ESWL型碎石机治疗上尿路结石5000例临床疗效研究

８年来应用国产ＥＳＷＬ碎石机治疗上尿路结石５０００例,占同期收治该病的９７．２９％。肾结石治疗成功率９８．１３％,复治率３８．５０％。输尿管结石治疗成功率９７．９９％,复治率２８．９％。复杂性肾结石占１９．３０％,９０％以上的复杂性肾结石复治后收到满意效果。随访６个月～８年,结石复发１７６例,复发率３．５２％。ＥＳＷＬ治疗后结石复发与碎石存留、ＥＳＷＬ治疗次数、尿路感染、代谢因素和尿路梗阻、性别等因素有显著相关。因此对复发结石的治疗应找出病因加以治疗。     

体外冲击能量大小与肾脏损伤程度的实验研究和临床观察

对８只右肾结石犬和４５只独肾家兔进行体外冲击波碎石（ＥＳＷＬ）实验，以评价低能量体外冲击波碎石效果及比较冲击波能量不同对肾脏的损伤程度。结果表明，低能量体外冲击波碎石效果与高能量相比无明显差异，且对肾脏的损伤程度明显轻于高能量冲击波。体外冲击波能量的高低与肾脏的损伤程度之间呈显著的正相关（ｒ＝０．８５７３，Ｐ＜０．０５）；临床应用高能量ＥＳＷＬ治疗上尿路结石７９５例，碎石成功率９８．１１％，平均碎石次数１．４９次／例，用低能量ＥＳＷＬ治疗上尿路结石２４８例，成功率９７．１７％，平均１．５８次／例，两者相比均无显著性差异（Ｐ＞０．０５）。低能量体外冲击波碎石病人与高能量碎石相比具有术中反应轻，术后血尿发生率低，程度轻，麻醉药用量少和无严重并发症等优点。     

体外震波碎石治疗小儿上尿道结石：（附14例报告）

应用国产ＪＴ－ＥＳＷＬ－Ⅲ型碎石机治疗小儿上尿道结石１４例，其中双肾结石２例，输尿管结石４例；结石大小５ｍｍ×４ｍｍ～５０ｍｍ×３５ｍｍ；７８％患者在肌注安定镇痛药下行碎石治疗，避免了全麻的副作用。所有结石均完全粉碎，无严重并发症，１个月结石排空率为９２％。认为体外震波碎石不仅可用于门诊小儿上尿道结石的碎石治疗，而且可用于治疗小儿复杂性、多发性肾结石。     

8例孤立肾结石ESWL治疗的护理体会

８例孤立肾结石ＥＳＷＬ治疗的护理体会武警四川总队医院泌尿外科（乐山６１４０００）陈宏李浮萍陈葳关键词孤立肾ＥＳＷＬ护理孤立肾合并肾结石较为少见。体外冲击波碎石治疗（ＥＳＷＬ）的应用使其治疗更加安全、简便。我科１９９２年１０～１９９５年１１月共收治孤立...     

体外震波碎石手术前后心功能的变化及临床意义

近年来 ,体外震波碎石术 (ＥＳＷＬ)在临床广泛应用 ,其安全性、术后并发症以及高能震波对心血管系统的影响越来越受到临床的重视[1] 。我们通过测定ＥＳＷＬ前后左室收缩及舒张功能 ,探讨ＥＳＷＬ对心功能可能带来的影响 ,为临床上更安全地开展ＥＳＷＬ提供参考。1　资料和方法1 1　一般资料　选择肾结石患者 71例 ,左侧结石 30例 ,右侧结石 4 1例 ;男 4 5例 ,女 2 6例 ;年龄 2 0～ 5 6岁 ,平均 38岁。既往无高血压及其它心血管病史。结石大小 0 .9～ 2 .3ｃｍ ,全部采用国产ＣＳＭ— 1型体外震波碎石机进行ＥＳＷＬ。震波电压 6 .0～ 7.0…     

体外震波碎石治疗肾及输尿管结石—720例临床及X线疗效评定

本文重点分析７２０例肾结石及输尿管结石在ｅｘｔｒａｃｏｒｐｏｒｅａｌ ｓｈｏｃｋ－ｗａｖｅ ｌｉｔｈｏｔｒｉｐｓｙ（简称ＥＳＷＬ）治疗时，结石被粉碎过程中的Ｘ线动态变化，并将ＥＳＷＬ过程中Ｘ线变化分为：①完全粉碎型；②不碎型；③部分粉碎型。同时对辰皮技术进行改进以扩大治疗指征和治疗范围。     

体外震波碎石治疗泌尿系结石的护理

ＥＳＷＬ ,是一种无创伤、安全、有效的治疗泌尿系结石的方法。自 1998年 9月～ 1999年 12月 ,采用体外震波碎石5 0 0 0例 (水槽式ＥＳＷＬ机治疗 ) ,效果较好 ,现将治疗前的准备和治疗中的观察护理及注意事项报告 :1　一般资料与方法1.1　一般资料　 5 0 0 0例中 ,其中肾结石 2 80 7例 ,占总数5 6 1%。输尿管结石 2 15 7例 ,占总数 4 3 1% ,膀胱结石 3 6例 ,占 0 7%。男性 2 84 4例 ,占总数 5 6 9% ,女性 2 15 6例 ,占总数 4 3 1% ,最小年龄 5岁 ,最大年龄 79岁 ,平均年龄 4 0岁。1.2　方法　冲击波的冲击次数为 80 0～ 2 0 0 0次 ,电压…     

影响上尿路结石体外冲击波碎石治疗后复发的多因素研究

分析了上尿路结石体外冲击波碎石（ＥＳＷＬ）治疗后复发的１１３例和无复发的１１２例病人，对可能导致复发的３２个因素分为５２个水平。应用Ｌｏｇｉｓｔｉｃ回归模型进行相关分析。结果显示：排石效果、次数、感染因素、代谢因素和性别２是ＥＳＷＬ治疗后复发的危险因素，有显著性差异。根据５个显著性指标，建立了上尿路结石ＥＳＷＬ治疗后预报数学模型（ＰＶ），为预测ＥＳＷＬ的预后提供理论依据，将理论预后与实际预后进行比     

体外震波治疗尿路结石(附905例分析)

体外冲击碎石术的临床应用成为利用非手术治疗常规的手段，１９８０年德国ＤＯＲＮＩＥＲ公司首先研制成功体外冲击碎石机，并用于治疗肾结石，取得满意的效果。１９８５我国北京、上海先后研制完成具有国际水平的第一代体外碎石机，并在临床应用上获得成功、我所自８９年引进ＪＴ—ＥＳＷＬⅢ型碎石机，临床体外震波尿路结石共９０５例，取得满意效果。临床资料　本组男５４３例，女３６２例，成功率９８％。治疗前准备：ＥＳＷＬ治疗前，病人应做以下几项检查，血常规和出凝血时间、尿常规、心电图、ＫＵＢ、ＩＶＰ、肾图及肝功能检查，病…     

ESWL对肾结石患者血清、尿液中表皮生长因子水平的影响

体外冲击波碎石术 (ＥＳＷＬ)是广泛应用于临床治疗泌尿系结石的主要手段 ,但高能量冲击波引起的肾脏损害已越来越多的被证实。开始人们对体外冲击波碎石术多集中在血清酶学和各项生化指标改变来研究肾组织的损伤和修复的影响。对从分子生物学多肽表皮生长因子的角度来研究ＥＳＷＬ对尿表皮生长因子 (ＥＧＦ)的表达 ,迄今少有报告。本文通过ＥＳＷＬ对肾结石患者术前后血、ＥＧＦ水平的观察 ,欲了解机械性肾损害后ＥＧＦ和肾损害的相互关系和规律 ,为今后预防和促进修复损害的研究提供理论依据。1　材料和方法1 1　研究对象　本组 2 1例 ,…     

多尼尔腔内泌尿外科工作站在上尿路结石中的综合应用

目的 探讨多尼尔腔内泌尿外科工作站在上尿路结石一站式微创治疗的功效。方法总结262例上尿路结石患者经输尿管镜钬激光碎石术、微造瘘经皮肾镜钬激光碎石术、体外冲击波碎石术的临床资料。结果239例患者一次碎石成功,占91、2％。结石排净253例,占96．5％。结论在多尼尔腔内泌尿外科工作站内采用体外冲击波碎石术联合腔内碎石技术的一站式综合治疗是处理上尿路结石的最佳手段,具有创伤小、效果好、方便、快捷的优势,值得临床推广应用。     

复式脉冲体外碎石机的临床应用分析

目的总结复式脉冲体外碎石治疗泌尿系结石的经验。方法应用复式脉冲体外碎石机治疗泌尿系结石患者1206例,其中肾结石508例,输尿管结石603例,膀胱结石95例,结石大小0.4cm×0.5cm~2.5cm×2.5cm。碎石机工作电压4~8.5kV,放电次数1500~3000。结果肾结石的治愈率58.3%(296/508),输尿管结石的治愈率72.7%(438/603),膀胱结石的治愈率82.4%(78/95),并发症:81.8%(986/1206)的患者复式脉冲体外碎石治疗后有不同程度肉眼血尿,13.6%(164/1206)的患者出现肾绞痛,14例患者治疗后出现高热,2例患者出现肾被膜下血肿。结论体外复式脉冲碎石技术应作为泌尿系结石的首选治疗方法。     

体外冲击波碎石治疗上尿路阴性结石的研究

探讨X线定位系统碎石机治疗泌尿系阴性结石的定位方法。应用国产HX902型碎石机,采用静脉尿路造影术（IVU）和逆行尿路造影术（RGU）定位法,X线双重定位碎石机进行体外冲击波碎石术（ESWL）,治疗泌尿系阴性结石63例,首次碎石治愈率为87.3％（55／63）。观察上尿路不同部位阴性结石的碎石效果,首次碎石治愈率分别为：肾阴性结石40％（2／5）;输尿管上中段阴性结石88.24％（30／34）;输尿管下段阴性结石95.83％（23／24）,疗效满意。提出了利用双束交叉X线定位碎石机,通过尿路造影协助,对阴性结石进行ESWL治疗时的几种定位方法,认为X线定位碎石机,只要在尿路造影协助下,治疗阴性结石可取得同样良好效果。     

Percutaneous nephrostomy in conjunction with ESWL in treatment of nephrolithiasis

The use of percutaneous nephrostomies (PCNs) in 1456 patients (1660 kidneys) treated with extracorporeal shock-wave lithotripsy (ESWL) was evaluated. In this group, 138 PCNs (130 patients) were performed in 133 kidneys. Forty-seven percent of PCNs were placed in patients with staghorn calculi; 24% were for stones in the renal pelvis, and 20% for ureteral stones. The most common indication for PCN was fever and obstruction (57%). In 15%, the indications were failure to decompress an obstructed system from a retrograde direction, clogged double-J ureteral stents, and perforation of the ureter. Prophylactic PCN placement in the treatment of staghorn calculi and large stones in the renal pelvis accounted for 12%. Five percent were placed for miscellaneous other reasons, and for 11% there was no documentation of the indication because they were placed before the patients came to our center. Localization of the collecting system for optimal placement of PCN is unique in ESWL patients because the residual stone fragments provide natural contrast. This eliminates the need for administration of contrast material in 50% of the patients. Twenty-six percent of PCN tracts were subsequently used for other procedures (e.g., percutaneous nephrolithotomy, fragment irrigation, ureteral stone manipulation). Bleeding complications from PCN occurred in 7%. Other minor complications occurred in 12% of cases. PCN is a useful adjuvant to ESWL treatment of kidney stones. Although its major use is to relieve urinary tract obstruction, it is also used as a preliminary step in planning other percutaneous interventional procedures. This is particularly the case in the treatment of large bulky stones in the renal pelvis and staghorn calculi.     

双侧输尿管中上段结石梗阻的同期处理

目的探讨双侧输尿管中上段结石合理的处理方法。方法 2009年9月—2010年8月收治双侧输尿管中上段结石患者9例。4例存在急性肾衰,血肌酐401～1 552μmo/L。双侧输尿管镜钬激光碎石4例;一侧输尿管镜下钬激光碎石,另一侧输尿管切开取石1例;一侧留置双J管,另一侧输尿管切开取石2例;双侧输尿管切开取石2例。结果所有患者均同期解除梗阻,肾衰患者肾功能恢复良好。除2例单侧留置双J管,结石进入肾盂,术后结合ESWL排出结石外,余未见残余结石。结论双侧输尿管中上段结石致上尿路梗阻,应及时解除梗阻。输尿管镜创伤小,多可同期解除双侧梗阻,可作首选。患者身体条件许可时,开放性手术也能同期解除双侧梗阻。     

B超引导下经皮肾镜钬激光联合超声碎石清石术治疗上尿路结石

目的探讨B超引导下经皮肾镜钬激光联合超声碎石清石术治疗上尿路结石的安全性和有效性。方法上尿路结石患者376例,其中肾结石患者287例,输尿管上段结石65例。结石最大径0.8～7.5 cm。B超引导下经皮肾穿刺,建立F20工作通道,使用钬激光联合第四代EMS超声碎石清石系统治疗。总结分析手术方法、手术时间、结石清除率及并发症等。结果 376例患者B超引导下1次穿刺成功建立经皮通道,5例因穿刺或扩张时出血明显,及时终止手术。碎石清石总成功率为93.6%(352/376)。287例肾结石患者一期结石清除率为70.0%(201/287),65例输尿管上段结石患者一期结石清除率为95.4(62/65)。二期碎石48例,残留结石最大径0.5～1.0 cm。23例患者行体外震波碎石治疗,残留结石最大径≤0.4 cm。23例患者经体位排石等保守治疗排净。平均手术时间(110.5±28.6)min,术中平均出血量(104±37.2)ml;输血5例。肾造瘘管留置时间平均8 d,术后平均住院时间9 d。大出血3例行选择性肾动脉栓塞治疗后痊愈;术后气胸1例行胸腔闭式引流后痊愈;术后肾周巨大血肿1例,行保守治疗后好转。术后低、中度发热者31例,高热者5例。结论 B超引导下经皮肾镜钬激光联合第四代EMS碎石清石系统治疗上尿路结石创伤小、恢复快、安全高效、并发症少,疗效可靠,是治疗上尿路结石的优先选择。     

Extracorporeal shock-wave lithotripsy: prevalence of renal stones 3-21 months after treatment

One hundred and four (70%) of the first 148 patients who underwent extracorporeal shock-wave lithotripsy (ESWL) at the University of Florida were evaluated for persistent or recurrent renal stone disease. Radiographs obtained 3-21 months after treatment showed that 53 (50%) of 106 treated kidneys were free of stones. In 48 of the 53 kidneys that contained stones, the stones were residual fragments dating from the period immediately after ESWL. New stones had developed in only five kidneys. The 50% incidence of stone-free kidneys 3-21 months after ESWL is less than the 65-90% rate reported by other institutions in the United States and Europe. After stone removal by ESWL, new stone formation occurs at a rate of 5%, which is much lower than the expected recurrence rate of 37-50%.     

Functional evaluation of the urinary tract by color-Doppler ultrasonography (CDU) in 100 patients with renal colic

INTRODUCTION AND OBJECTIVE: To evaluate if the addition of a renal color-Doppler ultrasonography (CDU) in the setting of acute renal colic improves the sensitivity of conventional sonography. MATERIALS AND METHODS: Between July 2002 and June 2003, 100 patients (median 49 years) with renal colic have been evaluated. Within 24 h of the admission, a CDU study of the urinary tract was performed using a sonograph GE Logiq 500 PRO with a multifrequency (3-5 MHz) convex probe. The following parameters were evaluated: ultrasonography (US) of both kidneys, ureters and bladder; resistive index (RI) of the arciform arteries of both kidneys in three different parenchymal areas; ureteric jets in response to hydration. A renal RI>0.70 and/or a 10% difference between the kidneys were considered as diagnostic of obstructive uropathy; an asymmetric and/or reduced ureteric jet from the ureteric orifices was an additional indicator of obstruction. All patients underwent a CT scan both with and without the administration of contrast medium. RESULTS: Enhanced helical CT demonstrated an urinary stone in 90 out of the 100 patients (90%): 29 pyelic, 28 at the pyelo-ureteral junction, 23 lumbo-iliac and 10 juxtavesical stones. Among 90 patients with urolithiasis, the stone was undetectable with US in 11 cases (12.2%); in 8 cases (8.9%) pyelocalicectasis was absent, and in 6 patients (6.6%) a non-obstructive hydronephrosis was present. Median RI in obstructed and non-obstructed kidney was 0.73 (range 0.71-0.87) versus 0.62 (0.50-0.68), respectively; in two, obstructed kidneys RI was <0.70 but greater than 10% compared with normal side. Sensitivity and specificity of US, CDU (RI+ureteric jet), unenhanced helical CT and CDU in association with unenhanced helical CT were 94.8 and 55.5, 98.9 and 90.9, 100 and 100%, respectively. DISCUSSION AND CONCLUSIONS: CDU in patients with renal colic and/or pelvicalicectasis improves the diagnostic accuracy of US in distinguishing between obstructive and non-obstructive dilatation. Combined with unenhanced CT, CDU has a 100% sensitivity and specificity. Moreover, due to the absence of contraindications and side-effects, CDU is indicated for the follow-up of patients after ESWL, pregnant women and children.     

Renal obstruction from persistent struvite stone matrix: a complication of extracorporeal shock wave lithotripsy

Struvite calculi occurring in patients with chronic urinary tract infections consist of an inorganic component of magnesium ammonium phosphate crystals and an underlying organic mucopolysaccharide matrix. Shock waves used to destroy these stones during extracorporeal shock wave lithotripsy (ESWL) therapy may affect the inorganic and organic components of the stone differently. In a 26-year-old woman, renal obstruction resulted from retained struvite stone matrix after ESWL therapy.     

尿路结石经ESWL治疗后并发症产生的原因及处理

目的　探讨ESWL治疗后并发症产生的原因、预防及处理。方法　本组采用X线双球管双向定位碎石机对 472例尿路结石患者行ESWL治疗。结果　 472例行ESWL治疗后 ,有 14 6例有不同并发症出现 ,其中血尿 12 7例 ,腹痛及腹胀痛 83例 ,石街形成 3 4例 ,尿路感染17例 ,肾包膜下血肿 1例。结论　在行ESWL治疗尿路结石时 ,应合理掌握碎石指标及时机 ,术后可服用消炎、利尿 ,中药配合排石等以减少并发症的发生。