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he Application of Retroperitoneoscopic Ureterolithotomy in Treatment of Impacted Stone of Upper Ureter (Reports of 58 Cases)

摘要:目的:探討后腹腔鏡輸尿管切開取石術治療嵌頓性輸尿管結石的臨床價值和技術要點。 方法:2006年12月至 2009年3月,對58例嵌頓性輸尿管中上段結石采用后腹腔鏡輸尿管切開取石術,術中取石后于鏡下直接置入雙J管,間段縫合輸尿管切口。 結果:58例手術均獲成功,無中轉開放手術,結石清除率100%。術后創腔引流液量少,3～5d拔除引流管,1周出院,術后3周膀胱鏡下拔除雙J管。隨訪1～27個月,B超復查顯示腎積水明顯好轉或消失,無結石復發。 結論:后腹腔鏡輸尿管切開取石術治療嵌頓性輸尿管結石具有創傷小\療效好、術后恢復快等特點,明顯優于開放手術及其它手術,值得推廣應用。Abstract: Objective: To summarize our experience and evaluate the outcome of retroperitoneal laparoscopic ureterolithotomy of the upper ureter impacted stone. Methods: Between December 2006 and March 2009, 58 patients underwent retroperitoneal laparoscopic ureterolithotomy of the upper ureter. After removal of the stones, the double J was put in and interrupted suture was performed for upper ureter. Results: Retroperitoneoscopic ureterolithotomy was successful in all patients, there was neither ureteral stricture nor recurrent calculus, the blood loss ranged from 510 mL, without urine leakage occurred.The mean hospital stay was 7 days, after 3 weeks double J was removed by cystoscopy. With 127 months followup, the hydronephrosis relieved and no recurrence of ureter calculus founded. Conclusion:Retroperitoneoscopic ureterolithotomy is a safe and effective minimally invasive operation, and worth to generalization.

宮頸癌術后留置尿管出院患者自我護理需求調查

【摘要】 目的 了解宮頸癌術后患者留置尿管出院后的自我護理需求，以便提供個性化的專業護理。 方法 2009年3月-2009年12月采用問卷方式，對110例宮頸癌術后留置尿管的出院患者進行自我護理需求調查，著重患者的尿管護理、盆底肌肉鍛煉、取尿管測殘余尿處置等相關知識與技能。 結果 回收問卷110份且均為有效問卷。調查顯示，留置尿管出院患者多數希望獲取有關留置尿管護理的專業知識和個性化指導，以滿足自我護理需求。 結論 對留置尿管出院患者進行相關知識宣教和護理技能指導，可提高自我護理的能力，安全渡過留置尿管期。

急診體外沖擊波碎石治療輸尿管結石合并腎絞痛1 264例報道

摘要:目的:評價急診體外沖擊波碎石(ESWL)治療輸尿管結石,緩解腎絞痛的療效。方法: 回顧性分析1 264例急診ESWL治療輸尿管結石的臨床資料。結果:治愈946例(74.8%),明顯好轉280例(22.0%),無效38例(3.2%),總有效率96.8%。結論: 急診ESWL治療輸尿管結石合并腎絞痛是行之有效的方法。

常規彩色多普勒超聲組合拳法在輸尿管非典型結石診斷中的實用價值

目的總結常規彩色多普勒超聲組合拳法對輸尿管非典型結石診斷的實用價值，提高彩色多普勒超聲對其診斷水平。 方法對2008年10月－2014年12月178例輸尿管非典型結石患者采用排除法，凸陣、線陣探頭加壓追蹤檢查，彩色多普勒超聲閃爍偽像輔診，必要時結合口服利尿劑飲水膀胱充盈聚焦檢查，輸尿管口射尿多普勒彩色信號觀察法與采用腔內探頭經陰道超聲檢查有機組合應用，以確定結石的存在。 結果輸尿管非典型結石多比較小，患側輸尿管擴張及腎積水程度較輕；輸尿管腹段結石5例，盆段結石29例，膀胱壁段結石144例；二維B型超聲共檢出132枚（74%，132/178），通過彩色多普勒超聲觀察結石后方閃爍偽像進一步明確檢出170枚（96%，170/178），采用腔內探頭經陰道超聲檢出6枚，2例通過適量飲水后對比觀察雙側輸尿管膀胱入口處噴尿現象，提示存在結石梗阻。 結論彩色多普勒超聲聯合多種探查方法診斷可提高輸尿管非典型結石的顯示率。

FOLLOW-UP EVALUATION OF A NEW URETERAL ANASTOMOSIS TECHNIQUE IN RENAL TRANSPLANTATION

Objective To compare the therapeutic effect of new “One-Stitch” ureterovesical anastomosis to that of the classic Lich-Gregoir method. Methods From January 2002 to December 2004, 445 patients suffering from uremia due to chronic nephritis were treated with renal transplantation. Among them, 121 patients were operated with our new modified ureteroneocystostomy technique (the new One-Stitch group), and 324 patients were operated with Lich-Gregoir technique (the Lich-Gregoir group). In the new One-Stitch group, there were 79 males and 42 females, aged 20-62 years (35.7 years on average). The course of the disease was 2-11 years (2.7 years on average). In the Lich-Gregoir group, there were 211 males and 113 females, aged 19-65 years (33.9 years on average). The disease course was 1-14 years (2.3 years on average). There was no significant difference between the two groups in age, proportion of genders, primary diseases and course of the disease (P gt; 0.05). The operative time, the ureteral compl ications and non-ureteral compl ications were compared between the two groups after the renal transplantation. Results The operative time for the new One-Stitch and Lich-Gregoir techniques was (8.7 ± 1.1) minutes and (22.4 ± 5.1) minutes, indicating the difference was significant (P lt; 0.05). All recipients were followed up for 3-5 years. In the new One-Stitch group, there were 5 patients with leakage of urine, 15 with gross hematuria, 4 with ureteral obstruction and 28 with urinary system infection. Symptomatic vesicoureteral reflux and stone formation were not observed in this group. In the Lich-Gregoir group, there were 17 patients with leakage of urine, 12 with gross hematuria, 13 with ureteral obstruction, 86 with urinary system infection, 6 with symptomatic vesicoureteral reflux and 2 with stones. In the new One-Stitch group, the incidence rate of compl ications of gross hematuria was 12.4%, which was significantly different from 3.7% in the Lich-Gregoir group (P lt; 0.05). The incidence rates of ureteral compl ications in the Lich-Gregoir and the new One-Stitch groups were 19.8% and 15.4%, respectively. The difference was not significant (P gt; 0.05). There was no significant difference between the two groupsin incidence rate of urinary system infection, delayed recovery of kidney function after kidney transplantation and rejectionreaction (P gt; 0.05). Conclusion The new One-Stitch group has no significant difference in ureteral compl ications ompared with the Lich-Gregoir group, and has become a preferential ureterovesical reimplantation technique because of its simple and has convenient operation.

Targeted Surveillance of Nosocomial Infection in Intensive Care Unit

ObjectiveTo investigate the incidence of nosocomial infection and device-related infection in the Intensive Care Unit (ICU), analyze its related risk factors, and search for effective measures to prevent and control nosocomial infection. MethodsBy prospective objective monitoring method, we surveyed 294 patients hospitalized in the ICU for at least 48 hours between January and December 2012. The doctor in charge filled in relevant information of the patients to complete the questionnaires, and hospital infection management staff was responsible for tracking, judging, and statistical analysis. ResultsIn the 294 patients, 61 had hospital infections, and there were 78 cases. The hospital infection rate was 20.75%, and the case infection rate was 26.53%. The day incidence of patient infection was 16.01‰, and day infection rate was 20.47‰ for infection cases. After average severity of illness score adjustment, the day case infection rate was 7.48%, ventilator associated pneumonia (VAP) infection rate was 27.27‰, central venous catheter associated bloodstream infection rate was 6.58‰, and catheter associated urinary tract infection rate was 3.15‰. ConclusionICU has a high risk of hospital infection. In the device related infections, VAP infection rate is the highest. Continuous improvement can be achieved through monitoring and discovering problems, strengthening hospital infection management training for the medical personnel of the hospital, close communication between doctors and hospital infection management staff, and strict implementation of hospital infection management measures.

Clinical Comparision of the Effects of Two Different Anesthesia for Surgery of Pediatric Ureteral Calculi

摘要:目的:分析與比較七氟醚吸入麻醉和丙泊酚靜脈復合麻醉應用于三聚氰胺致嬰幼兒輸尿管結石手術的麻醉效果。方法:60例輸尿管結石患兒隨機分為七氟醚(Sev)組(n=30)和丙泊酚(Pro)組(n=30)。觀察并記錄誘導時間、氣管內插管時間、蘇醒時間、拔除氣管插管時間、PACU滯留時間。記錄麻醉誘導和蘇醒期的不良反應。另外記錄兩組病人誘導前、插管前、插管后3 min、5 min、15 min、30 min時點的血壓、心率、脈搏血氧飽和度(SPO2)。結果:七氟醚組誘導時間(63.2±6.9)s長于丙泊酚組(38.2±12.7)s,七氟醚組拔除氣管插管時間(11.9±4.7)min短于丙泊酚組(15.6±8.2)min,兩組相比有統計學意義(Plt;0.05)。七氟醚組躁動發生率53.3%顯著高于丙泊酚組13.3%(Plt;0.01)。七氟醚組在插管前、插管后各時點的血壓、心率與誘導前相比,差異無統計學意義(Pgt;0.05),丙泊酚組插管前、插管后3 min、5 min與誘導前相比血壓、心率顯著降低(Plt;0.05),與同時間點七氟醚組相比血壓顯著降低(Plt;0.05)。結論:兩種麻醉方法均可安全有效用于嬰幼兒輸尿管結石手術,七氟醚組血流動力學更平穩,但躁動發生率較高。Abstract: Objective: To analyze and compare sevoflurane with propofol for anesthesia in infants with Melamineinduced ureteral stone surgery. Methods: Sixty infants who were to undergo Melamineinduced ureteral stone surgery were randomly divided into sevoflurane (Sev) group (n=30) and propofol (Pro) group (n=30). Observe and record the induction of anesthesia time, intubation time, awakening time, time to extubation, time to stay at PACU. Record adverse effects during induction of anesthesia and the awake period. In addition, recorded BP, HR, SPO2 of two groups before induction and intubation, after 3min、5min、15min、30min　after intubation. Results: Induction time ［（63.2 ± 6.9） s］ in sevoflurane group was longer than propofol group ［(38.2±12.7） s］,but extubation time ［（11.9 ± 4.7） min］ was shorter than propofol group ［(15.6 ± 8.2） min］, there was significantly different between two groups (Plt;0.05). The incidence of restlessness in sevoflurane group 53.3% was significantly higher than propofol group 13.3% (Plt;001). In sevoflurane group the BP, HR before intubation compare with after intubation has no significant difference (Pgt;0.05). Compared with before induction,the BP, HR before induction, after intubation 3 min, 5 min, decreased significantly (Plt;0.05) in propofol group.when compared the same point with sevoflurane group, blood pressure decreased significantly (Plt;0.05). Conclusion: Both propofol and sevoflurane can be used effectively and safely for anesthesia of ureteral calculi stone surgery in pediatric. The hemodynamics is more stable but restlessness is more common in sevoflurane group.

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

目的:比較與評價我院改良創新的后腹腔鏡輸尿管支架管留置方法與目前常用的留置方法的臨床效果。方法:回顧性分析我院改良創新留置方法、目前常用留置方法應用于24例患者的資料。 結果:我院改良創新留置方法18例,目前常用留置方法6例。全部病例留置輸尿管支架管均成功。我院改良創新留置方法平均留置時間2 min,目前常用留置方法平均留置時間6 min。結論: 我院改良創新留置方法為后腹腔鏡輸尿管支架管的留置提供了一種新的選擇,且操作便捷、易于掌握和適宜推廣。

引流袋接頭帽在封閉三腔尿管中的應用

Effect of evidence-based nursing of catheterization on urinary tract infection in patients with spinal cord injury and catheterization

ObjectiveTo explore the influence of evidence-based nursing care of catheterization on the incidence of urinary tract injury and urinary tract infection in patients with spinal cord injury and long-term indwelling catheters.MethodsFrom July 1st, 2017 to November 30th, 2018, 100 patients with spinal cord injury indwelling catheters in Department of Spinal Surgery were prospectively selected as the research objects. According to the admission time, patients admitted between July 2017 and February 2018 were assigned into the control group (n=50), and patients admitted between March 2018 and November 2018 were assigned into the observation group (n=50). Traditional catheter placement was used in the control group, while evidence-based catheter placement was used in the observation group. The incidences of catheter-related urethral injury and urinary tract infection after the catheterization were compared between the two groups.ResultsThere was no statistically significant difference in gender, age, diagnosis, or length of hospital stay between the two groups (P>0.05). Catheter placement was performed 57 times in the control group and 59 times in the observation group during hospitalization. After catheterization, the incidences of urethral hemorrhage and gross hematuria in the control group [22.80% (13/57) and 15.78% (9/57), respectively] were higher than those in the observation group [both were 1.69% (1/59)], with statistical differences between the two groups (P<0.05). The incidence of urinary tract infection in the control group differed from that in the observation group [42.0% (21/50) vs. 18.0% (9/50), P=0.009].ConclusionThe evidence-based urinary catheterization method for patients with spinal cord injury and long-term indwelling catheter can effectively prevent catheter-related urinary tract injury, reduce the incidence of catheter-related urinary tract infection during hospitalization, and improve the quality of clinical care.