结石

In addition, the principle of treating calculi on both sides of the upper urinary tract, acute anuria, stag-horn calculi , replacement of the ureter with ileum, perinephric abscess formed on the basis of urinary obstruction by the calculi , excretion of calculi by treatment with medicinal herbs and other proble...

本文报告双侧上尿路结石40例，对其临床情况、手术措施、治疗效果及并发症等均作了阐述和分析；对双侧上尿路结石处理原则、急性尿闭、鹿角状结石、肾部分切除、回肠代输尿管、由于结石梗阻而形成的肾周围脓肿、中药排石等问题作了较充分的讨论。

Results:1 case with complicated pyonephrosis was treated with puncture and canalization;Two-stage operations of mini-PCNL was treated 1 week later.20 cases underwent one-stage PCNL,and were treated with single-access PCNL.The total stone clearance rate in one-stage PCNL was 95.2%;residual stones were seen in 5 case(23.8%),Only 1 case had obviously bleeding in or after operation.The mean time of operation was 2 hours,average hospitalization was 12 days.All were followed for 3-12 minths,1 case had recurrent stones.

结果：21例患者中，并发肾积脓1例，先行经皮肾穿刺造瘘术，1周后行二期mini-PCNL，其余20例均行一期穿刺取石，均为单通道穿刺取石，一期结石清除率95.2%；其中术后5例有残余结石，残余结石发生率为23.8%；术中术后有明显出血1例；手术平均时间2小时；平均住院时间12天；随访3～12个月，1例结石复发。

Cholesterol gallstones formed in C57L mice and fatty livers developed in AKR mice. Conclusions Biliary cholesterol hypersecretion is the key pathophysiological defect of gallstone formation, lith genes have effects on biliary cholesterol hypersecretion and susceptibility to cholesterol gallstone formation in C57L mice. Lithogenic bile is formed at the canalicular membrane and precedes the development of cholesterol gallstones. It is most likely that cholesterol and bile acid hyposecretion make the AKR strain susceptible to the development of fatty livers and resistant to gallstone formation.

结论胆道胆固醇的高分泌是胆囊胆固醇结石形成的主要病理生理基础，结石基因决定了C57L鼠肝内胆汁中胆固醇的高分泌和胆囊胆固醇结石的易患性，成石胆汁形成在肝内胆管，先于胆囊结石的形成；肝内胆汁中胆固醇和胆酸的低分泌可能与AKR鼠脂肪肝的发生和胆囊结石的免患性有关。

We have a senior team of authority experts who have many years of clinical treatment and research experience in lithiasis.

资深的权威专家团队拥有多年结石病临床诊疗与研究经验，精于各类结石疾病诊断与切除缝合治疗，在结石病微创诊疗领域有极高造诣，对于中国结石病诊疗技术的整体发展孝敬突出。

According to the size, the gallstones were divided into 3 groups: maxims stones group, middle stones group, microlith group.

根据结石梗阻的部位将病人分为3组：胆总管下端结石组，壶腹部结石嵌顿组，结石排出组。

The results revealed that the uroliths of goats associated with feeding cottonseed meals diet were the mixture of amount powdery and few granular. X-ray radiology of 'sandy uroliths' feeding cottenseed meals diet to goats was negative. Intravenous urography demonstrated granules of uroliths in the bladder with different density.'sandy uroliths' in kidney, bladder and sigmoid flexure were found with B-mode ultrasonogram.

结果显示：饲喂棉饼诱发的山羊泌尿系统结石呈砂石样，X射线腹部平片呈阴性，经泛影葡胺静脉尿路造影后可见膀胱内有密度不均匀的结石样颗粒分布；B超检查在泌尿道多处出现结石颗粒的强光点或光团并伴有声影；螺旋CT检查发现在泌尿系统的膀胱和尿道中有明确的结石影。

Methods: 328 patients with choledocholithiasis were given EST or EPBD, including single biliary stone in 174 cases, two stones in 112 cases and three stones in 42 cases (one case with 20 stones).

经EST和EPBD共治疗胆总管结石328例，其中单颗结石174例，2颗结石112例，3颗以上结石42例(最多1例20颗结石)。

Abstract］ objective to summarize the methods and experience and analysing of curative effects of open operation combined eswl treating renal staghorn calculi.methods therapeutic results of 8 cases of renal staghorn calculi were analysed retrospectively.results the lithous horn of 8 cases were broken by eswl before operation,then the renal calculus were removed by pyelolithotomy or extended pyelolithotomy.conclusion the method was a good choice of renal staghorn calculi with high stone-free rate,little trauma and less complication.

摘要］ 目的总结开放性手术结合eswl治疗鹿角状肾脏结石方法经验并进行疗效分析。方法回顾分析了8例鹿角状肾脏结石患者的治疗结果。结果 8例患者术前eswl将结石角粉碎，然后应用肾盂切开或肾窦扩大切开手术取出肾盂和肾盏内结石。结论该方法对于鹿角状肾脏结石治疗，结石取净率高，对肾脏损伤小、并发症少，是较为适合的方法。

objective to study the ct diagnosis of ureteral calculus at the distal end of ureter.methods 82 cases of ureteral caculus were examined by ct scanning.all cases were proved by clinical therapeutic results.results ureteral calculuses were showed as high density image in ct scanning.the ct values of the ureteral calculuses less than 7.5mm in diameter were beyond 83hu.the detection rate by ct was 96.3%.in all the 82 cases,ureteral with calculuses were found dilated and 69 cases with nephrohydrosis.in 13 cases with no nephrohydrosis,caculuses less than 3.8 mm in diameter were found.conclusion ct is the most valuable way to diagnose ureteral calculus at the lower end of ureter.appropriate methods of ct scanning are essential.

目的 回顾性分析输尿管膀胱入口处结石的ct诊断结果，评价其ct检查的临床应用价值。方法分析82例输尿管膀胱入口处结石的ct检查结果，所有病例均经尿道排石证实。结果输尿管膀胱入口处结石具有特征性的ct表现，即圆形或枣核状钙化高密度影，结石直径＜7.5mm，ct值≥83hu，ct确诊率96.3%。82例均发现病侧输尿管增粗，69例发现病侧肾盂少量积水，肾盂未见积水的输尿管膀胱入口处结石13例，其结石直径＜3.8mm。结论 ct检查输尿管膀胱入口处结石具有准确、无创、直观等优点，是诊断输尿管膀胱入口处结石不可替代的检查方法。

objective to evaluate efficacy of extracorporeal shock wave lithotripsyfor treating ureteral stones in situ,investigate the cause of higher re-treatment rate.methods total of 687 patients with ureteral stone were received eswl between january 2000 and december 2004,included 455 male(66.2%) and 232 female(33.8%) patients,6 cases have bilateral ureteral calculi,12 cases have unilateral multiple calculi.hence,together 709 ureteral calculi were treated.patients upper ureteral calculi were treated in the supine position,for lower ureteral calculi patients were turned prone.to reduce eswl-induced renal trauma and pain,using lower energy source,adjusted power setting from 9.8 to 13.2kv,limited 1500 shock wavs per one session.no auxiliary procedure were used before eswl.the stone size was measured as the surface area of stone length by stone width on x-ray film.the interval between two treatment sessions was two weeks.results of 709 ureteral calculi,the overall stone free rate was 97.3%(690 calculi),re-treatment rate was 34.1%(292 calculi).according to the performed treatment sessions,one session 467 calculi,the mean stone size 37.27mm2,stone free rate 65.4%(464 calculi).two sessions 138 calculi,the mean stone size 62.48mm2,stone free rate 18.4%(131calculi).three sessions 52 calculi,the mean stone size 79.60mm2,stone free rate 7.1%(50calculi).four sessions 19 calculi,the mean stone size 101.63mm2,stone free rate 2.4%(17calculi).fivesessions 33 calculi,the mean stone size 119.33mm2,stone free rate 3.9%(28 calculi).overall 19 cases(2.7%)turned to other treatment modalities.of 335 upper ureteral calculi,303 achieved stone free (95.8%),re-treatment rate was 38.5%(129 calculi).of 374 lower ureteral calculi,369 achieved stone free(98.7%),re-treatment rate was 30.2%(113 calculi).the re-treatment rate of upper ureteral calculi was higher than lower ureteral calculi(p＜0.05,χ2=5.40).the difference of stone-free rate between upper and lower ureteral calculi was no significant(p＞0.05,χ2=0.15).conclusion eswl should be considered first line therapy for ureteral stone still.stone burden are the main variable of higher re-treatment rate,upper ureteral stone may moving with respiring during eswl.so efficinet shock wave was decreared,re-treatment rate become higher.

目的 评估体外震波碎石治疗输尿管结石的疗效，探讨再治疗率高的原因及输尿管结石的治疗选择。方法回顾2000年1月～2004年12月间eswl治疗输尿管结石的临床资料687例，男455例（66.2%），女232例（33.8%），平均年龄46.6岁（15～83岁）。有双侧输尿管结石6例，单侧多发性输尿管结石12例（4颗1例，3颗2例，2颗9例），共计输尿管结石709颗（含透光结石13颗）。应用上海爱申公司生产的desunit6030型碎石机，c臂x线球管做结石定位。上段输尿管结石（肾盂输尿管交界处至骶髂关节上缘）取仰卧位，下段输尿管结石（骶髂关节上缘下至输尿管口）取俯卧位。为减少eswl引起的肾损伤和疼痛，应用较低的能量，震波发生器电压从9.8～13.2kv，震波频率1.5s。每次治疗设定为1500次震波。治疗后3天摄腹部平片或b超，以后每隔7日重复检查。假如结石未碎或有残留结石最长径＞3mm以上，再次eswl，两次治疗的间隔时间为两周。结石的大小用x线片上的表面积（mm2表示。结果 709颗输尿管结石总的治愈率为97.3%（690颗），再治疗率34.1%（242颗）。其中一次治疗467颗，平均结石大小37.27mm2，治愈464颗（65.4%），3颗改治疗；两次治疗138颗，平均结石大小62.48mm2，治愈131颗（18.5%），7颗改治疗；第1和第2次治疗治愈率（1个月治愈率）为83.8%。3次治疗52颗，平均结石大小79.60mm2，治愈50颗（7.1%），2颗改治疗；4次治疗19颗，平均结石大小101.63mm2，治愈17颗（2.4%），2颗改治疗；5次及5次以上治疗33颗，平均结石大小119.33mm2，治愈28颗（3.9%），5颗改治疗。总计19颗（2.7%）结石改变治疗方式。上段输尿管结石335颗，治愈321颗（95.8%），再治疗129颗（38.5%）。下段输尿管结石374颗，治愈369颗（98.7%），再治疗113颗（30.2%）。经χ2检验，上、下段输尿管结石的再治疗率差异有显著性（χ2=5.40，p＜0.05），治愈率差异无显著性（χ2=0.15，p＞0.05）。不良反应：血压升高13例（1.9%），震波区域疼痛26例（3.8%），震波进入处皮肤点状淤血33例（4.8%），肉眼血尿128例（18.6%），均于第2、3天自行消失。结论 eswl目前仍是输尿管结石的第一线治疗，结石的大小是再治疗率高的主要因素。结石的位置有影响，上段输尿管结石可随呼吸移动，有效震波次数减少，再治疗率比下段输尿管结石高。eswl前注重病例筛选可降低再治疗率。

Neither the killing of Mr Zarqawi nor any breakthrough on the political front will stop the insurgency and the fratricidal murders in their tracks.

在对危险的南部地区访问时，他斥责什叶派民兵领导人对中央集权的挑衅行为。

In fact,I've got him on the satellite mobile right now.

实际上 我们已接通卫星可视电话了