物理振动排石对促进输尿管软镜术后肾脏残石排出的疗效分析

目的 探讨体外物理振动排石对促进输尿管软镜（RIRS）术后肾脏残石排出的临床价值。方法 回顾性分析2018年1月至2019年3月在我中心行RIRS术后肾脏残留结石的128例患者的临床资料,根据碎石术后是否行体外物理振动排石（EPVL）分为EPVL组（n=64）和自然排石组（n=64）,比较2组患者术后不同时间及不同部位的无石率、并发症等。结果 EPVL组和自然排石组术后2、4、6周无石率分别为53.1% vs.32.8%、76.6% vs.56.3%、90.6% vs.65.6%,组间差异均有统计学意义（P<0.05）。术后6周EPVL组和自然排石组在下盏、多盏残石中的无石率分别为88.2%vs.56.3%、83.3%vs.35.7%,组间差异均有统计学意义（P<0.05）。EPVL组和自然排石组术后6周血尿、尿常规中白细胞阳性率分别为10.9%vs.28.1%、6.3%vs.21.9%,2组差异均有统计学意义（P<0.05）。 结论 EPVL可加速RIRS术后肾脏残石排出,尤其对加快肾下盏及多盏残石的排出优于自然排石法,可降低术后并发症,而且几乎无创,易被患者接受。     

输尿管软镜碎石术治疗上尿路结石的临床疗效及安全性分析

目的 研究输尿管软镜碎石术治疗上尿路结石的临床疗效及安全性。方法 选取2022年1月-2023年10月我院诊治的46例上尿路结石患者为研究对象,采用随机数字表法分为对照组和观察组,各组23例。对照组采用经皮肾镜取石术治疗,观察组采用输尿管软镜碎石术治疗,比较两组结石清除率、并发症发生率、临床手术指标、疼痛（VAS）评分、肾功能指标。结果 观察组结石直径＜2 cm清除率高于对照组,结石直径≥2 cm清除率低于对照组（P＜0.05）;观察组并发症发生率为8.70%,低于对照组的21.74%（P＜0.05）;观察组手术时间长于对照组、术中出血量少于对照组、住院时间短于对照组（P＜0.05）;观察组术后24、72 h的VAS评分均低于对照组（P＜0.05）;观察组术后Scr、血红蛋白、尿素氮均优于对照组（P＜0.05）。结论 输尿管软镜碎石术可有效提升上尿路结石患者的结石清除率,降低术后并发症发生率,且具有对肾功能影响小、术中出血量少、疼痛程度轻的优势。     

提前预留输尿管支架对输尿管软镜下治疗上尿路结石手术效果的影响分析

目的分析提前预留输尿管支架对输尿管软镜下处理上尿路结石手术效果的影响。方法回顾性分析212例2016年1至2018年12月期间于我科行输尿管软镜联合钬激光治疗上尿路结石患者的临床资料,根据患者术前是否预留输尿管支架分为预留组(124例)和未预留组(88例)。比较两组患者的手术效果。结果预留组患者输尿管软镜输送鞘(UAS)置入率明显高于未预留组(P0.05);预留组患者手术时间为(56.54±8.21min),明显少于未预留组的(58.34±6.50min)(P0.05);预留组患者结石残余率为(12.9%),明显低于未预留组的25%(P0.05);两组患者均未发生严重不良反应。结论提前预留输尿管支架有利于UAS的置入,可以缩短患者的手术时间,提高患者术后残石率。     

输尿管软镜碎石术与经皮肾镜碎石术治疗直径≤2 cm肾结石的临床疗效对比

目的 比较输尿管软镜碎石术（FURS）与经皮肾镜碎石术（PCNL）治疗直径≤2 cm肾结石患者的临床疗效,为≤2 cm肾结石患者选择合适的治疗方法提供依据。方法 选取2017年7月~2018年7月来我院就诊的160例直径≤2 cm的肾结石患者为研究对象,按手术方式分为FURS组和PCNL组,每组80例。对比两组的手术时间、术中出血量、手术成功率、住院时间、住院费用、碎石成功率以及并发症发生率。结果 FURS组平均手术时间少于PCNL组[（45.05±12.89）min vs （65.95±14.63）min],术中出血量、住院时间及费用均低于PCNL组,差异具有统计学意义（P＜0.05）。FURS组和PCNL组的手术成功率分别为95.00%和92.50%,结石清除率分别为90.79%和87.84%,差异均无统计学意义（P＞0.05）。FURS组术后并发症发生率低于PCNL组（5.26% vs 17.57%）,差异具有统计学意义（P＜0.05）。结论 治疗直径≤2 cm的肾结石,FURS和PCNL两种手术方式均具有较高的结石清除率,但PCNL的术后并发症发生率更高,相比PCNL,FURS具有术中出血量少、住院时间短以及住院费用低等优势,因此FURS是治疗直径≤2 cm肾结石更好的手术选择。     

经直肠诊断输尿管盆段结石与灌肠排石疗法的疗效分析

目的 探讨经直肠彩色多普勒超声诊断输尿管盆段结石与灌肠排石疗法的临床应用价值。方法 彩色多普勒经直肠或阴道检查输尿管盆段结石，并用温盐水灌肠。结果 73例患，经直肠检查64例，经阴道检查9例，其中输尿管盆段结石67例，输尿管盆段肿瘤6例。67例输尿管盆段结石均行灌肠排石疗法，9例灌肠后结石当日排出，47例输尿管盆段结石疼痛立即缓解，周内结石排出，11例排石失败行手术取石。结论：经直肠或阴道检查输尿管盆段结石，方法简单，定位准确，是诊断输尿管盆段病变的可靠途径。灌肠疗法对输尿管盆段结石治疗具有重要的临床应用价值。     

组合式输尿管软镜治疗孤立肾输尿管上段结石

目的探讨使用F8组合式输尿管软镜联合钬激光处理孤立肾输尿管上段结石的临床价值。方法孤立肾输尿管上段结石患者26例,其中左侧结石12例,右侧结石14例。结石直径0.6~2.2 cm,平均直径为(1.38±0.22)cm。采用F8"铂立"输尿管软镜联合钬激光进行碎石。术后常规留置F6 D-J管4周,留置导尿1周。术后1 d查腹部平片(KUB)。结果 23例一次顺利置入输尿管导引鞘,2例留置D-J管2周后二次软镜碎石成功,1例D-J管头端未越过结石,仍无法逆行输尿管软镜碎石,改经皮肾通道顺行输尿管软镜碎石成功。一次碎石成功率88.5%(23/26),二次碎石成功率100%(26/26)。手术时间15~45 min平均(27±3.2)min。术中输尿管穿孔1例,术后感染1例。结论采用F8组合式输尿管软镜处理孤立肾输尿管上段结石安全、微创、有效,可作为治疗孤立肾输尿管上段结石的首选方式。     

微创经皮肾镜与输尿管软镜治疗直径≤3 cm上尿路结石疗效与安全性的Meta分析

目的 利用系统评价分析微创经皮肾镜（≤20Fr）和输尿管软镜在治疗直径≤3 cm上尿路结石的疗效与安全性。方法 通过检索CNKI、万方数据库、VIP、SinoMed、Cochrane图书馆、PubMed、EMBase、Springer等电子数据库,搜集发表于2010年~2020年有关于微创经皮肾镜（≤20Fr）对比输尿管软镜治疗直径≤3 cm上尿路结石的临床研究,对所得文献进行严格筛选排除、风险质量评估及数据提取,运用RevMan5.3软件对数据进行Meta分析。结果 共计纳入随机对照试验14篇,非随机对照实验20篇。累计患者样本量3771例（微创经皮肾镜1918例,输尿管软镜1853例）。Meta分析结果显示微创经皮肾镜组结石清除率[OR=2.11,95%CI（1.66,2.67）,P＜0.05]、手术时间[SMD=-5.80,95%CI（-6.60,-4.99）,P＜0.05]、住院费用[SMD=-15.93,95%CI（-17.66,-14.20）,P＜0.05]优于输尿管软镜组,差异有统计学意义;而输尿管软镜组术后轻度并发症[OR=2.37,95%CI（1.86,3.02）,P＜0.05]、术后VAS评分[SMD=1.26,95%CI（1.18,1.33）,P＜0.05]、术中出血量[SMD=15.73,95%CI（14.71,16.74）,P＜0.05]、住院时间[SMD=1.87,95%CI（1.81,1.93）,P＜0.05]优于微创经皮肾镜组,差异有统计学意义。两组术后发热率[OR=1.22,95%CI（0.91,1.65）,P=0.19]比较,差异无统计学意义。结论 两种术式在治疗直径≤3 cm上尿路结石均具备良好的疗效和安全性,微创经皮肾镜在结石清除效率和经济方面具有优势,输尿管软镜则具有更好的安全性。     

输尿管软镜下钬激光碎石术治疗直径＜2 cm上尿路结石的效果及对炎性因子的影响

目的 分析输尿管软镜下钬激光碎石术治疗直径＜2 cm上尿路结石的效果及对炎性因子的影响。方法 选取2019年1月-2022年12月我院诊治的64例上尿路结石患者为研究对象,采用随机数字表法分为对照组（n=32）和观察组（n=32）,对照组采用经皮肾镜钬激光碎石术,观察组采用输尿管软镜下钬激光碎石术治疗,比较两组结石清除率、临床手术指标、疼痛情况、炎性因子水平[白细胞计数（WBC）、C反应蛋白（CRP）、白细胞介素-6（IL-6）]、并发症发生率。结果 观察组结石清除率、手术时间与对照组比较,差异无统计学意义（P＞0.05）;观察组术中出血量少于对照组、住院时间短于对照组（P＜0.05）;观察组术后5、12、24 h的VAS评分均低于对照组（P＜0.05）;两组术后WBC、CRP、IL-6水平均高于术前,但观察组低于对照组（P＜0.05）;观察组并发症发生率为6.25%,低于对照组的15.63%（P＜0.05）。结论 直径＜2 cm上尿路结石患者采用输尿管软镜下钬激光碎石术的治疗效果确切,具有结石清除率高、术中出血量少、住院时间短、疼痛度小、并发症发生率低的优势,且对炎症因子应激反应小。     

输尿管软镜与经皮肾镜碎石术在治疗肾结石中的对比分析

目的：探讨输尿管软镜与经皮肾镜碎石术在肾结石治疗中的临床效果对比。方法从我院2010年1月~2012年1月接收并治疗的肾结石患者中抽取126例,随机分为对照组和观察组,观察组使用输尿管软镜治疗,对照组使用经皮肾镜碎石术进行治疗,对比分析两者治疗效果。结果观察组患者治疗效果显著,总有效率达到95.2%,明显高于对照组的74.6%。结论在肾结石患者的治疗过程中,对于结石直径在20mm以下的,采用输尿管软镜效果较好,而结石直径在20mm以上的,适合使用经皮肾镜碎石术进行治疗。而当患者具有凝血功能以及解剖结构异常、穿刺困难、肾功能不全情况时,无论结石直径是否大于20mm,均当选用输尿管软镜治疗。     

经直肠诊断输尿管盆段结石与灌肠排石疗法的疗效分析

目的　探讨经直肠彩色多普勒超声诊断输尿管盆段结石与灌肠排石疗法的临床应用价值。方法　彩色多普勒经直肠或阴道检查输尿管盆段结石 ,并用温盐水灌肠。结果　 73例患者 ,经直肠检查 6 4例 ,经阴道检查 9例 ,其中输尿管盆段结石 6 7例 ,输尿管盆段肿瘤 6例。 6 7例输尿管盆段结石均行灌肠排石疗法 ,9例灌肠后结石当日排出 ,47例输尿管盆段结石疼痛立即缓解 ,周内结石排出 ,11例排石失败行手术取石。结论 :经直肠或阴道检查输尿管盆段结石 ,方法简单 ,定位准确 ,是诊断输尿管盆段病变的可靠途径。灌肠疗法对输尿管盆段结石治疗具有重要的临床应用价值     

上尿路结石致重度肾积水的临床治疗（附27例报道）

目的探讨上尿路结石致重度肾积水的临床治疗及最大可能保肾的可行性。方法 27例上尿路结石均致患侧重度肾积水,其中输尿管中下段结石12例,肾盂出口及输尿管上端结石8例,肾脏多发结石5例,肾脏多发结石伴输尿管结石2例;27例患者中,6例伴有对侧上尿路结石,采用经尿道输尿管镜,开放性肾切除、经皮肾穿刺造瘘及经皮肾输尿管镜等治疗手段。结果3例行肾切除,其余24例均成功处理结石并保肾成功。结论对于上尿路结石致重度肾积水患者,可结合尿动力学检查,在安全膀胱情况下尽可能保肾。     

杜冷丁镇痛在气压弹道碎石术治疗输尿管中、下段结石中的应用

目的探讨杜冷丁镇痛在经输尿管镜气压弹道碎石术治疗输尿管中、下段结石中的可行性并总结其应用经验。方法分析经经输尿管镜气压弹道碎石术治疗输尿管中、下段结石229例的临床资料。对比分析杜冷丁镇痛组（86例）与麻醉组（143例）的总体疗效及并发症发生率。结果总体碎石成功率92．1％（211／229），其中杜冷丁组91．8％（79／86），与麻醉组92．3％（132／143）相比无差异（P〉0．05）；杜冷丁组手术总时间，住院天数，治疗费用小于对照组（P〈0．05）。经输尿管镜气压弹道碎石术术后主要并发症为血尿、肾绞痛，以及泌尿系感染、输尿管穿孔、输尿管狭窄，两组间差异无统计学意义（P〉0．05），经保守治疗或腔内手术后均治愈。结论经输尿管镜气压弹道碎石术是输尿管中、下段结石的理想治疗方法；杜冷丁镇痛及麻醉均为保证手术顺利进行的重要辅助措施；其中杜冷丁镇痛可以缩短手术总时间，减少住院天数及治疗费用，值得在临床推广应用。     

Structural and functional modification of hollow organs (urinary bladder and stomach) in vibration syndrome

Exposure to total and local vibration leads to the formation of specific forms of hollow organ diseases: vibration cystopathy and gastropathy. Their characteristic signs are organ dysfunction, thinned wall, atrophy of the mucosa, reduction of the capillary bed, and degenerative atrophic changes in the epithelium, associated with reduction of the protein-producing function and focal metaplasia. Vibration cysto-and gastropathies are systemic manifestations of microangio-and visceropathies of vibration origin. __________ Translated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 142, No. 12, pp. 693–697, December, 2006     

Prediction of physical activity level in adulthood by physical characteristics,physical performance and physical activity in adolescence: an 11-year follow-up study

The purpose of the study was to investigate to what extent the physical activity pattern in adulthood can be predicted by physical characteristics, performance and activity in adolescence. A group of 62 men and 43 women completed a questionnaire concerning physical activity during their leisure time at the ages of 16 and 27 years. An activity index produced from the questionnaire. At the age of 16 years, the subjects were also tested for strength (strength test battery) and running performance (9-min run). Maximal oxygen uptake ( ) was estimated from a submaximal test and a muscle biopsy specimen was taken and analysed for fibre types (percentages of types I, IIA, 1113). The proportion of subjects engaged in some kind of physical activity during their leisure time was approximately 70% among the women and 80% among the men at both ages. The time spent on physical activity (minutes per week) decreased with age for the men but not for the women. The women devoted less time. to physical activity than the men both at age 16 and 27 years. The attitude to endurance activities had changed to a more positive attitude among the women and to a less positive attitude among the men at age 27 years. The aerobic potential ( and percentage of type I fibre), running performance, strength performance, physical activity and marks in physical education at age 16 years explained 82% of the physical activity level in adulthood for the women and 47% for the men. The aerobic potential at age 16 years alone explained 31% of the adult physical activity level in the women and 24% in the men. Strength performance, physical activity and marks in physical education at age 16 years further increased the predictive value for the physical activity level in adulthood for the women but not for the men. It is suggested that the major portion of the variation in physical activity level in adult women, but not in the adult men, could be predicted from physical characteristics, physical performance, and the activity level in adolescence.     

Modifications of serum glycoproteins the days following a prolonged physical exercise and the influence of physical training

Summary Eight male subjects (mean age 24.1±2.6 years) performed at intervals of 2 weeks successively a 3 h and two 2 h runs of different running speed. The days following the running there were moderate elevations of C-reactive protein, haptoglobin, alpha-1-acid glycoprotein, coeruloplasmin, transferrin, alpha-1-antitrypsin and plasminogen. There were small or no changes of albumin, alpha-2-macroglobulin and hemopexin. The elevations of the acute phase reactants were examined in three male subjects following a 2 h run before and after an endurance training period of 9 weeks. This demonstrated a decreased acute phase response after training as illustrated by the changes of C-reactive protein, haptoglobin and alpha-1-acid glycoprotein in spite of higher posttraining running speeds. Well-trained athletes have elevated levels of the serum protease inhibitors alpha-1-antitrypsin, alpha-2-macroglobulin and C₁-inhibitor. These antiproteolytic glycoproteins might limit exercise-induced inflammatory reactions.This research was supported by the Bundesinstitut für Sportwissenschaften (Köln-Lövenich)     

Risk for losing physical independence in older adults: The role of sedentary time,light, and moderate to vigorous physical activity

This study examined the association of a range of physical activity intensities and sedentary behavior with the risk of losing physical independence later in life in community-dwelling older adults. A total of 131 males and 240 females, aged 65–103 years, were enrolled. Physical activity (PA) and sedentary time were assessed with accelerometers and the risk for losing physical independence in later years was assessed with the self-reported composite physical function (CPF) scale adjusted for age. Participants were divided in two groups – high risk group (HRG) and low risk group (LRG), according current CPF. According to the multiple logistic regression analyses, sedentary time was not a significant predictor. The odds of a male participant being in the LRG were 12.19 times higher than those of a female (95% CI 5.06–29.39). Both, light PA (OR = 1.01; 95% CI 1.01–1.02) and MVPA (OR = 1.432; 95% CI 1.21–1.69) had a significant main effect on the risk of losing physical independence. Age and gender interacted with moderate to vigorous PA (MVPA) to predict the risk of losing physical independence. Thus, as age increases, participants that are more physically active became less likely (OR = 0.997; 95% CI 0.995–0.999) to be in the HRG than younger participants. Similarly, the odds of a physically active women being physical independent in later life are higher (OR = 0.94; 95% CI 0.91–0.96) than those of a physically active men. These new findings suggest that light PA, and MVPA are significantly associated with the risk of losing physical independence later in life, and age and gender combined with MVPA have an interaction effect on physical independence of older adults.     

Effects of physical exercise therapy on mobility, physical functioning, physical activity and quality of life in community-dwelling older adults with impaired mobility, physical disability and/or multi-morbidity: a meta-analysis

This is the first meta-analysis focusing on elderly patients with mobility problems, physical disability and/or multi-morbidity. The aim of this study is to assess the effect of physical exercise therapy on mobility, physical functioning, physical activity and quality of life. A broad systematic literature search was performed in the databases PubMed, CINAHL, Embase, PEDro and The Cochrane Library. Relevant study characteristics were reviewed and meta-analyses using standardized mean differences (SMDs) were performed. The results show that physical exercise therapy has a positive effect on mobility (SMD final value: 0.18; 95% CI: 0.05, 0.30; SMD change value: 0.82; 95% CI: 0.54, 1.10) and physical functioning (SMD final value: 0.27; 95% CI: 0.08, 0.46; SMD change value: 2.93; 95% CI: 2.50, 3.36). High-intensity exercise interventions seem to be somewhat more effective in improving physical functioning than low-intensity exercise interventions (SMD final value: 0.22; 95% CI: −0.17, 0.62; SMD change value: 0.38; 95% CI: −0.48, 1.25). These positive effects are of great value for older adults who are already physically impaired. The effect on physical activity and quality of life was not evident and no definite conclusions on the most effective type of physical exercise therapy intervention can be drawn.     

雷公藤多甙联合奥美沙坦脂治疗早中期糖尿病肾病的临床观察

目的观察雷公藤多甙治疗早中期糖尿病肾病（DN）的临床疗效。方法将80例早中期DN患者随机分为治疗组45例、对照组35例,两组患者均口服奥美沙坦脂。治疗组在此基础上加服雷公藤多甙。观察两组患者治疗前后尿白蛋白排泄率（UAER）、尿β2微球蛋白（β2-MG）、单核细胞趋化因子（MCP-1）、血清白蛋白（ALB）、血肌酐（SCr）和谷丙转氨酶（ALT）等指标变化。结果治疗组的总有效率为84.44%,对照组的总有效率为54.29%,治疗组的疗效较对照组好,差异有统计学意义（P〈0.01）。治疗后两组UAER、β2-MG和MCP-1水平较治疗前出现明显下降（P〈0.05或〈0.01）,但治疗组下降更为明显,与对照组比较差异有统计学意义（P〈0.01）。仅治疗组SCr较治疗前和对照组出现明显下降（P〈0.01）,而治疗组ALB水平较对照组和治疗前出现明显提高,差异有统计学意义（P〈0.01）。两组治疗前后的ALT水平差异无统计学意义（P〉0.05）。结论雷公藤多甙联合奥美沙坦酯治疗DN疗效显著,其机理可能与降低MCP-1水平有关,并且毒副作用较小。