目的：提高原发性输尿管癌的诊断与治疗水平。方法:回顾性分析20例原发性输尿管癌患者的临床表现、诊断与治疗方法。结果:对中老年人不明原因的单侧腰痛、肾积水、间歇性全程肉眼血尿应考虑该病。术前采用B超、IVU、CT、膀胱镜、逆行尿路造影、MRU检查，确诊为原发性输尿管癌14例，术后病理检查20例均为原发性输尿管移行细胞癌。结论：要提高原发性输尿管癌的术前诊断准确率，需要术前采用多种诊断方法。
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.
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.
【摘要】 目的 探讨老老年患者留置尿管内壁细菌生物被膜形成情况及其对导管相关感染(CRI)的影响。〖HTH〗方法〖HTSS〗 分析2007年2月—2009年10月住院的175例留置尿管患者,均为男性,年龄75~96岁,平均86岁。不同留置时间(7~15 d 53例、16~30 d 49例、31~45 d 44例、gt;45 d 29例)的尿管,于拔出尿管后运用超声震荡使尿管内表面生物被膜完全脱落,梯度稀释后进行生物被膜活菌计数,细菌的培养分类及构成比分析；采用扫描电镜观察尿管内壁细菌生物被膜形成的情况；观察尿管留置时间与生物被膜CRI的关系。结果 随着尿管留置时间的延长,尿管内表面生物被膜活菌计数呈指数趋势增长,CRI发生率有升高趋势,各置管时段组间尿管内表面生物被膜活菌计数及CRI发生率比较差异均有统计学意义(Plt;0.05)。扫描电镜见生物被膜的形成随时间的延长而明显增多。结论 细菌生物被膜形成是老老年患者留置尿管相关性尿路感染的重要致病因素,尿管留置时间越长,尿管生物被膜感染的危险性及几率越高。更换尿管或缩短留置时间仍是防止尿管生物被膜感染的主要方法。
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。
Objective To explore the emergence agitation resulting from postoperative indwelling urethral catheters in patients of thoracic surgery. Methods In this prospective cohort study, we recruited 140 patients who were scheduled for thoracic surgery under general anesthesia in West China Hospital from January through April 2014. These patients were divided into two groups including a control group and a trial group with 70 patients in each group. The patients in the control group had indwelled urethral catheter routinely. The catheter removed after the surgery at operation room in the trial group. Intraoperative urinary volume, emergence agitation (EA) occurrence, postoperative urinary retention, and urethral irritation were recorded. Results There was no statistical difference in postoperative urinary retention rate between the control group and the trial group (1.43% vs. 2.86%, P=0.230). However, the urethral irritation rate in the control group was significantly higher than that in the trial group (12.86% vs. 0.00%, P=0.012) . And there was a statistical difference in adverse event rate (2.86% vs. 0.00%, P=0.039) between the two groups. There was a significantly higher incidence of urethral irritation in male patients (20.51%, 8/39) than female patients (3.23%, 1/31, P=0.033).The rate of EA in the control group was significantly higher than that in the trial group (28.57% vs. 12.86%, P=0.010). There was a significantly higher EA rate in the patients who had urethral irritation by postoperative indwelling catheters compared with those without indwelling catheters (45.00% vs. 12.86%, P=0.043). Conclusion This study suggests that postoperative EA is a result from urethral irritation than local pain, and the EA rate can be decreased by removal of catheter before anaesthetic recovery.
Tissue engineering technology and stem cell research based on tissue engineering have made great progresses in overcoming the problems of tissue and organ damage, functional loss and surgical complications. Traditional method is to use biological substitute materials to repair tissues, while tissue engineering technology focuses on combining seed cells with biological materials to form biological tissues with the same structure and function as its own to repair tissue defects. The advantage is that such tissue engineering organs and tissues can solve the problem that the donor material is limited, and effectively reduce complications. The purpose of tissue engineering is to find suitable seed cells and biomaterials which can replace the biological function of original tissue and build suitable microenvironment in vivo. This paper mainly describes current technologies of tissue engineering in various fields of urology, and discusses the future trend of tissue engineering technology in the treatment of complex urinary diseases. The results of this study show that although there are relatively few clinical trials, the good results of the existing studies on animal models reveal a bright future of tissue engineering technology for the treatment of various urinary diseases.
ObjectiveTo screen the current optimal evidence for early removal of urinary catheters in patients after gastrointestinal surgery both domestically and internationally. MethodsWe systematically searched the following databases or website, including the UpToDate, the British Medical Journal Best Practice, the Jonna Briggs Institute Evidence-Based Healthcare Center, the Guidelines International Network, the National Institute for Health and Clinical Excellence Guidelines, the Registered Nurses’ Association of Ontario, the Scottish Intercollegiate Guidelines Network, the European Association of Urology Nurses, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, ClinicalKey, Embase, PubMed, Web of Science, CNKI, Wanfang, and VIP. The literature was evaluated, and the evidence was extracted and summarized. ResultsA total of 27 articles were included, including 3 clinical decisions, 4 guidelines, 18 systematic reviews, 1 practice recommendation, and 1 expert consensus. The 23 evidence items were classified into five categories: pre-catheterization assessment (6 items), institutional and personnel requirements (2 items), strategies to shorten catheter indwelling time (8 items), bladder recovery strategies (5 items), and timing of catheter removal (2 items). These items were classified 5 evidence levels ccording to the 2014 JBI Evidence-Based Healthcare System Evidence Pre-Grading and Recommendation Level System: level 1 (6 items), level 2 (8 items), level 3 (1 item), level 4 (0 items), and level 5 (8 items). Recommendation grades: grade A (strong recommendation, 14 items) and grade B (weak recommendation, 9 items). ConclusionsThe high-quality evidence identified in this study regarding early urinary catheter removal can be effectively applied in the clinical management of patients after gastrointestinal surgery. However, there are few studies on this in China. These best evidence should be adaptively implemented according to the specific situation after gastrointestinal surgery in China.
目的:探讨后腹腔镜离断式肾盂成形术的临床价值。方法:采用后腹腔镜技术对17例肾盂输尿管连接部梗阻(UPJO)患者实施离断式肾盂成形术。结果:17例手术全部成功,手术时间95～165 min,平均130 min,术中出血20～90 mL,平均50 mL。术后15例随访3～16个月,IVU检查吻合口无狭窄,患肾积水减轻或消失,腰部疼痛消失。结论:后腹腔镜离断式肾盂成形术创伤小、安全、有效,是肾盂输尿管连接部梗阻(UPJO)新的治疗选择,可替代传统的开放手术。
目的:探讨双猪尾型输尿管内支架(Double pigtail stent,DPS)作为泌尿外科上尿路疾病手术辅助治疗的适应症、并发症及并发症的治疗。方法:总结我院2004年6月至2008年12月共122例施行输尿管内支架放置术患者的适应症、并发症及并发症的治疗结果。结果:24例患者(19.6%)在置管期间出现1个或以上并发症。主要并发症包括肉眼血尿(9例)、疼痛(16例)、膀胱刺激征(12例)、高热(1例)。大部分并发症是轻微和可以耐受的,并迅速得到了适当的处理。2例须拔除内支架,其中剧烈疼痛1例、高热1例。结论:DPS用于上尿路疾病手术辅助治疗是安全和有效的,DPS引起的并发症大部分易于处理。