问题 单项选择题

肾结石2.0cm治疗方案()

A.药物的治疗及大量饮水

B.体外冲击波碎石

C.内镜治疗

D.开放手术

E.中西医结合

答案

参考答案:B

解析:

 (1)非手术治疗:结石<0.6cm,光滑,无梗阻及感染、纯尿酸结石或胱氨酸结石,应试行药物排石及溶石治疗。直径<0.4cm,光滑的结石,90%能自行排出。

(2)体外冲击波治疗(ESWL):适用于肾、输尿管上段<2.5cm的结石,具有正常肾功能,碎石成功率可达90%左右。结石过大常需分次碎石,间隔时间必须不少于1周。但结石远端尿路有梗阻、妊娠、出血性疾病、严重心脑血管病、安置心脏起搏器者、急性尿路感染、血肌酐>265μmoL/L、育龄妇女下段输尿管结石等应列为碎石禁忌证。因过度肥胖不能聚焦、肾位置过高、严重骨关节畸形致结石难以定位,也不适宜采用ESWL治疗。若击碎之结石堆积于输尿管内形成“石街”,患者会出现疼痛或不适,有时还可合并感染和肾功能受损等并发症。

(3)内镜治疗:输尿管镜取石或碎石术:适用于中、下段输尿管结石,平片不显影结石,因肥胖、结石硬、停留时间长和经ESWL治疗后并发(石街)等患者,经 * * 置镜入膀胱输尿管镜直达结石部位,直视下用激光、超声或气压弹道击碎结石。下尿路梗阻、输尿管细小、狭窄或严重扭曲等不宜采用此法。结石过大或嵌顿紧密,造成手术困难或失败。并发症有输尿管黏膜下损伤、假道、穿孔、撕裂、感染等,远期可有输尿管狭窄、闭塞或逆流等。

经皮肾镜取石或碎石术:经腰背部细针穿刺直达肾盏或肾盂,扩张并建立皮肤至肾内通道,放入肾镜,直视下取石或碎石。取石后安置肾造瘘管引流尿液。适用于>2.5cm的肾盂结石,部分肾盏结石及鹿角形结石。对结石远端尿路梗阻、肾内残余结石或结石质硬、复发结石、有活跃代谢性疾病及需再次手术者尤为适宜。还可与ESWL联合应用治疗复杂性肾结石。凝血机制障碍、对造影剂过敏、过于肥胖穿刺针不能达到肾内,或脊柱畸形者不宜采用此法。并发症有肾实质撕裂或穿破、出血、漏尿、感染、动静脉瘘、损伤周围脏器等。

腹腔镜输尿管取石术:适用于输尿管结石>2cm,或经ESWL、输尿管镜手术治疗失败者。手术途径有经腹腔和经后腹腔两种。手术时需用导尿管排空膀胱及鼻胃管对胃肠道减压,以利于手术。取石后要安置双“J”管于输尿管腔内引流尿液。

(4)开放手术:在上述治疗失败或无条件进行上述治疗方法时,可采用开放手术治疗。根据结石部位、大小、复杂程度、患肾功能等可选用输尿管切开取石术、肾盂或肾窦切开取石术、肾实质切开取石术、肾部分切除术或肾切除术。

阅读理解

Premier Win Jiabao continued his second trip around the quake disaster zone on May 23, 2008, visiting surviving students in Mianyang, one of the worst-hit cities.

In a tent school, where more than 500 students from the destroyed Beichuan Middle School were studying, Premier Wen encouraged them to study harder following the disaster. “let us not forget the earthquake,” he told the students. “Then you will know what life is all about—it is bumpy, as the roads are.  Today, people save us and take good care of us. In the future, we will help them in return.” He wrote on the blackboard to encourage them, “Hardships make a country stronger.”

His first trip to the area was on May 12, just hours after the powerful quake rocked Sichuan at 2:28 pm. During the next four days, Premier Wen set foot in almost all of the worst-hit counties, walking over rocks and tiles, comforting weeping children and encouraging rescuers.

The Chinese Premier says saving lives is the top priority. “We must try all means to get into those areas. The earlier, the better. One person can be saved one second earlier. As long as there is a gleam of hope, we will make efforts 100 times greater than that.’

Chinese are deeply moved by what the Premier has said and done. A mother sent a message to her son in Beijing, saying “The 66-year-old Premier Wen has worked really hard for quake relief. He has comforted and moved us. Pass this on to your friends, pray for him.”

67. What’s the main idea of the passage?

A. Hardships make a country stronger.

B. Premier Wen jiabao went on his first trip around the quake disaster zone.

C. Life is difficult.

D. The Chinese are deeply moved by Premier Wen.

68. By saying “Then you will know what life is all about—it is bumpy, as the

roads are.”, Premier Wen want to tell the students that _______________.

A. Life is filled with various difficulties , we must overcome them

B. roads of the area are rough, we should repair them

C. they should forget the earthquake and study harder

D. earthquakes are common on Sichuan, we shouldn’t be afraid

69. What did Premier Wen do when he first set foot in almost all of the worst-hit

counties EXPECT________________________________.

A. walking over rocks and tiles

B. comforting weeping children

C. encouraging rescuers

D. asking them not to forget the earthquake

70. What can we infer from the last paragraph?

A. The Chinese are grateful for what the Premier has said and done.

B. Chinese are deeply moved by what the Premier has said and done

C. What the Premier has said and done comforted the mother.

D. The mother’s message is moving.

单项选择题