输尿管切除术

From April 2000 to June 2002, 512 cases of laparoscopical urologic operation have been performed through transperitoneal and retroperitoneal or extraperitoneal approach: 41 cases of nephrectomy, 36 cases of radical nephrectomy, 10 cases of nephroureterectomy with cystoscopic en bloc excision of the distal ureter and bladder cuff, 3 cases of partial nephrectomy, 78 cases of partial adrenalectomy or resection of adenomas, 71 cases of total adrenalectomy, 17 cases of ureterolithotomy, 122 cases of decortication of renal cyst, 1 case of Anderson-Hynes dismembered pyeloplasty, 7 cases of renal pedical lymphatics disconnection, 2 cases of relative living donor nephrectomy.

本课题通过对223例肾疾病、149例肾上腺疾病、17例输尿管结石病人进行腹腔镜及后腹腔镜手术，其中肾囊肿去顶术140例、单纯肾切除术41例、根治性肾切除术36例、肾输尿管全切及输尿管口膀胱袖套状切除术10例、后腹腔镜肾部分切除术3例、Anderson-Hynes肾盂成形术1例、肾蒂淋巴管离断术7例、腹腔镜和后腹腔镜活体亲属供肾切取术各1例、肾上腺部分或单纯肿瘤切除术78例、肾上腺全部切除术71例、输尿管切开取石术17例。记录手术时间、手术中失血量、肠道功能恢复时间及并发症，将结果与传统开放手术和国外学者的腹腔镜手术结果进行比较，对数据进行统计分析。

Methods Three hundred and fifty patients for laparoscopic surgery were admitted to our department from August 2001 to February 2002. They included 45 cases of adrenal glands surgery, 55 simple nephrectomy, 25 radical nephrectomy, 11 nephroureterectomy, 3 partial nephrectomy, 110 renal cyst decortication, 4 polycystic kidney decortication, 12 ureterolithotomy, 16 pyeloplasty, 3 retrocaval ureteroplasty, 58 varicocele-varix ligation and 8 pelvic lymph node dissection.

从2001年8月～2004年2月，350例患者施行了腹腔镜下泌尿外科手术，其中肾上腺手术45例，单纯肾切除55例，根治性肾切除25例，肾输尿管全切11例，肾部分切除3例，肾囊肿去顶术110例，多囊肾去顶减压术4例，输尿管切开取石术12例，UPJ成型术16例，腔静脉后输尿管成型术3例，精索静脉高位结扎术58例，盆腔淋巴结切除术8例。

Methods The data of 16 cases of ureteral polyps were reviewed and discussed. 2 cases were treated with nephroureterectomy; 10 cases with local resection plus pyeloplasty or ureteral reimplantation; 4 cases with polyps resection plus basement fulguration.

回顾分析16例原发性输尿管息肉患者的临床资料，其中2例行肾输尿管大部切除术，10例行病变输尿管切除加肾盂成形术或输尿管再植术，4例行息肉切除加基底电灼术。

Results Irritative symptoms (78%) and gross hematuria (36%) were the most common symptoms encountered in these patients.

结果尿路刺激症状和血尿为最常见症状，分别为78％和36％。24小时尿抗酸杆菌和尿结核PCR的阳性率分别为25％和40％，IVU，逆行尿路造影及CT的诊断符合率分别为38％，63％和44％。33例患者接受了肾及部分输尿管切除术，肾上盏结核病灶清除术1例，对侧输尿管膀胱吻合术1例及肾穿刺造瘘术1例。1例患者并发血行播散型结核死亡。

Results Irritative symptoms (78%) and gross hematuria (36%) were the most common symptoms encountered in these patients.Acid-fast stains on urinary sediment were positive in 25% of cases and TB-PCR was positive in 40%.The diagnostic accuracy of IVU,retrograde urography and CT in these patients were 38%,63% and 44% respectively.33 patients underwent a nephrectomy and partial ureterectomy,one of them had a contralateral ureter reimplantation.One patients died of miliary tuberculosis. Conclusions Acid-fast stain remains a major pathogen-detecting tool and the value of TB-PCR needs to be confirmed.

结果 尿路刺激症状和血尿为最常见症状，分别为78%和36％。24小时尿抗酸杆菌和尿结核 PCR 的阳性率分别为25％和40％， IVU ，逆行尿路造影及 CT 的诊断符合率分别为38%，63%和44%。33例患者接受了肾及部分输尿管切除术，肾上盏结核病灶清除术1例，对侧输尿管膀胱吻合术1例及肾穿刺造瘘术1例。1例患者并发血行播散型结核死亡。

The positive rates of retrograde ureteropyelography,CT scanning,IVP,ultrasonography were86.7%、50%、12.5%、12.5%respectively.31of40cases were treated by total nephroureterectomy with segmental cystectomy,3cases by segˉmental ureterocystectomy with ureteroneocystostomy,2cases by segmental ureterectomy with end-to-end anastomoˉsis,2cases by single resection of tumor,2cases by resection of residual ureter with segmental cystectomy.

逆行输尿管插管造影、CT、IVP、B超检查的阳性率分别是86.7%、50%、12.5%、12.5%。40例患者中行患肾+全段输尿管+膀胱部分切除术31例，输尿管下段切除术+膀胱吻合术3例，输尿管肿瘤切除+输尿管端端吻合术2例，单纯输尿管肿瘤切除术2例。

Results Conservative treatment was carried out for 4 patients, ureteroureterostomy for 7 patients, ureteroneocystostomy for 22 patients, bladder valve-ureter anastomosis for 2 patients, vermiform appendix-ureter replacement for 2 patients, and nephrectomy for 1 patients.

结果 4例行双J管保守治疗，7例(9侧)行输尿管端端吻合术，2 2例行输尿管膀胱再植术，2例行膀胱壁瓣输尿管吻合术，2例行阑尾代右侧部分输尿管术，1例行肾切除术。

Three Cases with hydronephrosis were located in left kindey, and 3 cases in bilateral kidneys. Of 5 kidneys in 4 cases of ureteropelvic junction obstruction, Anderson-Heny's procedure was performed in 4 kidneys, and nephrectomy was performed in 1 hydronephrotic kidney because the renal function had lost. Cohen's procedure was performed in all 3 individual hydronephrotic kidneys in 2 cases.

病因及治疗：肾盂输尿管连接部梗阻4例5只肾，4只肾做了Anderson-Heny's手术，1只肾无功能行肾切除术；2例3只肾为巨输尿管症，均行Cohen's法输尿管膀胱移植术，其中1例合并膀胱重复畸形，手术中同时行共同壁切除；l例出生后肾积水渐减轻，未特殊处理，正在随访中。

The resection electrode types include: a hand-crafted, temperature-resistant tungsten wire-cutting loop; a coagulating perforated resector that provides a 40% greater coagulation zone than standard cutting loops and performs cutting and coagulation simultaneously during tissue resection; a dimpled vaporization roller that offers a smoother area of vaporization than a grooved roller while providing deep-tissue coagulation; a roller ball and roller barrel, which are used for coagulation and ablation of soft tissue in the bladder and prostate (the roller ball may also be used for endometrial ablation in the uterus); and a Collings knife that allows urologists access to all areas of the prostate and is most commonly used for ureteral meatotomy and transurethral incision of the prostate.

切除电极包括：手动操作、耐受高温、钨丝切除线圈；凝固穿孔前列腺切除器，比标准切除线圈的凝固面积大出40%，能够在组织切除过程中同时进行切除和凝固；一种漩涡汽化转子，比槽式转子提供更加平滑的汽化区域，同时产生深部组织凝固；一个转子球和转子滚筒，用于膀胱和前列腺软组织的凝固和汽化(转子球还可以用于子宫内膜的消融)；一个Collings刀能够帮助泌尿科医生进入前列腺的所有区域，通常用于输尿管切除术和经尿道前列腺切开。

Methods: From January 2004 to September 2006, 56 laparoscopic nephrectomies were performed. Hem-o-lok clips were used to control renal artery and vein in 38 cases, including 9 simple nephrectomies, 18 radical nephrectomies and 11 nephroureterectomies.

2004年1月至2006年9月我科行腹腔镜肾切除术56例，其中38例术中应用Hem-o-lok夹处理肾蒂血管，包括腹腔镜单纯肾切除9例，腹腔镜肾癌根治术18例，腹腔镜肾输尿管全长切除术11例。

Do you know, i need you to come back

你知道吗，我需要你回来

Yang yinshu、Wang xiangsheng、Li decang,The first discovery of haemaphysalis conicinna.

1〕 杨银书，王祥生，李德昌。安徽省首次发现嗜群血蜱。