscopy ureterolithotomy versus transurethral ureteroscopy lithotripsy for upper ureteral calculi. Two reviewers independently screened literature, extracted data, and evaluated methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2 software. ResultsA total of 16 RCTs involving 1 410 patients (transurethral ureteroscopy lithotripsy:747 cases; etroperitoneal laparoscopic ureterolithotomy:663 cases) were included. The results of meta-analysis showed that, transurethral ureteroscopy lithotripsy was lower than retroperitoneoscopy ureterolithotomy in success rates of surgery (OR=0.26, 95%CI 0.14 to 0.51), 3-day stone clearance rates (OR=0.06, 95%CI 0.03 to 0.11), and 1-month stone clearance rates (OR=0.21, 95%CI 0.08 to 0.53), while it showed superiority in operation time (MD=-22.35, 95%CI-35.29 to-9.41) and postoperative hospital stay (MD=-1.84, 95%CI-3.44 to-0.24). ConclusionCurrent evidence shows that, in the treatment of upper ureteral calculi, transurethral ureteroscopy lithotripsy causes less operation time and postoperative hospital stay, but it had no advantage in success rates of surgery, 3-day stone clearance rates, and 1-month stone clearance rates.
ObjectiveTo explore the nursing experience of preoperative treatment for urethral injury with ureteroscopic urethral realignment. MethodsThe key points of the nursing experience of preoperative treatment for 58 cases of urethral injury with ureteroscopic urethral realignment were retrospectively analyzed. The patients were treated between January 2008 and December 2012. ResultsUrethra catheterization of the 58 patients receiving the ureteroscopic urethral realignment was all successful. The catheter was extracted 4-8 weeks after the treatment, and then the urethra was dilated for two years. All patients had normal urination without any surgery complications during the 5-28-month clinical follow-up. ConclusionUrinary tract infections can be prevented effectively under professional and meticulous preoperative treatment. The incidence of urethral stricture can be reduced greatly. The quality of the patients' life can be improved a lot.
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。