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。     

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。     

体外冲击波碎石加自拟中药排石汤治疗泌尿系结石的临床观察

目的：探讨体外冲击波碎石加自拟中药排石汤治疗泌尿系结石的疗效。方法：对2003年～2010年6月住院治疗的1326例泌尿系结石患者分为2组,治疗组663例,在体外冲击波碎石后服用自拟中药排石汤。对照组663例、单纯采用体外冲击波碎石。结果：经观察治疗组在碎石后结石排净时间上较对照组明显缩短,疗效显著。结论：体外冲击波碎石术后加自拟中药排石汤可加速结石的排出,减少碎石次数,提高排石效率,值得推广应用。     

ESWL治疗输尿管石街的研究

目的：总结分析输尿管石街ESWL的技巧与方法,旨在提高其单纯ESWL的成功率。方法：将117例输尿管石街分为粉末型（26例）,蛇头型（72例）,石块型（19例）。不同类型的石街按不同治疗方法处理。结果：①粉末型石街长度≤5cm 21例,仅药物对症排石治疗2周排净13例,4周排净8例;长度〉5cm5例,ESWL一次2周排净3例,4周排净2例。②蛇头型石街72例,其中ESWL一次2周排净38例,4周排净22例,3个月排净5例,有7例2周复查时行第二次ESWL,2～4周复查均排净。③石块型石街19例,ESWL一次2周排净3例,4周排净4例,3个月排净5例;其中有7例2周复查时行第二次ESWL,4周复查排净3例,4例行第三次ESWL,2例2个月排净,1例3个月复查排净,1例历时半年排净。上述117病例中有9例出现患侧肾绞痛或（和）发热、明显肉眼血尿,予抗炎解痉等对症治疗或感染控制后即予ESWL,症状均缓解或消失,余病例均无严重并发症。结论：ESWL治疗输尿管石街具有清除率高、损伤少、安全性高、并发症少、可重复治疗等优点,对于碎石机性能较好、ESWL技术成熟的医疗单位,尤其对于无腔内微创治疗条件的医院,目前仍可作为首选的治疗方法。     

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.     

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.     

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