Hepatic subcapsular hematoma after extracorporeal shock wave lithotripsy (ESWL) for pancreatic stones

We present a patient with complication of huge hepatic subcapsular hematoma after extracorporeal shock wave lithotripsy (ESWL) for pancreatic lithotripsy. The hematoma measured 78–110 mm. Angiography showed a subcapsular hematoma, rather than a hematoma in the liver. In the arterial phase, the distal end of the small vessel showed spotty opacification similar to microaneurysma, suggesting that it was an injury caused by separation of the liver and its capsule, caused by the shock waves. The portal vein and hepatic vein were normal. After 8 weeks of conservative therapy, the hematoma was gradually absorbed and the patient was discharged. Eight months after the accident, the hematoma had decreased to 40 mm in size. After 20 months, it was completely absorbed. The reported rate of renal subcapsular hematoma after ESWL for renal or ureter stones is 0.1%–0.7%. To date, however, only five cases of hepatic subcapsular hematoma after right renal stone disintegration have been reported. This is the first report of hepatic subcapsular hematoma after ESWL for pancreatic stones. Received: September 11, 1998 / Accepted: April 16, 1999     

Efficacy of Spyglass-Guided Electrohydraulic Lithotripsy in Difficult Bile Duct Stones

Background/Aims:

We aimed to evaluate the efficacy and safety of Spyglass-guided electrohydraulic lithotripsy (EHL) for difficult common bile duct stones (CBD) not amenable to conventional endoscopic therapy.

Design:

A retrospective study evaluating the efficacy of Spyglass-guided EHL in treating difficult CBD stones, in a single tertiary care center.

Patients and Methods:

All patients who underwent Spyglass-guided EHL from 2012 to 2013 were compared with a historical cohort who had ECSWL.

Results:

A total number of 13 patients underwent Spyglass-guided EHL, 8 (61.5%) of them were males. The mean age was 46.5 ± 5.6 years. Bile duct clearance was achieved in 13 (100%) of them. Seventy-six percent required only one Endoscopic Retrograde Cholangiopancreatography (ERCP) to clear the CBD, 7.7% required two ERCPs, and 15.4% required three ERCPs. Adverse effects (cholangitis) occurred in one patient (10%), whereas only 30 patients (64.4%) of the ESWL group had complete CBD stone clearance. Thirty-seven percent required one ERCP to clear the CBD, 35.6% required two ERCPs, and 20% required three ERCPs. Adverse effects happened in seven (15.5%) patients, where five (11%) had cholangitis and two (4.4%) had pancreatitis.

Conclusion:

Although a retrospective design with a small sample size, we concluded that Spyglass-guided EHL is an effective procedure in treating difficult CBD stones.     

经皮肾镜治疗体外震波碎石失败的上尿路结石的临床研究（附视频）

目的探讨经皮肾镜技术应用于体外震波碎石（EswL）治疗失败的上尿路结石的疗效和安全性。方法本组共26例,男19例,女7例,年龄25～67岁,结石直径1～2．5cm,既往均有不同次数ESWL史,行肾镜下超声或气压弹道碎石,对于较低位置输尿管结石者则更换输尿管镜下碎石。结果全部病例均一次性成功建立单通道,通道建立时间6～17min,结石处理时间20～105min,出血量10～30ml。术中发现游离型结石7侧,其余25侧结石周围均有不同程度炎性息肉包裹,结石与周围管壁粘连,6例结石中心有大量基质成分堆积。术后复查清石率75％（24／32）,无临床意义残石率25％（8／32）。结论肾镜可有效治疗ESWL治疗失败的上尿路结石。     

体外冲击波碎石术治疗尿路结石(附2 725例报告)

目的：探讨体外冲击波碎石术(ESWL)治疗尿路结石的有效性和安全性。方法：结合文献，回顾分析1993-2004年采用ESWL治疗尿路结石患者2725例，其中肾结石922例，输尿管结石1789例，膀胱结石14例。结果：随访3个月，结石排净率94．4％(2572／2725)，结石残留109例(4．0％)，16例无效(0．6％)，改用手术治疗。结论：ESWL具有治疗成功率高、副作用少、无严重并发症的优点，是治疗尿路结石安全、有效的方法。     

超声技术在体外冲击波碎石中的应用

本文介绍了作者在近５年时间里，采用西德Ｗｏｌｆ体外冲击波碎石机（该机使用超声影像定位系统）共治疗３００６例尿路结石病人和４１０例胆结石病人的经验。本文将超声定位系统与Ｘ线定位系统做了比较。结果显示超声定位不仅可替代Ｘ线定位，而且还可以显示透Ｘ线的阴性结石。同时还可以定位的治疗胆囊结石。超声不仅可清楚定位不同部位的尿路结石。而且还可以鉴别一些不适宜碎石治疗的泌尿系统疾病。如肾髓质海绵肾和肾盏憩室合并     

Sialendoscopy-assisted transfacial surgical removal of parotid stones

Minimally invasive surgical approaches to parotid stones (such as extra-corporeal shockwave lithotripsy and sialendoscopy) have proved to be effective in a high percentage of cases, although success depends on factors such as the localisation of the stone, its size and its mobility. The failure rate of 10% is largely due to large and impacted stones and, in such cases, a combined external and sialendoscopic approach can be used to avoid morbidity and the risks of more invasive superficial parotidectomy. We treated eight patients with large parotid stones (>7 mm) using a sialendoscopy-assisted transfacial surgical approach that was effective in all but one case, which was successfully solved by combining this procedure with extra-corporeal lithotripsy and operative sialendoscopy. Our results confirm that the combined approach is a valid alternative to parotidectomy for large parotid stones and should be added to other minimally invasive techniques aimed at restoring the function of the affected parotid gland.     

肾结石治疗方法随机对照试验的Meta-分析

目的 客观评价体外冲击波碎石术、经皮肾穿刺造瘘碎石取石术治疗肾结石的疗效。方法 采用电子检索和手工检索进行文献初检,电子检索数据库有Medline data-base（1980年1月-2006年6月）、中国期刊全文数据库（CNKI,1980年1月-2006年6月）、中国循证医学/Cochrane中心数据库（CEBM/CCD）、Cochrane图书馆,手工检索近期《中华泌尿外科杂志》等4种杂志,鉴定有关随机对照试验,并采用RevMan4.2进行Meta-分析。结果 我们共收集纳入2个随机对照试验进行了结石清除率的比较,177例病人符合纳入标准,Meta-分析结果显示经皮肾穿刺造瘘碎石取石术治疗肾结石（直径〈3cm）在结石清除率方面明显高于体外冲击波碎石术。结论 经皮肾穿刺造瘘碎石取石术治疗肾结石方面显示出了巨大的优势。     

Mechanisms of shock wave induced endothelial cell injury

BACKGROUND AND OBJECTIVES: Medical procedures, for example, laser angioplasty and extracorporeal lithotripsy as well as high-energy trauma expose human tissues to shock waves (SWs) that may cause tissue injury. The mechanisms for this injury, often affecting blood vessel walls, are poorly understood. Here we sought to assess the role of two suggested factors, viz., cavitation or reactive oxygen species (ROS). STUDY DESIGN/MATERIALS AND METHODS: A laser driven flyer-plate model was used to expose human umbilical cord vein endothelial cell (HUVEC) monolayers to SWs or to SWs plus cavitation (SWC). Cell injury was quantified with morphometry, trypan blue staining, and release of (51)Cr from labeled HUVECs. RESULTS: HUVECs, exposed to SWs only, could not be distinguished from controls in morphological appearance or ability to exclude trypan blue. Yet, release of (51)Cr, indicated a significant cell injury (P < 0.05). HUVEC cultures exposed to SWC, exhibited cell detachment and cell membrane damage detectable with trypan blue. Release of (51)Cr was fourfold compared to SW samples (P < 0.01). Signs of cell injury were evident at 15 minutes and did not change over the next 4 hours. No protective effects of ROS scavengers were demonstrated. CONCLUSIONS: Independent of ROS, SWC generated an immediate cell injury, which can explain, for example, vessel wall perturbation described in relation to SW treatments and trauma.     

低能量ESWL治疗尿路结石

目的:探讨低能量体外冲击波碎石术(ESWL)治疗尿路结石的疗效、技术特点和副损伤。方法:普通B超定位、低能量(冲击电压3.7~6.3 kV)体外冲击波碎石术治疗各段尿路结石500例,冲击次数600~2 900次。结果:单序列冲击成功率为64.2%,总碎石成功率89.5%,再次碎石率32.6%。结论:B超定位低能量ESWL具有定位方便,成功率较高、无严重并发症、组织损伤轻微等特点,有一定的应用价值。