输尿管的

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。

6 cases of urethostenosis, 2 cases of urotithiasis and 1 case of urethral valves were cured one time. They were followed up from 10 months to 6 years and no dysuria occurred. 2 cases of external plank shedding after ureteropelvioplasty were treated with a placement of internal plank through the renal fistulization. The placement and evulsion of internal plank were carried out one time in 8 cases of ureteric calculi (the length of one calculi was as long as 4cm) and 12 cases of ureteropalsty. In 5 cases of upper remotion of internal plank, 4 cases were pulled out successfully and one failed to draw out. The effect is satisfactory to treat urological diseases by means of ureteroscopy in children.

结果 6例尿道狭窄、2例尿道结石、1例尿道瓣膜均一次性治愈，随访10个月~6年，无排尿异常。2例肾盂输尿管成形术后外支架管脱落经肾造瘘口放置内支架；8例输尿管结石（1例石街长约4cm）、12例输尿管成形术后内支架置入和／或拔出均一次完成。5例内支架上移中4例顺利拔出，1例失败、结论输尿管镜对小儿尿路系统大部分疾病的处理有满意效果。

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。

The 112 cases review analyses outpatient services are applied curing the clinical data of ureter disease patient through the trans-urethral ureteroscope, and among them cure in next section 97 cases in the middle and lower ureteral stone combination the going on nephralgia, blocking nature kidney, the ballistic lithotripsy etc through the trans-urethral ureteroscope, other is for diagnosis 15 cases URS.

回顾性分析112例急诊应用经尿道输尿管镜术治疗输尿管疾病患者的临床资料，其中经尿道输尿管镜术联合气压弹道碎石术治疗输尿管中下段结石合并持续性肾绞痛、梗阻性肾功能不全、感染等97例。

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。

Result The contour of bilateral kidney,renal pelvis and calices and ureters were showed clearly with digital laminography.19 cases showed normal.55 cases showed renal or ureteral calculus,ureterohydronephrosis.16 cases were chronic pyelonephritis,renal atrophy or renal tum...

结果运用数字化成像体层摄影能较好显示双肾轮廓，肾盂、肾盏及双侧输尿管，不单能较好显示肾结石、输尿管结石，对慢性肾盂肾炎、肾萎缩等肾内科肾病显示清楚，19例显影正常，肾结石及输尿管结石，肾积液及输尿管积液共55例，慢性肾盂肾炎、反流性肾病所致的肾瘢痕、肾萎缩、肾肿瘤等内科肾病16例。

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。

Methods A retrospective analysis was performed in 14 cases of urinary obstruction among 1090 cases of transplanted kidney in the year 2000-2006, including 9 cases of vesicoureteral anastomotic stricture, 6 of whom received a second vesicoureteral anastomosis, one had infection surrounding the renal graft and ureter end necrosis, two ureteral anastomosis with bladder muscle flap, and one stenostomia aerocyst distention under ureteroscope.

回顾总结2000-2006年我院1090例肾移植患者中的14例移植后上尿路梗阻患者，其中输尿管膀胱吻合口狭窄9例，6例行膀胱输尿管二次吻合手术，1例移植肾周感染输尿管末段坏死采用移植肾近端新鲜存活输尿管与自体输尿管吻合，1例采用膀胱肌瓣代移植输尿管，1例采用输尿管镜下气囊扩张后放置双J管。

If this process were bilateral, then the problem would originate in the bladder trigone or urethra (or the prostate around the urethra) or some process that could impinge on both ureters.

如果病变是双侧的，原因可能是膀胱三角或尿道前列腺部的病变；或是其它能侵犯两侧输尿管的病变。

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。

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。