Extracorporeal shock wave lithotripsy for bile duct stones: An Australian experience

Choledocholithiasis requires prompt therapy, particularly if complicated by ascending cholangitis. Endoscopic sphincterotomy with balloon and basket extraction clears the bile duct in 90% of patients. Failure is usually associated with large stones, that is, greater than 2 cm. Until recently such patients would have required surgical intervention. In 1986 St Vincent's Hospital installed a Dornier HM3 Lithotriptor to be used for both urinary tract and bile duct calculi. A retrospective analysis of patients referred for extracorporeal shock wave lithotripsy (ESWL) to bile duct stones was performed. There were 47 patients (28 female, 19 male) with an average age of 76 years. Twenty-two patients had a single stone with a mean diameter of 2.4 cm and 25 had multiple stones. In two patients the stone was not able to be visualized, so ESWL could not be performed. Complete stone clearance was achieved without further intervention in 13 patients, and in a further 23 after endoscopic extraction of fragments. In five patients only partial duct clearance was achieved. However, this provided palliation and enabled the patient to be discharged. Surgical intervention was required in the remaining four cases. Overall success rate was 80% with a further 11% being palliated with improved biliary drainage. There were no serious adverse effects from ESWL. All patients were discharged from hospital. Mortality at 30 days was 4.7% and at 6 months was 19.4%. One patient succumbed to ascending cholangitis 22 weeks post-ESWL (2.7%). All other deaths were unrelated to ESWL or biliary disease. We conclude that ESWL is a safe and effective treatment for bile duct stones not amenable to endoscopic extraction.     

急诊ESWL治疗输尿管结石疗效观察

为论证体外冲击波碎石术（ＥＳＷＬ）治疗输尿管结石绞痛的临床效果，对１０９例输尿管结石绞痛患者行急诊ＥＳＷＬ治疗，结果经１次ＥＳＷＬ治疗成功者９６例（８８．１％），余经第２次ＥＳＷＬ治疗全部碎石成功。经１次ＥＳＷＬ治疗后绞痛缓解者９５例（８７．１％）。认为出现输尿管结石绞痛时应及早施行ＥＳＷＬ，以求尽早解除患者痛苦；结石定位诊断应遵循简单、快捷的原则，综合分析，防止误诊；施行ＥＳＷＬ时应尽可能采用仰     

上尿路结石ESWL治疗后再行开放手术原因分析（附37例报告）

报告上尿路结石经ＥＳＷＬ治疗后仍需行开放手术者３７例，占同期上尿路结石开放手术的１２．５％，其中肾切除１０例。提示经ＥＳＷＬ治疗后再行开放手术时需行肾切除的可能性明显高于未经ＥＳＷＬ治疗者。肾周粘连、输尿管增粗、僵硬是术中所见的主要病理改变，占４８．６％。并着重讨论了ＥＳＷＬ治疗后开放手术的原因，认为结石残留、ＥＳＷＬ对组织的损伤是造成ＥＳＷＬ后仍需开放手术的重要因素。     

B超引导经皮肾盂穿刺造影配合ESWL治疗输尿管结石（附45例报告）

通过Ｂ超引导经皮肾盂穿刺造影配合ＥＳＷＬ，治疗用常规方法Ｘ线难以定位的输尿管结石４５例。一次性穿刺全部成功，碎石成功率９３．３％。本组未出现严重并发症。     

ESWL治疗泌尿系结石14年经验总结

目的 探讨ESWL治疗泌尿系结石的疗效和安全性。方法采用同一台体外冲击波碎石机在二个阶段不同治疗参数(不同冲击次数、不同工作电压、不同治疗间隔时间)治疗泌尿系结石4824例，并在治疗体位等方面进行改进和尝试。结果阶段Ⅰ：结石粉碎率97．2％，结石排净率90．1％。阶段Ⅱ：结石粉碎率96．5％，结石排净率90．1％。阶段Ⅱ较阶段Ⅰ并发症明显减少、减轻，阶段Ⅰ、Ⅱ均无严重并发症发生。结论ESWL治疗泌尿系结石安全、效果好、痛苦小，适当降低ESWL冲击波次数及工作电压并不明显影响疗效，但可明显减少并发症。     

超声定位体外冲击波碎石术治疗输尿管结石

目的 探讨体外冲击波碎石技术在输尿管结石治疗中的价值。方法 对752例输尿管结石进行超声检查诊断，其中696例在实时超声引导下用冲击波碎石治疗。结果 经超声定位体外冲击波治疗输尿管结石的总有效率为97．8％。结论 体外冲击波碎石是治疗输尿管结石的首选方法，技术的熟练和操作的适当可改善疗效。     

PR-AⅡ、PGI_2-TXA_2在ESWL后高血压中的作用

通过对60例患者血液标本的检测,发现体外震波碎石术(ESWL)后出现高血压的患者其血浆肾素(PR)—血管肾张素Ⅱ(AⅡ)系统活性及血栓素A_2(TXA_2)浓度明显高于ESWL后血压正常者,而血浆前列腺素(PGI_2)浓度则正好相反。认为PGI_2合成减少和TXA_2合成相对增多,PGI_2/TXA_2比率下降,导致PR—AⅡ系统活性升高,血管壁对PR—AⅡ系统的敏感性增加,是ESWL后患者出现高血压的主要原因。     

体外冲击波碎石术对犬肾远期影响的实验研究

为了进一步了解体外冲击波碎石术（ＥＳＷＬ）对肾脏的远期影响，观察了２１只犬在ＥＳＷＬ后１、３、６及１２个月肾的肉眼、光镜和电镜的形态。结果显示：ＥＳＷＬ后１、３个月主要是肾小管的改变，但ＥＳＷＬ后６、１２个月时肾小管的病理改变不明显，而肾间质及肾小球的病理变化却逐渐明显，特别是肾小球系膜细胞胞浆中散在分布的肾素颗粒，表明ＥＳＷＬ后出现的高血压可能与所谓的“ｐａｇｅｋｉｄｎｅｙ效应”有关。     

ESWL治疗后尿道结石68例报告

目的提高体外冲击波碎石术（ESWL）治疗后尿道结石成功率,降低并发症.方法采用截石位,尿道液状石蜡灌注后,复式脉冲体外碎石.结果 68例后尿道结石,均一次性完全粉碎,成功率达100%,无严重并发症.结论后尿道结石采取ESWL治疗可作为首选的方法.     

Outpatient basis extracorporeal shock wave lithotripsy for ureter stones: Efficacy of the third generation lithotripter as the first line treatment

Aim:   We assessed the efficacy of a third generation extracorporeal shock wave lithotripsy (ESWL) machine for ureter stones using the Dornier Lithotriptor Compact Delta.
Methods:   A total of 471 consecutive ureter stones were treated with ESWL using the Dornier Lithotriptor Compact Delta from December 2001 on an outpatient basis. Four hundred and one cases were followed up at least once after the procedure and were included in this study. All of the cases, except one patient who was three years old, were treated without anesthesia, and the procedure was principally performed on outpatient basis.
Results:   The overall stone free rate was 94.5% and the mean number of treatment sessions was 1.23. The stone free rates were compared considering various clinical factors and significant differences were observed in the stone length, the stone location and the sex in univariate analysis. However, only the stone length maintained a statistically significant impact in multivariate analysis and the stone free rates were 91.2% and 98.0% respectively in larger stones (length 10mm) and smaller stones (length < 10mm) (p = 0.004). In mid-distal stones, the stone free rate was higher than that of proximal stones (97.5% vs 92.6%, p = 0.04) and not affected by stone length.
Conclusions:   Extracorporeal shock wave lithotripsy performed by the third generation machine achieved an excellent stone free rate with a relatively small number of treatment sessions. This procedure is strongly recommended as the first line therapy for all ureter stones including mid-distal ones.