目的 采用診斷敏感性及ROC曲線評價多排螺旋CT泌尿系統造影常用三維重建方法診斷上尿路疾病的價值。方法 前瞻性收集本院41例上尿路疾病患者，行多排螺旋CT泌尿系統造影（MDCTU）進行MPR、MIP以及VR重建。以金標準為對照，分別采用診斷敏感性指標及ROC曲線評價MDCTU、MPR、MIP及VR對上尿路疾病的診斷價值。結果 ① 該41例患者共有49處上尿路病變。② MPR、MIP及VR對上尿路疾病的定位診斷敏感性分別為48/49（98.0%）、27/49（53.2%）及19/49（38.8%）；定性診斷敏感性分別為47/49（95.9%）、17/49（34.7%）及13/49（26.5%）；MPR與MIP、VR兩者相比，其差異均有統計學意義（Plt;0.05）。③ MPR、MIP及VR鑒別病變良惡性的ROC曲線下面積（AZ值）分別為0.998、0.736及0.669；MPR與MIP、VR兩者相比，其差異也均有統計學意義（Plt;0.05）。④ MPR與MDCTU有相同的診斷敏感性及Az值。結論 多排螺旋CT泌尿系統造影常用的三維重建方法各有優缺點，其中以MPR的診斷效能最高，其與MDCTU相同，是診斷的基礎；而MIP及VR立體感較強。由此可見，綜合應用CTU中的三維重建方法對上尿路疾病的診斷及良惡性評估具有重要價值。
【摘要】 目的 探討多層螺旋CT低劑量掃描在小兒上尿路梗阻性疾病中的應用價值。 方法 2008年1月-2009年6月經臨床手術證實尿路梗阻的患兒52例，按梗阻的原因分為結石組13例與非結石組39例。將非結石組患兒，按照年齡分為0~1歲（8例）、1~5歲（16例）和5~10歲（15例）3個組，均采用個性化的低劑量掃描方式。 結果 結石組與非結石組陽性診斷率均為100%。低劑量掃描患兒所接受的輻射劑量明顯降低，CT掃描管電流不變，管電壓降低1/3，CT檢查的輻射劑量可降低約70%，且均可達到臨床診斷要求。 結論 多層螺旋CT低劑量個性化掃描在小兒上尿路梗阻性疾病中診斷中具有明顯優勢。【Abstract】 Objective To evaluate low-dose multislice spiral CT for upper urinary tract obstruction in children. Methods From January 2008 to June 2009, 52 children with upper urinary tract obstruction were diagnosed via clinical surgeries. The patients were divided into two groups according to whether having renal calculus (13 patients) or not (39 patients). The patients in non-calculus group were divided into three sub-groups: aged 0-1 (eight patients), 1-5 (16 patients), and 5-10 (15 patients). Low dose multislice spiral CT with different doses was performed. Results The rate of positive predictive diagnosis was 100% in both calculus and non-calculus group. Low dose scan reduced the radiation dose of children. The fixed tube current and the decreased tube voltage (decreased 1/3) led to the decrease of the radiation dose (decreased 70%), which were feasible for diagnosis. Conclusion Low-dose multislice spiral CT was available for upper urinary tract obstruction in children.
【摘要】 目的 探討微創經皮腎鏡下鈥激光碎石術治療上尿路結石的方法及療效。 方法 2007年9月-2010年10月在B型超聲引導下應用微創經皮腎鏡下鈥激光碎石術治療上尿路結石138例，其中腎鹿角形結石64例，單發腎盂、腎盞結石38例，雙腎結石8例，輸尿管上段結石28例，孤立腎結石2例。 結果 136例取石成功，其中95例一期取石成功（包括雙通道取石5例），41例二期取石，2例因經皮腎穿失敗改行開放手術取石。27例術后體外震波碎石治療。平均結石清除率78.9%（109/138）。平均手術時間112 min，平均住院時間10 d，腎造瘺管平均留置時間4 d，雙J管平均留置時間4周。5例因術中出血較多需輸血。11例術后1周內出血較多，其中3例需要輸血。12例出現尿外滲。7例術后出現高熱（gt;39 ℃）。隨訪: 98例伴有腎積水，時間3~6個月，平均4個月，24例積水消失，68例積水減輕，6例無改善也無加重；22例殘余結石隨訪4~9個月，平均6個月，6例結石增大，16例結石無變化；87例隨訪12個月無殘余結石，7例結石復發。 結論 微創經皮腎鏡下鈥激光碎石術治療上尿路結石創傷小，恢復快，并發癥少，療效滿意。【Abstract】 Objective To discuss the method and the curative effect of minimally invasive percataneous nephrolithotomy (mini PCNL) with holmium laser in treating upper urinary tract calculi. Methods From September 2007 to October 2010, 138 patients with upper urinary tract calculi were treated with mini PCNL with holmium laser under the conduction by type-B ultrasonography. Of the 138 cases, 64 patients had staghorn calculi, 38 had single renal pelvis or renal calyx stones, eight had bilateral renal calculi, 28 had upper-ureteral calculi, and two had solitary kidney calculi. Results Successful stone removal was achieved in 136 cases, among which there were 95 cases of stage-one nephrolithotomy (double tracts were used in five cases) and 41 cases of sfage-two neploolithotomy. Two cases were changed to open operation due to failures of percutaneous nephrolithotory. Extracorporeal shock-wave lithotomy was used in 27 cases after operation. The average stone removal rate was 78.9% (109/138). The average operation time was 112 minutes. The average hospital stay was 10 days. The average nephrostomy tube stay was four days. The average double J tube stay was four weeks. Five patients needed blood transfusion in operations due to a large amount of blood loss. Eleven patients suffered from massive hemorrhage one week after operation and blood transfusion was performed in three patients. Urine exosmosis happened in 12 cases. And there were seven cases of high fever (gt;39 ℃) after operation. Follow-up was done for 98 patients accompanied by hydronephrosis for a time period ranged from three to six months averaging at four months. Hydronephrosis disappeared in 24 patients, alleviated in 68 cases, and did not change in six cases. Twenty-two cases of residual calculi were followed up for a period ranged from four to nine months averaging at six months. Enlarged calculi occurred in six cases and no change happened to the calculi in 16 cases. Eighty-seven patients without residual calculi were followed up for 12 months, and there were seven cases of reoccurrence. Conclusion Treatment of upper urinary tract calculi with minimally invasive percutaneous nephrolithotomy with holmium laser is a simple and safe method with little injury, quick recovery, few complications and satisfactory results.
【摘要】 目的 探討微創經皮腎鏡碎石術后并發感染性休克的原因和防治措施。 方法 回顧性分析2005年1月-2010年12月5例經皮腎鏡術300例，其中術后并發感染性休克5例的臨床資料。男1例，女4例，均表現為術后2~8 h內出現寒戰、高熱、煩燥不安，血壓降至80/50 mm Hg（1 mm Hg=0.133 kPa）以下，心率超過120次/min。所有患者均行抗感染和抗休克治療。 結果 所有患者均在72 h內停用升壓藥，1周內體溫及血常規恢復正常，術后15 d治愈出院。 結論 感染性休克是微創經皮腎鏡碎石術嚴重的并發癥之一，術前有效抗感染、術中低壓灌注、術后加強生命體征的監測、早期發現并合理處理，可有效防治感染性休克的發生。【Abstract】 Objective To explore the etiology and treatment of septic shock after percutaneous nephrolithotomy. Methods From Janurary 2005 to December 2010, the clinical data of five patients with septic shock after percutaneous nephrolithotomy in our hospital were retrospectively analyzed. The patients, including one male and four females, had chillness and high temperature after the nephrolithotomy. The blood pressure decreased to under 80/50 mm Hg （1 mm Hg=0.133 kPa）, and the heart rate was more than 120 per minute. All patients underwent anti-shock and anti-infection therapies rapidly. Results Five patients were cured in the end, their temperature and blood routine tests returned to normal within one week. Conclusions Septic shock is one of the serious complications after percutaneous nephrolithotomy. Effective preoperative preparation, low pressure irrigation during operation, early diagnosis and treatment postoperatively are the effective ways to prevent the septic shock.
目的:探討雙豬尾型輸尿管內支架(Double pigtail stent,DPS)作為泌尿外科上尿路疾病手術輔助治療的適應癥、并發癥及并發癥的治療。方法:總結我院2004年6月至2008年12月共122例施行輸尿管內支架放置術患者的適應癥、并發癥及并發癥的治療結果。結果:24例患者(19.6%)在置管期間出現1個或以上并發癥。主要并發癥包括肉眼血尿(9例)、疼痛(16例)、膀胱刺激征(12例)、高熱(1例)。大部分并發癥是輕微和可以耐受的,并迅速得到了適當的處理。2例須拔除內支架,其中劇烈疼痛1例、高熱1例。結論:DPS用于上尿路疾病手術輔助治療是安全和有效的,DPS引起的并發癥大部分易于處理。
目的:探討急性上尿路梗阻性腎功能衰竭的治療方法。方法:采用輸尿管鏡檢查,酌情鈥激光碎石,放置雙J管內引流治療32例急性上尿路梗阻性腎功能衰竭患者。結果:術后患者血清BUN、SCr均明顯下降,尿量不同程度恢復,結石排凈率90.6%(29/32)。結論:對于上尿路結石梗阻性急性腎功能衰竭的患者,急診輸尿管鏡下鈥激光碎石,療效確切,創傷小,可同時處理雙側輸尿管結石。
目的探討輸尿管軟鏡術（RIRS）治療上尿路結石術前留置輸尿管支架的必要性。 方法2013年6月-2014年12月，將85例上尿路結石患者分為2組，A組（不留置輸尿管支架管組）42例，B組（留置輸尿管支架管組）43例，比較兩組患者輸尿管支架管相關下尿路癥狀發生率、手術時間、輸尿管軟鏡鞘（UAS）一次性置入成功率、結石清除率。 結果兩組患者手術時間、結石清除率比較，差異無統計學意義（P＞0.05）；B組術前5例（11.6%）患者出現輸尿管支架管相關下尿路癥狀；B組UAS一次性置入成功率均明顯高于A組，差異有統計學意義（P＜0.05）。 結論為了一期手術成功，經RIRS治療上尿路結石術前有必要留置輸尿管支架。
目的系統評價上尿路尿路上皮癌（UTUC）患者根治性腎輸尿管切除（RNU）術后膀胱內復發（IVR）的危險因素。方法計算機檢索 PubMed、EMbase、The Cochrane Library、CBM、CNKI、VIP 和 WanFang Data 數據庫，搜集有關 UTUC 患者 RNU 術后 IVR 危險因素的病例-對照研究，檢索時限均為建庫至 2017 年 8 月。由 2 名研究者獨立篩選文獻、提取資料并評價納入研究的偏倚風險后，采用 RevMan 5.3 軟件進行 Meta 分析。結果共納入 23 個研究，包括 8 614 例患者。Meta 分析結果顯示：既往膀胱癌病史［HR=1.77，95%CI（1.42，2.22），P<0.001］、腫瘤分期（≥T2）［HR=1.41，95%CI（1.09，1.82），P=0.009］、輸尿管腫瘤［HR=1.34，95%CI（1.20，1.49），P<0.000 01］、多發性腫瘤［HR=1.51，95%CI（1.34，1.69），P<0.001］、淋巴血管浸潤［HR=1.43，95%CI（1.20，1.70），P<0.000 1］、腹腔鏡手術［HR=1.52，95%CI（1.08，2.15），P=0.02］、腫瘤切緣陽性［HR=1.87，95%CI（1.17，2.99），P=0.009］和術前輸尿管鏡檢查［HR=1.46，95%CI（1.21，1.75），P<0.001］均是 UTUC 患者 RNU 術后 IVR 的危險因素。結論當前證據表明，既往膀胱癌病史、腫瘤分期（≥T2）、輸尿管腫瘤等是 UTUC 患者 RNU 術后 IVR 的危險因素。受納入研究質量限制，上述結論尚待更多高質量研究予以驗證。
