经尿道输尿管镜下气压弹道碎石术后常见并发症原因分析及护理对策

目的：对输尿管镜下气压弹道碎石并发症原因进行分析并探讨术后护理的相关事宜。方法选取本院2011年6月~2013年6月两年间的196例行输尿管镜下气压弹道碎石术的患者,观察分析其中69例术后出现并发症的原因,并提出应对措施。结果196例患者中有69例出现并发症,并发症发生率为35.20%。其中血尿的发生率（70.00%）明显高于发热、尿外渗、腰疼、输尿管断裂、输尿管黏膜受损的发生率10.14%、7.25%、10.14%、0.00%、1.45%,差异具有统计学意义（P〈0.05）。输尿管镜下气压弹道碎石术后因操作经验引起并发症的发生率明显高于器械优劣、患者选择、其他原因引起的发生率,差异具有统计学意义（P〈0.05）。结论减少尿道输尿管镜下气压弹道碎石术后常见并发症的关键是,保证医疗设备的质量、在导丝引导下输尿管镜能够直视进镜,并要求操作者技术娴熟。     

输尿管镜联合气压弹道碎石治疗输尿管结石的效果分析

目的探讨输尿管镜联合气压弹道碎石治疗输尿管结石的临床效果。方法对本院2010年6月～2012年9月收治的34例行输尿管镜下气压弹道碎石术的输尿管结石患者的临床资料进行回顾性分析。结果所有患者的碎石成功率为91．2％（31／34）,其中输尿管上段碎石成功率为78．6％（11／14）,中下段碎石成功率为100．0％（20／20）,差异有统计学意义（P〈0．05）。结论输尿管镜联合气压弹道碎石治疗输尿管结石效果显著,碎石成功率高、并发症少、操作简单,是输尿管中下段结石治疗首选的方法,值得临床推广。     

输尿管镜下气压弹道碎石术治疗输尿管结石的可行性及安全性

目的 评价输尿管镜下气压弹道碎石术治疗输尿管结石的临床效果及安全性.方法 选取2006年6月～2013年12月本院收治的输尿管结石患者156例,随机分为观察组和对照组各78例,观察组采用输尿管镜下气压弹道碎石术治疗,对照组采用体外冲击波碎石术治疗,观察并比较两组输尿管不同部位结石的成功率及不同部位术后并发症的发生率.结果 观察组上段结石总有效率为75.00％,中下段结石总有效率为94.83％,合计总有效率为89.74％;对照组上段结石总有效率为88.89％,中下段结石总有效率为71.67％,合计总有效率为75.64％.观察组上段结石总有效率低于对照组,中下段结石总有效率高于对照组,合计总有效率高于对照组,差异有统计学意义（P＜0.05）.两组并发症发生率差异无统计学意义（P＞0.05）.结论 对于输尿管中下段结石应首选输尿管镜下气压弹道碎石术,而输尿管上段结石应结合患者的具体情况加以选择.     

钬激光碎石术与气压弹道碎石术治疗输尿管结石的对比研究

目的：比较钬激光碎石术与气压弹道碎石术治疗输尿管结石的临床效果和安全性。方法选择2013年11月~2014年12月本院收治的输尿管结石患者120例,随机分为两组,每组60例。观察组采用输尿管镜下钬激光碎石术治疗,对照组采用气压弹道碎石术治疗,比较两组患者的治疗效果和临床安全性。结果钬激光组的碎石成功率为96.7%,结石排净率为96.7%,手术时间为(47.6±9.6)min,住院时间为(2.4±1.2)d;气压弹道组的碎石成功率为93.3%,结石排净率为90.0%,手术时间为(50.3±11.9)min,住院时间为(3.5±1.4)d,两组比较差异有统计学意义(P<0.05)。钬激光组的术后并发症发生率为65.0%,气压弹道组的术后并发症发生率为66.7%,差异无统计学意义(P>0.05)。结论钬激光碎石术治疗输尿管结石的效果显著优于气压弹道碎石术,值得临床推广应用。     

Clinical comparison of extracorporeal piezoelectric lithotripsy (EPL) and intracorporeal electrohydraulic lithotripsy (EHL) in difficult bile duct stones

Today, nearly 90% of common bile duct stones are extracted endoscopically. Problems are encountered if there are large stones or a duct stenosis. Extracorporeal piezoelectric lithotripsy (EPL) as well as intracorporeal electrohydraulic lithotripsy (EHL) serve as an alternative to surgical intervention for those few patients in whom endoscopic measures have failed. A total of 35 patients with common bile duct stones in whom conventional endoscopic treatment had failed were selected on the condition that stone visualization through ultrasound was possible and that the papilla was within easy reach of the endoscope. Patients fulfilling the inclusion criteria were randomly treated either by EPL or EHL. The average age of our patients was 73 years. The main reasons for failure of conventional endoscopy were due to the large size of the stones (13 patients), impacted stones (16), or the presence of a biliary stricture (6). In the EPL group, visualization of the stones by ultrasound and ensuing treatment were possible in 16 of 18 patients (89%); stones could be fragmented in 15 patients. In 13 patients, the biliary tree could then be completely freed of calculi; the success rate was 72% for all the patients (13 of 18). On average, the patients had 2.3 treatments on the lithotripter, and 3870 shock waves were applied per treatment. In the EHL group stones were successfully fragmented in 13 of 17 patients (76.5%). The average number of treatments was 1.4. Comparing both therapies, there was no difference in stone-free rates. In both groups, additional endoscopic interventions were necessary to clear the bile duct. The mean number of lithotripsy sessions was less in the EHL group (1.4 vs 2.3). There were no major differences in average hospital stay, 30-day mortality was zero in both groups. Combined treatment including EPL, EHL, and intracorporeal laser lithotripsy was finally successful in 32 patients (91.5%). It is concluded that EHL might be the method of choice for smaller, single stones in the more proximal parts of the common bile duct. In these cases, complete duct clearance in one lithotripsy session can be achieved. Multiple and large stones are probably best accessible to EPL. With a combination of the methods described, the bile duct can be cleared of concrements in almost every instance. As a result, surgery for choledocholithiasis has become the absolute exception.This work was presented in part at the 1993 Annual Meeting of the american Gastroenterological Association in Boston and published in abstract form (Gastroenterology 104:A347, 1993).     

经皮肾镜取石术治疗输尿管上段结石临床观察

目的 观察经皮肾镜取石术治疗输尿管上段结石的临床疗效.方法 将108例输尿管上段结石患者随机分为观察组和对照组各54例.对照组患者行经尿道输尿管镜取石术治疗,观察组患者行经皮肾镜取石术治疗.观察两组患者的手术时间、术中出血量、住院时间、结石清除情况及并发症的发生情况,对比两组临床疗效.结果 观察组患者的手术时间和住院时间均明显长于对照组,差异具有统计学意义（P＜0.01）;两组的术中出血量无显著差异（P＞0.05）;观察组患者的结石清除情况及并发症的发生情况均明显优于对照组,差异具有统计学意义（P＜0.05）.结论 在输尿管上段结石的临床治疗中,经皮肾镜取石术与经尿道输尿管镜取石术各有优缺点,都具有较高的临床应用价值,应根据患者具体情况合理选用治疗方法.     

超声手控器和输尿管镜的连接改造

通过分析输尿管镜下超声碎石术中的超声探针损坏率高的原因,设计了两种新型的超声手控器和输尿管镜的连接器械。通过对比,选择其中一种连接器械进行临床使用,结果表明,该器械便于临床操作,同时可以延长镜下超声探针的使用寿命。