预防性使用阿托品对无痛膀胱镜检查术中诱发迷走神经反射的防治效果

目的:探讨预防性使用阿托品对无痛膀胱镜检查术中诱发迷走神经反射的防治效果。方法:选择2022年10月—2023年11月在青岛大学医学院松山医院行静脉复合全麻下无痛膀胱镜检查的144例患者作为研究对象,采用完全随机化分组的随机数表法将144例入选病例分为对照组、观察组,各72例。两组均采用地佐辛(0.05 mg/kg)复合1%丙泊酚(1.5~2.0 mg/kg)进行麻醉诱导,待患者睫毛反射消失时开始进行膀胱镜检查。术中丙泊酚以3~6 mg/(kg·h)维持,患者术中如发生体动,则追加丙泊酚0.5 mg/kg,直至检查结束。对照组在1%丙泊酚20 mL中加入0.9%氯化钠溶液1 mL,观察组在1%丙泊酚20 mL中加入阿托品1 mg。两组在麻醉过程中出现心率低于50次/min时,静脉注射阿托品0.5 mg,当血压降低超过20%时静脉注射麻黄碱6 mg。比较两组无痛膀胱镜检查操作时间、术后清醒时间、丙泊酚用量、术中迷走神经反射及并发症发生情况。结果:观察组无痛膀胱镜检查操作时间短于对照组,差异有统计学意义(P<0.01);两组术后清醒时间、丙泊酚用量比较,差异无统计学意义(P>0.05)。观察组术中发生迷走神经反射发生率低于对照组,差异有统计学意义(P<0.01)。两组均无严重并发症,对照组均经及时应用阿托品、麻黄碱等积极抢救治疗而痊愈。结论:无痛膀胱镜检查中预防性使用阿托品不仅有利于缩短操作时间、有利于呼吸管理,更有利于预防迷走神经反射,减少并发症,具有较高的安全性。

分层递进教学模式在膀胱镜教学中的可行性研究

目的评价分层递进教学模式在本科实习生泌尿外科膀胱镜技能培训中的效果,为改进外科教学方法提供参考依据。方法选取2022年5月至2023年4月于新疆喀什地区第二人民医院实习的临床本科生共计40名,根据教学方法不同,随机分为对照组和试验组,对照组采用传统带教模式,试验组采用分层递进教学模式,比较2组学生膀胱镜操作培训效果;记录试验组膀胱镜操作并发症发生例数。结果2组实习生数据对比显示,试验组膀胱镜操作成绩(68.00±6.10)分高于对照组成绩(61.40±4.96)分,差异有统计学意义(P<0.05);试验组膀胱镜检查并发症发生2例,未出现严重并发症。结论分层递进教学模式在临床本科实习生膀胱镜操作培训中的效果优于传统教学模式,为安全、可行的教学方法。

The optimal stent pusher position to achieve successful ureteral stent insertion under fluoroscopic guidance

Objective: To examine factors to predict the optimal stent pusher position when inserting ureteral stents under fluoroscopy.Methods: We retrospectively reviewed 327 patients who underwent ureteral stent insertion. We considered the pubic bone as a useful anatomical landmark to insert ureteral stents under fluoroscopic guidance. Thus, we categorized patients into three groups (proximal, middle, and distal groups) according to the position of the radiopaque tip of the push catheter when inserting the ureteral stent. Success was defined as a completely curled ureteral stent tail. We compared stent insertion success rates among the three groups. A multivariate analysis was performed to identify the factors affecting stent insertion success.Results: In men, 36 (63.2%) cases were deemed successful in the proximal group compared with 40 (80.0%) cases in the middle group and 12 (20.7%) cases in the distal group (p<0.001). In women, 26 (45.6%) cases were deemed successful in the proximal group compared with 54 (98.2%) cases in the middle group and 38 (76.0%) cases in the distal group (p<0.001). With the multivariate analysis, the stent pusher position was the most significant factor influencing successful stent insertion (men: odds ratio 6.00, 95% confidence interval 2.66-13.51, p<0.001;women: odds ratio 37.80, 95% confidence interval 4.94-289.22, p<0.001).Conclusion: The position of the stent pusher affects stent insertion success. The middle of the pubic symphysis is the optimal position for the radiopaque tip of the pusher when inserting ureteral stents under fluoroscopic guidance.

Fine-needle aspiration technique under endoscopic ultrasound guidance:A technical approach for RNA profiling of pancreatic neoplasms

BACKGROUND Early diagnosis of pancreatic ductal adenocarcinoma(PDAC)has been a longstanding challenge.The prognosis of patients with PDAC depends on the stage at diagnosis.It is necessary to identify biomarkers for the detection and differentiation of pancreatic tumors and optimize PDAC sample preparation procedures for DNA and RNA analysis.Most molecular studies are done using paraffin-embedded blocks;however,the integrity of DNA and RNA is often compromised in this format.Moreover,RNA isolated from human pancreatic tissue samples is generally of low quality,in part,because of the high concentration of endogenous pancreatic RNAse activity present.AIM To assess the potential of endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)to obtain specimens from pancreatic neoplasms for subsequent RNA molecular profiling,including next-generation sequencing(NGS).METHODS Thirty-four EUS-FNA samples were included in this study:PDAC(n=15),chronic pancreatitis(n=5),pancreatic cysts(n=14),mucinous cysts(mucinous cystic neoplasia/intraductal papillary mucinous neoplasia)n=7,serous cystic neoplasms n=5,and pseudocysts n=2.Cyst material consisted of cyst fluid and cyst wall samples obtained by through-the-needle biopsy(TTNB).Samples were stored at -80℃ until analysis.RNA purity(A260/230,A260/280 ratios),concentration,and integrity(RIN)were assessed.Real-time polymerase chain reaction was conducted on all samples,and small RNA libraries were prepared from solid mass samples.RESULTS RNA was successfully extracted from 29/34(85%)EUS-FNA samples:100% pancreatic adenocarcinoma samples,100% chronic pancreatitis samples,70% pancreatic fluid cyst samples,and 50%TTNB samples.The relative expression of GAPDH and HPRT were obtained for all successfully extracted RNA samples(n=29)including lowquality RNA specimens.Low concentration and nonoptimal RIN values(no less than 3)of RNA extracted from EUS-FNA samples did not prevent NGS library preparation.The suitability of cyst fluid samples for RNA profiling varied.The quality of RNA extracted from mucinous cyst fluid had a median RIN of 7.7(5.0-8.2),which was compatible with that from solid neoplasms[6.2(0-7.8)],whereas the quality of the RNA extracted from all fluids of serous cystic neoplasms and TTNB samples had a RIN of 0.CONCLUSION The results demonstrate the high potential of EUS-FNA material for RNA profiling of various pancreatic lesions,including low-quality RNA specimens.

门诊膀胱镜检查患者的人文关怀理念护理服务效果及对疼痛评分的影响

目的探究人文关怀理念护理服务对门诊膀胱镜检查患者的效果及疼痛评分的影响。方法简单随机选取2022年10月-2023年8月盐城市第一人民医院膀胱内镜室接受膀胱镜检查的100例患者为研究对象,随机选出50例作为对照组,实行常规护理,另外选出50例作为观察组,在常规护理基础上加入人文关怀护理服务。对比两组紧张和恐惧程度、依从性、插管成功率、疼痛程度、护理满意率。结果观察组患者紧张和恐惧程度比对照组更优,差异有统计学意义(P均<0.05)。观察组依从性和插管成功率均对照组,差异有统计学意义(P均<0.05)。观察组护理后疼痛程度轻于对照组,差异有统计学意义(P<0.05)。观察组护理总满意率(100.00%)明显高于对照组(82.00%),差异有统计学意义(χ^(2)=9.890,P<0.05)。结论门诊膀胱镜检查过程中,积极开展人文关怀理念护理服务,可以有效减轻患者紧张、恐惧感和疼痛度,更好地配合插管,保证插管成功率,大大提高患者护理满意度。

知信行护理联合耳穴压豆对膀胱镜检查患者的影响

目的:分析知信行护理联合耳穴压豆对膀胱镜检查患者的影响。方法:选取2020年8月—2023年8月徐州市中医院收治的70例膀胱镜检查患者。根据随机数表法将其分为观察组和对照组,各35例。对照组实施常规护理,观察组实施知信行护理联合耳穴压豆。比较两组干预前后负性情绪、疼痛程度及治疗依从性。结果:干预后,两组汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)评分、汉密尔顿抑郁量表(Hamilton depression scale,HAMD)评分均低于干预前,观察组HAMA、HAMD评分均低于对照组,差异有统计学意义(P<0.05)。干预后,观察组视觉模拟评分法(visual analogue scale,VAS)评分显著低于对照组,差异有统计学意义(P<0.05)。观察组完全依从率高于对照组,差异有统计学意义(P<0.05)。结论:膀胱镜检查患者应用知信行护理联合耳穴压豆,可有效改善患者负性情绪,减轻疼痛感,增强检查依从性。

Efficacy and Safety of COX-2 Inhibitor Parecoxib for Rigid Cystoscopyrelated Pain Management in Male Patients:A Prospective,Randomized and Controlled Study

Using anesthetic gel may not sufficiently exclude pain perception during and after cystoscopy in male patients.To evaluate the analgesic efficacy and safety of intramuscular parecoxib(40 mg)for outpatient-based rigid cystoscopy,we performed a prospective,randomized and controlled study.Consecutive male patients requiring diagnostic cystoscopy in our hospital were divided into group A(1%tetracaine gel,n=50)and group B(parecoxib,n^5l)at random.Patients received intramuscular injections of either 2 mL sterile saline in group A or 40 mg parecoxib in group B 30 min before the procedure.Tetracaine gel was injected into the urethra 3 min before the procedure in group A,with patients receiving plain lubricant gel in group B at the same time.Cystoscopy-associated pain levels were evaluated using the Visual Analog Score(VAS)during the procedure.Post-procedure urethral pain and complications were recorded and analyzed.The results showed that male patients experienced significantly less pain in group B than in group A(2.70±1.36 V5.3.56±1.74,P=0.008).The percentage of patients with dysuria pain was not significantly different between the two groups.In addition,24 h after cystoscopy,the patients with no previous experience of cystoscopy were more likely to declare urethral pain(59.2%vs.33.3%,P=0.012,relative risk=1.78).No difference was observed in analgesic-related complications between the two groups.We conclude that intramuscular injection of 40 mg parecoxib may improve comfort for male patients undergoing rigid cystoscopy.

Wireless Capsule Cystoscopy: How Near? How Far?

It is a fact that performing endoscopy using conventional methods requires substantial time and development of alternative diagnostic modalities. Replacement of rigid endoscopes with flexible and digital devices in time, faster performance of the procedures and reduced time for them to turn back to work brought about the expectancy. It was possible that easier and more reliable methods could exist. Idea of capsule endoscopy was born following examination of the gastrointestinal tract with an endoscope with shape of a capsule. Although idea of capsule endoscopy was suggested long years ago, it fell behind the advances in conventional step of the endoscopy, especially developmental speed of the flexible devices. Furthermore, three-dimensional (3D) organ views can be processed digitally by means of sophisticated software in the fields of computerized tomography and magnetic resonance imaging. Thus, virtual cystoscopy of high resolution and specificity is possible by means of both methods. Wireless capsule endoscopy is still in the experimental stage. “Steerable independent intracorporeal endoscope” with feature of consecutive instillation in addition to its diagnostic utility is not a dream.

Modern advances in reducing anxiety and pain associated with cystoscopy:Systematic review

AIM:To investigate if music reduces anxiety and pain in the Veterans Affairs population undergoing flexible cystoscopy. METHODS:This study was reviewed and approved by the University of California,San Diego Human Research Protections Program Institutional Review Board. Patients were prospectively randomized to undergo flexible cystoscopy with or without music. Thirty-eight patients were randomized into either the No Music group(n = 24) or the Music group(n = 14). We used the state-trait anxiety inventory and the visual analog pain scale,respectively. Statistics were generated and compared using an independent t-test and chi-squared tests. P values < 0.05 were considered statistically significant. Outpatient cystoscopy is a safe and useful procedure employed frequently in Urology for diagnosis and evaluation of genitourinary pathologies. However,cystoscopy-related distress cannot be ignored. Three components of outpatient cystoscopy have been evaluated to improve the cystoscopic experience:local anesthetic control,cystoscopic equipment redesign and environmental modification. We reviewed the literature pertaining to these modifications. RESULTS:The mean age was 65.3 and 67.1 years for men in the No Music and Music groups,respectively.Although,the majority of patients in each group selfidentified as Caucasians(66%),African American,Hispanic and other ethnicities represented 13%,8% and 13% respectively. The majority of patients(68%) reported experiencing hematuria. Thirty-four percent had a history of bladder cancer,and eighteen percent had a history of prostate cancer. Ten patients(26%) admitted to taking antidepressants. Physiologic parameters that correlated to pain and anxiety(systolic blood pressure,diastolic blood pressure,and heart rate) were statistically similar in both groups prior to and after flexible cystoscopy. The median delta anxiety between the No Music and Music groups were not significantly different(0.78 vs-1.46),and the pain scores between the No Music and Music groups(1.5 vs 1.6) were not statistically different(P = 0.28 and P = 0.92,respectively).CONCLUSION:Preliminary results demonstrate that music does not reduce anxiety or pain associated with flexible cystoscopy.

Autonomic Dysreflexia Severity between Urodynamics and Cystoscopy in Patients with Spinal Cord Injury above T6

Objective: The objective is to evaluate autonomic dysreflexia (AD) severity between urodynamics and cystoscopy in patients with spinal cord injury (SCI) above thoracic 6 (T6). Design: It is a cross-sectional survey. Subject and methods: The study was carried out in 22 patients with SCI above T6 who underwent both procedures of urodynamics and cystoscopy;all patients developed episodes of AD. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured and recorded at the beginning and during the various stages of the two examinations. AD was defined as a rise in SBP above 20 mm Hg. Results: There was no significant difference in SBP and DBP at baseline before urodynamics and cystoscopy. Both urodynamics and cystoscopy triggered episodes of AD. The volume of water instilled during cystoscopy was typically standard and smaller (150 mL) in comparison with urodynamics, where volume varied depending on cystometric bladder capacity (the mean bladder volume in our study was 234.86 ± 139.06 mL). The SBP was significantly different between cystoscopy and urodynamics (49.23 ± 23.07 mm Hg and 35.14 ± 15.75 mm Hg, respectively;P = 0.023). Conclusions: Although bladder distension during cystoscopy was less than that in urodynamics, the severity of AD was more pronounced during cystoscopy. It is recommended that monitoring of cardiovascular parameters during these procedures should be routinely performed.

The Additional Value of Cystoscopy with Urodynamic Study in the Assessment of Patients with Urinary Incontinence

Background: Urinary incontinence (UI) is generally defined as the involuntary loss of urine from the bladder through the urethral meatus. Filling cystometry is the method by which the pressure/ volume relationship of the bladder is measured during bladder filling. Purpose: To determine the value of diagnostic cystoscopy in addition to Urodynamic study (UDS) in patients with primary urinary incontinence. Material and Methods: 200 patients with primary incontinence studied prospectively from January 2013 to June 2014. Their age ranges from (14 - 93 years), 86.5% were female, and 13.5% of them were male. In addition to physical, neurological examination and bio-chemical investigations, urine analysis and urine culture with Ultra-sound and Post void residual volume (PVRV), all patients underwent diagnosticflexible cystoscopy under local anesthesia, and urodynamic study. Result: 43.5% of patients age were between (34 - 53 years), (39%) between (54 - 73 years), (9%) between (14 - 33 years) and (8.5%) were between (74 - 93 years). Atonic bladder on UDS were (40.5%), Detrusor over activity (29%), patients with normal UDS were (22%) and patients that had DSD (Detrusor Sphincter Dyssynergia) were (8.5%). Eighty-four cases (42%) were found to have normal cystoscopy, those with grade-I-II bladder wall trabeculations were (49%) and patients with grade-III were (8.5%). Sixty-one patients (30.5%) with normal diagnostic cystoscopy have abnormal UDS (Atonic bladder, over-active bladder and DSD) while twenty-one (10.5%) patients with normal UDS had bladder wall trabeculations (grade-I-III) on diagnostic cystoscopy. Conclusion: Diagnostic cystoscopy in addition to urodynamic study will put in further knowledge in the assessment of patients with urinary incontinence. To some extent, it can predict the diagnosis.

不同剂量阿芬太尼复合丙泊酚在无痛膀胱镜检查中的临床应用效果

目的:研究不同剂量阿芬太尼复合丙泊酚在无痛膀胱镜检查术中的临床应用效果。方法:选取2021年1月—2021年12月在我院行静脉全麻下膀胱镜检查的患者105例,采用随机数字表法将患者随机分为A组、B组和C组,分别采用阿芬太尼5μg/kg、7.5μg/kg和10μg/kg复合丙泊酚麻醉,目标镇静深度为改良警觉/镇静评分(MOAA/S)≤2分。记录膀胱镜检查中检查时间、低氧血症发生率、不自主体动事件、低血压、心动过缓、术后恶心、头晕发生率、术后尿路刺激征发生率、中重度尿路刺激征发生率、镇静成功率、丙泊酚用量、血管活性药物使用人数、诱导时间、苏醒时间及满意度评分。结果:C组患者术中低氧血症发生率明显高于B组(25.0%vs 3.2%,P<0.05);A组低血压发生率显著高于B组(32.4%vs 9.7%,P<0.05),A组心动过缓发生率(35.3%)显著高于B组(12.9%)、C组(12.5%),差异有统计学意义;A组尿路刺激征发生率(67.6%)显著高于B组(35.5%)、C组(25.0%),差异有统计学意义。A组丙泊酚用量、血管活性药人数及苏醒时长均显著高于B、C组,差异有统计学意义;3组患者的镇静成功率、中重度尿路刺激征及满意度评分差异均无统计学意义。结论:阿芬太尼7.5μg/kg复合丙泊酚麻醉在无痛膀胱镜检查中安全有效,麻醉效果较好。

荧光膀胱镜在尿路上皮膀胱癌中的诊断价值

目的:评估以5-氨基乙酰丙酸(5-aminolevulinic acid,5-ALA)作为荧光剂的荧光膀胱镜检查对非肌层浸润性膀胱癌的诊断价值。方法:按照筛除纳入标准,纳入97名研究对象,膀胱灌注50 mL浓度为3%的5-ALA溶液,保留1小时后,排空膀胱后置入膀胱镜,分别在普通白光和荧光下观察,对白光和/或荧光下显示阳性或可疑区域取组织做病理活检,同时行电切术。结果:97例患者中,19例患者普通白光膀胱镜及荧光膀胱镜下检查均为阴性,剩余78例患者取156处组织进行活检,平均每例患者取2块组织。结果显示97处病理报告为尿路上皮癌。经计算得出荧光膀胱镜的敏感性为91.75%(89/97),特异性为64.41%(38/59);普通白光膀胱镜的敏感性为71.13%(69/97),特异性55.93%(33/59);P<0.05,差异具有统计学意义。结论:荧光膀胱镜在诊断尿路上皮膀胱癌上的敏感性和特异性均显著高于普通白光膀胱镜,具有较高的临床应用价值。

瑞马唑仑复合曲马多在膀胱镜相关手术中的应用研究

目的探讨瑞马唑仑复合曲马多在膀胱镜相关手术中的应用效果。方法120例行膀胱镜相关短小手术的患者,采用随机抽签法分为对照组和观察组,每组60例。对照组采用丙泊酚复合曲马多进行麻醉,观察组采用瑞马唑仑复合曲马多进行麻醉。比较两组患者麻醉药物起效时间、苏醒时间、镇静成功率、体动反应情况,不同时间点[麻醉前(T0)、睫毛反射消失(T1)、进镜时(T2)、操作至5 min时(T3)、退镜时(T4)、麻醉苏醒时(T5)]生命体征[心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_(2))],不良反应发生情况。结果两组麻醉药物起效时间、镇静成功率比较,差异无统计学意义(P>0.05);观察组苏醒时间(3.81±1.03)min短于对照组的(8.62±1.87)min,体动反应发生率3.33%低于对照组的15.00%,差异有统计学意义(P<0.05)。观察组T0、T1、T2、T3、T4、T5时MAP分别为(85.65±5.23)、(85.96±5.72)、(86.74±5.67)、(86.69±5.71)、(86.96±4.67)、(86.31±5.67)mm Hg(1 mm Hg=0.133 kPa),HR分别为(73.93±4.67)、(74.41±4.31)、(74.73±4.57)、(75.15±3.98)、(74.93±3.67)、(74.53±3.87)次/min,SpO_(2)分别为(97.15±1.23)%、(96.94±1.82)%、(96.74±1.17)%、(96.69±1.31)%、(96.76±1.37)%、(96.94±1.67)%;对照组T0、T1、T2、T3、T4、T5时MAP分别为(85.64±5.67)、(82.05±4.63)、(80.34±4.46)、(81.65±4.07)、(82.87±4.07)、(83.08±4.66)mm Hg,HR分别为(73.65±4.66)、(70.35±3.67)、(68.51±3.34)、(69.67±3.67)、(71.64±4.02)、(72.07±3.57)次/min,SpO_(2)分别为(97.64±1.66)%、(94.25±1.63)%、(93.04±1.06)%、(91.57±1.61)%、(93.64±1.07)%、(94.01±0.66)%。观察组T1、T2、T3、T4、T5时MAP、HR、SpO_(2)与T0时比较,差异无统计学意义(P>0.05);对照组T1、T2、T3、T4、T5时MAP、HR、SpO_(2)均明显低于T0时,差异有统计学意义(P<0.05);T0时,两组MAP、HR、SpO_(2)比较,差异无统计学意义(P>0.05);T1、T2、T3、T4、T5时,观察组MAP、HR、SpO_(2)均高于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率15.00%低于对照组的33.33%,差异有统计学意义(P<0.05)。结论膀胱镜相关手术中,瑞马唑仑复合曲马多的麻醉效果优于丙泊酚复合曲马多麻醉,应用瑞马唑仑复合曲马多麻醉可降低对患者血流动力学的影响,且不良反应少,值得临床推广。

腺性膀胱炎误诊为膀胱肿瘤临床分析

目的探讨腺性膀胱炎早期误诊为膀胱肿瘤的原因及防范措施。方法回顾性分析2021年2月—2022年10月收治术前误诊的腺性膀胱炎11例的临床资料。结果11例以不同程度尿频、尿急、尿痛伴或不伴肉眼血尿、排尿困难、下腹部胀痛等为主要症状就诊,结合经腹超声检查结果,初步诊断为膀胱肿瘤,不排除恶性可能。为鉴别肿瘤性质,行膀胱镜下活检术,确诊为腺性膀胱炎。误诊时间为5~7 d。11例确诊后予经尿道电气化术联合药物膀胱灌注治疗,治疗结束后2~3个月,复查膀胱镜膀胱黏膜恢复正常。结论腺性膀胱炎发病率较低,早期临床表现、超声声像学表现多样且无特异性,在未行膀胱镜和手术病理检查前易误诊为膀胱肿瘤。

The natural course of bacillus Calmette-Guerin induced bladder lesions:A long-term follow-up study and systematic review

Objective:Bacillus Calmette-Gue´rin(BCG)instillation is the standard adjuvant treatment for intermediate-and high-risk non-muscle-invasive bladder cancer after transurethral resection.Nevertheless,its toxicity often causes bladder complications.On follow-up cystoscopy,post-BCG bladder lesions can be pathologically benign,urothelial carcinoma recurrence,or other types of bladder malignancy.Only a small number of case reports have been published on post-BCG bladder lesions.Their clinical features,natural course,and management remain unknown.Methods:We retrospectively studied cystoscopic videos and medical records of BCG-treated bladder cancer patients at our center.During a long-term follow-up,we took biopsies on tumor-like lesions and described their changes.In addition,we summarized previous studies on post-BCG bladder lesions by systematic literature searching and review.Results:We described a series of three cases with post-BCG bladder lesions mimicking tumor recurrence from a total of 38 cases with follow-up data for more than 5 years.Those lesions could last,grow,or disappear spontaneously,and remain pathological benign for years.In systematic review,we identified and analyzed a total of 15 cases with post-BCG bladder lesions with detailed clinical information.Eleven of the 15 were benign and have a good prognosis with nephrogenic adenoma being the most common pathological type.Conclusion:Based on previous studies and our experience,benign lesions after BCG instillation cannot distinguish with cancer recurrence by cystoscopy alone,even under narrow band imaging mode.Nonetheless,given most of them have a good prognosis,random biopsy or transurethral resection might be spared in the patients with long-term negative biopsy and urine cytology.

Intra Uterine Device (IUD) Migration into the Bladder. Diagnosis Issues and Management

Background: Intra uterine device (IUD) is commonly used as contraceptive procedure. A mislocation is possible and may reduce quality of life. Aim: This paper aims to present a rare case report and emphasize on the difficulty of diagnosis. Case Presentation: A 40-year-old woman had a history of IUD implantation after her last delivery. Six years later, she visited a doctor for a pelvic pain going on for a long period. The diagnosis of mislocated intra uterine device (IUD) was made using imaging techniques. Conclusion: A pelvic pain in a woman, going on for a long period, should evoke a migrated IUD. Thorough exploration and management are required.

膀胱镜联合腹腔镜切除术治疗膀胱憩室的初步疗效

目的探索性分析膀胱镜联合腹腔镜切除术治疗膀胱憩室的疗效及其安全性。方法回顾性收集2007年3月至2022年9月北京协和医院行手术治疗膀胱憩室患者的临床资料,根据术式其分为单纯开放手术/腹腔镜组、膀胱镜联合腹腔镜组。比较两组手术相关指标及并发症发生率。结果共入选符合纳入与排除标准的膀胱憩室患者11例,包括单纯开放手术/腹腔镜组6例、膀胱镜联合腹腔镜组5例,其憩室最大径分别为7.5(4.5,11.5)cm、5.2(5.0,7.9)cm,憩室口直径分别为1.1(1.0,1.6)cm、1.5(1.1,1.8)cm。两组均顺利完成手术,拔除尿管后均正常排尿;随访6~60个月均无憩室复发。膀胱镜联合腹腔镜组与单纯开放手术/腹腔镜组的手术时间[150.0(142.5,180.0)min比160.0(108.8,300.0)min]、术中出血量[50.0(35.0,50.0)mL比50.0(45.0,62.5)mL]、引流管拔除时间[5.0(3.5,5.5)d比4.5(4.0,6.8)d]均相近;相较于单纯开放手术/腹腔镜组,膀胱镜联合腹腔镜组术后住院时间缩短[6.0(6.0,8.5)d比9.5(7.0,16.0)d],尿管拔除时间延长[14.0(10.5,14.0)d比11.5(6.5,13.3)d]。膀胱镜联合腹腔镜组无并发症发生,单纯开放手术/腹腔镜组2例出现术后并发症,包括下肢深静脉血栓形成1例、术后高热1例。结论膀胱镜联合腹腔镜切除术治疗膀胱憩室可取得与单纯开放手术或腹腔镜手术相近的疗效,且其安全性更高、患者术后恢复更快。

丁卡因胶浆联合全程心理干预对膀胱镜检查手术患者生理心理不适的影响

目的:探讨丁卡因胶浆联合全程心理干预在膀胱镜检查手术中的应用效果,为减少患者并发症和生理心理不适提供可行方法。方法:选择2017年1-12月某院收治的膀胱镜检查患者451例,依据随机数字表法分为对照组(n=225)和治疗组(n=226),治疗组采用丁卡因胶浆联合全程心理干预,对照组采用达克罗灵胶浆联合常规心理干预,检查后采用视觉模拟评分量表(VAS)评估两组的疼痛程度,并采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评估两组干预前后的负性情绪,采用心理弹性量表(CD-RISC)评估两组干预前后的心理弹性,比较两组接受检查的依从性和对干预的满意度。结果:治疗组在膀胱镜检查中的疼痛情况明显优于对照组(Z=4.494,P<0.05);干预后,治疗组的SAS、SDS评分均明显低于对照组(t=5.499,4.307;P<0.05),CD-RISC各维度评分均显著高于对照组(t=9.386,8.081,6.764;P<0.05);且治疗组患者的依从性高于对照组,满意度亦明显高于对照组(χ~2=8.076,5.147;P<0.05)。结论:丁卡因胶浆联合全程心理干预应用于膀胱镜检查手术中,有助于减轻患者心理生理不适反应,提高患者检查的依从性,保证检查顺利完成;同时提高了患者的满意度,值得临床推广应用。

小剂量艾司氯胺酮联合环泊酚在老年患者无痛膀胱镜检查中的价值

目的探讨老年患者接受无痛膀胱镜检查期间采用小剂量艾司氯胺酮、环泊酚联合麻醉的效果与价值。方法随机选择2022年1—12月于沛县人民医院接受无痛膀胱镜检查的老年患者80例作为研究对象,按照随机编号抽签结果进行分组,对照组(40例)患者检查前单纯以环泊酚麻醉;观察组(40例)患者检查前采用小剂量艾司氯胺酮、环泊酚联合麻醉。对比麻醉情况,监测两组患者血压、心率,对比组间差异,观察统计各组患者检查结束后出现的不良反应。结果两组患者麻醉诱导时间及检查时间比较,差异无统计学意义(P>0.05)。观察组患者苏醒时间低于对照组,差异有统计学意义(P<0.05)。同时检查过程中观察组患者体动概率2.50%低于对照组20.00%,差异有统计学意义(χ^(2)=4.507,P<0.05)。观察组检查即刻、完成检查及结束后20 min平均动脉压、心率均高于对照组,差异有统计学意义(P<0.05)。观察组产生不良反应的总发生率低于对照组,差异有统计学意义(P<0.05)。结论老年患者接受无痛膀胱镜检查时可通过小剂量艾司氯胺酮、环泊酚联合麻醉,相比单药麻醉效果更理想,对患者生理指标影响低,不良反应少。