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Clinical Analysis of Treating Ureteral Calculus with Ureteroscopic Pneumatic Lithotripsy by Ultraobservation

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。

双输尿管镜下尿道会师术治疗男性尿道损伤

目的　总结双输尿管镜下尿道会师术治疗男性尿道损伤的疗效和安全性。 方法　回顾性分析2006年7月－2010年10月24例经双输尿管镜下尿道会师术治疗的男性尿道损伤患者的临床资料。观察手术时间、术后排尿通畅情况、尿流率及是否并发尿道狭窄、尿瘘、尿失禁和阴茎勃起功能障碍。 结果　球部损伤患者16例会师成功，后尿道损伤患者6例会师成功，2例失败。手术时间20～35 min，平均28 min。术后均常规尿道扩张。2例并发严重尿道狭窄，行尿道狭窄内切开术，疗效佳。随访1年时行尿流率检测，最大尿流率18～25 mL/s，平均22 mL/s。无尿瘘、尿失禁和阴茎勃起功能障碍。。 结论　双输尿管镜尿道会师术疗效确切、安全、操作简单，手术时间短，微创和并发症少。

经输尿管软镜钬激光治疗盆腔异位肾伴结石一例

A Meta-analysis of Percutaneous Nephrolithotomy versus Ureterolithotripsy in the Treatment of Impacted Proximal Ureteral Stones >1 cm

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.

体外冲击波碎石联合枸橼酸氢钾钠颗粒治疗输尿管上段尿酸结石

目的 探讨枸橼酸氢钾钠联合体外冲击波治疗输尿管上段尿酸结石的临床疗效。 方法 2007年1月-2009年5月收治输尿管尿酸结石患者89例， 枸橼酸氢钾钠联合体外冲击波碎石治疗输尿管上段尿酸结石48例，并与复方金钱草颗粒联合体外冲击波碎石治疗的患者41例进行对比。 结果 试验组排出结石41例，有效率85.4%，对照组排出结石24例，有效率58.5%；排出结石时间试验组（12±3）d，对照组（20±5）d。 结论 输尿管上段尿酸结石体外冲击波碎石治疗后口服友来特可以提高治愈率，并可以减少输尿管石街的形成。

Necessity and Safety of Ureteral Stenting after Ureteroscopic Lithotripsy in Treatment of Ureteral Calculi: A Systematic Review

Objective 　To assess the necessity and safety of ureteral stenting after ureteroscopic lithotripsy in treatment of middle and distal ureteral calculi. Methods　We electronically searched MEDLINE, EMbase, Cochrane Library, CBM, VIP and CNKI to collect randomized controlled trials (RCTs) involving men with or without ureteral stenting after ureteroscopic lithotripsy from 2000 to March 2010. The quality of included trials was assessed. Data were extracted and analyzed with RevMan5.0 software. Results　Six RCTs involving 543 patients were identified. The results of meta-analysis showed that: a) There was no statistical difference between two groups in stone clearance rate (RR=0.45, 95% CI 0.98 to 1.01, P=0.15), dysuria rate (RR=1.35, 95% CI 0.99 to 1.84, P=0.06), and hematuria rate (RR=2.12, 95% CI 1.00 to 4.49, P=0.05); b) There was statistical difference between two groups in frequent micturition rate (RR=2.17, 95% CI 1.13 to 4.17, P=0.02), the mean visual analog score 3 days postoperatively (WMD=0.94, 95% CI 0.47 to 1.42, P=0.000?1), and the operation time (WMD=3.57, 95% CI 1.40 to 5.72, P=0.001). Without postoperative ureteral stenting can shorten the operation time, decrease the irritation signs of bladder, and can improve quality of postoperative life without influence on stone clearance. Couclusions　The routine ureteral stenting after ureteroscopic lithotripsy may be not necessary in order to keep patients from unsafety. More reasonable randomized double blind controlled trails with large sample are required to provide proofs with high quality because the methodology quality of included studies is lower.

Ureteroscope Pneumatic Lithotripsy for Calculi in Distal Common Bile Duct (Report of 19 Cases)

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。

Comparison of the Effects between Four Methods for Ureteroscope to Enter the Ureter

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。

Comparison between Two Methods for Placement of A Ureteral Stent by Retroperitoneal Laparoscopy

目的:比较与评价我院改良创新的后腹腔镜输尿管支架管留置方法与目前常用的留置方法的临床效果。方法:回顾性分析我院改良创新留置方法、目前常用留置方法应用于24例患者的资料。 结果:我院改良创新留置方法18例,目前常用留置方法6例。全部病例留置输尿管支架管均成功。我院改良创新留置方法平均留置时间2 min,目前常用留置方法平均留置时间6 min。结论: 我院改良创新留置方法为后腹腔镜输尿管支架管的留置提供了一种新的选择,且操作便捷、易于掌握和适宜推广。

经电切镜外鞘输尿管镜气压弹道碎石术治疗下尿路结石

【摘要】　目的　总结经电切镜外鞘输尿管镜气压弹道碎石术治疗下尿路结石的疗效。　方法　2009年10月－2010年4月，采用经电切镜外鞘输尿管镜直达结石部位，采用气压弹道碎石术治疗下尿路结石20例。其中男15例，女5例；年龄35~80岁，平均54岁。膀胱结石18例，后尿道（尿道膜部）结石2例，结石直径0.5~2.0 cm，均为单发。病程6 h~2年，平均15 d。　结果　20例均一次性成功碎石，碎石成功率100%。碎石时间15~45 min，平均27 min；术后住院时间2~6 d，平均3.7 d。术后无大出血、水中毒、感染等术后早期并发症。13例患者获随访，随访时间1~3个月，平均1.2个月。所有患者均未出现结石复发、尿道狭窄等并发症。　结论　经电切镜外鞘输尿管镜下气压弹道碎石术治疗下尿路结石疗效确切、微创，是一种治疗下尿路结石的安全方法。