尿石症住院患者1100例分析

目的了解近年来尿石症住院患者情况的变化。方法对1998年~2003年间的尿石症住院患者1100例进行分析。结果本组中,肾结石251例(22.8%)、输尿管结石742例(67.5%)、膀胱结石97例(8.8%)、尿道结石10例(0.9%)。上、下尿路结石的比例为9.28∶1。高钙尿患者27例(13.0%)、高钙血症91例(9.1%)、高尿酸血症167例(17.8%)。结石成分分析结果:草酸钙168例(62.7%);磷酸钙59例(22.0%);尿酸及尿酸盐25例(9.3%);磷酸镁铵10例(3.7%);碳酸盐5例(1.7%);胱氨酸1例(0.4%)。治疗:ESWL658例(59.8%)、肾切开取石术35例、肾切除术6例、输尿管切开取石术92例(占8.4%)、输尿管镜加气压弹道碎石52例(4.7%)、膀胱切开取石53例(其中前列腺摘除术加膀胱切开取石术26例);膀胱镜加气压弹道碎石20例;前列腺电切术加气压弹道碎石7例;膀胱镜加大力钳碎石术9例。尿道切开取石术1例;经尿道镜取石术2例;尿道镜加气压弹道碎石3例。结论本组尿石症患者以上尿路结石为主,含钙结石占绝大多数。尽管微创手术的普遍开展,ESWL仍不失为一种创伤小、效果好的治疗方法。     

Current status of extracorporeal shock wave lithotripsy

Summary Extracorporeal shock wave lithotripsy (ESWL) is standard therapy for urolithiasis. With comparable technical principles, various lithotripters have been developed and are in routine use. Renal pelvic stones, calyceal stones, ureteral stones, and other special forms can be treated with varying results. Currently, the so-called clinically insignificant residual fragments and the recurrence of calculi are under discussion. Whereas the side effects of ESWL are well known, studies comparing ESWL with other endourological procedures are still lacking.      

Symptoms, diagnosis and endoscopic management of common bile duct stones

Symptomatic BDS commonly cause significant morbidity and attempt at stone removal should be attempted if possible. Complications of CBDS include biliary colic, jaundice, cholangitis and pancreatitis. Investigations aimed to predict the presence of stones within the bile duct include serum bilirubin, AST, ALP, common bile duct diameter and age as independent predictors of choledocholithiasis. TUS is a sensitive test in detecting bile duct dilatation but the sensitivity is reduced in its ability to detect choledocholithiasis. A NIH consensus statement found that ERC, MRC and EUS were comparable in their sensitivities, specificities and accuracy rates for detection of choledocholithiasis. ERC and stone removal using a balloon or basket is often performed following EST. EBD may be performed if patients have uncorrected coagulopathies but the risk of pancreatitis is higher than for EST (although the risk of bleeding complications is lower for EBD). ML is often required in difficult to remove CBDS and using this device, CBDS can be removed in 90–95% of cases. Other forms of lithotripsy including laser lithotripsy and EHL are confined to specialised centres and the evidence for their use is based on small studies. ESWL may clear stones from the bile duct in up to 93% of patients but frequently ERC and stone fragment removal is required post ESWL. The role of medical therapy in difficult to remove CBDS (or in CBDS in patients with severe co-morbid illness preventing ERC + stone removal) is still currently uncertain due to a lack of large randomised control trials.     

Why laparoscopic cholecystectomy today?

Traditional open cholecystectomy became the gold standard of surgical treatment for symptomatic gallstone disease during the last century. In spite of its good results, clinicians have been trying to establish effective nonsurgical methods of eliminating gallstones. Although oral, percutaneous, or retrograde litholysis can be used effectively for cholesterol stones, these represent only 10% of all gallstones. Moreover, intracorporeal lithotripsy is an invasive method, and while extracorporeal shock wave lithotripsy is a promising procedure, even after careful selection, only 70%–80% of the patients become stone-free within 1 year. In fact, none of the methods which leave the gallbladder intact are free of complications, and they are followed by 50% stone recurrence within 5 years. Since 1987, laparoscopic cholecystectomy has become the procedure of choice as it is safe and only minimally invasive. We believe that the laparoscopic technique is a promising way to the surgery of the future.     

ESWL疗效相关因素分析

近年来，随着体外冲击波碎石术（ESWL）治疗泌尿系统结石的普及，如何提高结石的治愈率、初碎的有效率、碎石的排净率，降低复碎率，避免并发症的发生，已成为临床亟待解决的问题。笔者通过14000例ESWL的疗效观察，就其相关因素进行探讨。     

泌尿系统结石3218例综合观察

目的探讨治疗泌尿系结石的最佳方案。方法对3218例泌尿系结石患者的临床分类和治疗方法作回顾性分析。本组单纯性肾结石1365例，复杂性肾结石651例，输尿管结石Ⅰ类558例，Ⅱ类452例，Ⅲ类192例。结果本组手术取石1164例，行ESWL治疗1923例，行输尿管镜直视下碎石131例。复杂性肾结石手术组残余结石57例（8.8％），行肾切除12例（1．8％）。ESWL组3个月排石率为81．6％，转手术率为18．4％，切肾率为0％。输尿管镜下气压弹道碎石效果不佳改行手术取石8例（61％）。结论ESWL、输尿管镜直视下碎石、术中应用气压弹道式碎石或两种以上方法联合应用治疗泌尿系结石可减轻患者痛苦或降低手术难度。开放性手术放置内引流可减少术后并发症。ESWL治疗后应积极处理石街、控制感染和最大限度减轻医源性肾功能损害。输尿管镜直视下碎石要有熟练的内腔镜操作技术。     

经皮肾微造瘘取石术结合ESWL治疗复杂性肾结石

目的:探讨经皮肾微造瘘取石术(PCNL)结合ESWL治疗复杂性肾结石的临床效果.方法:对34例复杂性肾结石患者采用经皮肾微造瘘取石术,结合一次或多次ESWL治疗.结果:经皮肾微造瘘取石术结合一次ESWL治疗后结石清除率为76.5%,二次ESWL治疗后结石清除率88.2%,三次ESWL治疗后结石清除率为94.1%.结论:经皮肾微造瘘取石术结合一次或多次ESWL治疗复杂性肾结石是安全,有效的方法.     

经皮肾穿刺微造瘘碎石取石术治疗复杂肾结石的临床应用

目的 通过观察经皮肾穿刺微造瘘碎石取石术(MPCNL)治疗复杂肾结石的临床疗效,总结其临床价值.方法 回顾性分析2010~2011年期间收治的复杂性肾结石患者200例,其中100例患者采用经皮肾穿刺微造瘘碎石术治疗,另外100例患者进行常规的体外碎石术(ESWL).观察两组的治疗效果,主要是对住院时间、并发症,碎石率、复发率进行比较.结果观察组中住院时间、并发症发生率、碎石率、复发率等均与对照组有明显差异具有统计学意义 (P<0.05).经皮肾穿刺微造瘘碎石取石术治疗复杂肾结石的临床疗效有着姣好的临床评价.结论 采用经皮肾穿刺微造瘘碎石取石术(MPCNL)治疗复杂肾结石的效果比常规治疗的效果好,碎石率高,复发率小.对肾结石的治疗效果明显,值得临床推广使用.     

输尿管软镜下钬激光碎石治疗体外震波碎石失败后复杂性输尿管结石的临床探讨

目的：探讨输尿管软镜下钬激光碎石治疗体外震波碎石失败后复杂性输尿管结石的临床效果。方法选取2014年2月-2014年12月期间该院收治的复杂性输尿管结石患者80例,其中40例体外震波碎石失败后使用微创经皮肾穿刺取石+术(MPCNL)的患者作为对照组,另外40例体外震波碎石失败后使用输尿管软镜下钬激光碎石治疗的患者作为研究组,分析研究两组的治疗效果。结果对照组患者碎石成功率为95.0%(38/40),研究组患者中碎石成功率为92.50%(37/40),上段结石成功率80.00%(8/10),中段结石成功率90.00%(9/10),下段结石成功率95.00%(19/20),失败3例,占7.50%(3/40),研究组与对照组碎石成功率之间差异无统计学意义(P>0.05)。其中有2例冲入肾盂后再次经输尿管软镜下钬激光碎石治疗,1例通过后腹腔镜下输尿管结石切开取石的方式取石,手术中输尿管穿孔1例,手术平均时间(65±15.50)min,住院时间(7.50±1.50)d。结论输尿管软镜下钬激光碎石是一种治疗体外震波碎石失败后复杂性输尿管结石的可靠手段,临床应用前景广阔。     

梯形式升降电压法在体外冲击波碎石中的应用效果评价

目的：探讨梯形式升降电压法在体外冲击波碎石中的碎石效果。方法对47例泌尿系结石患者在行体外冲击波碎石治疗时运用梯形式升降电压三步法进行碎石治疗。结果本组患者体外冲击波碎石治疗显效率为72．3％,总有效率为87．2％。结论在体外冲击波碎石术中应用梯形式升降电压法碎石效果显著,可促进结石排出。