上尿路结石的急诊ESWL治疗

报告８４例上尿路结石患者经急诊ＥＳＷＬ后效果满意，结石一次治疗粉碎率为１００％，结石一周内排净率为１００％。９例急性无尿患者经急诊ＥＳＷＬ后均在１～１２ｈ内迅速排尿，肾功能得已恢复。５６例急性肾绞痛患者经急诊ＥＳＷＬ后绞痛解除，结石排净。１９例输尿管结石在输尿管镜取石过程中将结石推入肾脏后即行ＥＳＷＬ均获一次治疗成功。急诊ＥＳＷＬ是治疗尿石症引起的急性无尿、急性肾绞痛等患者的简单、有效方法之一，能获得立竿见影之效果。     

ESWL与输尿管镜治疗输尿管下段结石的比较

目的：比较体外冲击波碎石术（ＥＳＷＬ）与输尿管治疗输尿管下段结石的结石排净率和并发症。方法：治疗输尿管下段结石患者３９０例,其中用ＥＳＷＬ治疗２１０例,输尿管镜治疗１８０例。结果：两组患者术后１个月的结石排净率分别为７８．１％和９３．３％（Ｐ〈０．０５）;ＥＳＷＬ组的主要并发症为再次治疗率高（１１．９％）,而输尿管镜组的主要并发症为输尿管穿孔（３．３％）。结论：输尿管镜治疗输尿管下段结石的疗效优于     

坐位ESWL治疗输尿管末端结石疗效观察：附126例报告

采用坐位体外冲击波碎石术（ＥＳＷＬ）治疗输尿管末端结石１２６例，治愈率９８．３％，１次碎石排净率为７２．２％，２次碎石排净率为２２．２％，所有患者均在门诊治疗，不需任何辅助措施。结果提示，坐位ＥＳＷＬ治疗输尿管末端结石具有定位准确、快速、方便，碎石效果好，患者容易接受，并发症少等优点，可在基层医院推广使用。     

腔镜下处理输尿管结石并息肉

目的　介绍输尿管镜下处理输尿管结石并息肉的经验。　方法　１９９１ 年７ 月至１９９８年１１ 月,对１ ８４７ 例输尿管结石行２ ０５９ 例次输尿管镜检查及治疗,其中１０７ 例检查前曾先后行１ ～５次体外冲击波碎石（ＥＳＷＬ） 未获成功。　结果　１ ８４７ 例输尿管结石中并发息肉５５３ 例（２９ ．９ ％ ） ,其中４５０ 例在输尿管镜下处理成功（８１ ．４ ％ ） 。　结论　输尿管结石并息肉为常见病;输尿管结石嵌顿时间超过３ 个月,肾积水程度与结石大小不相符的患者不宜行ＥＳＷＬ;输尿管镜下行输尿管息肉切除及气压弹道碎石治疗效果满意。     

输尿管结石的治疗:体外冲击波碎石与内腔镜体内碎石的比较

输尿管结石可用体外冲击波碎石（ＥＳＷＬ）或内腔镜体内碎石两种常用的方法治疗，体内碎石又可选用液电（ＥＨＬ）、超声（ＵＳＬ）、激光（ＬＬ）和气压弹道（ＰＬ）等能源，医生和病人应如何选择？作者总结了１９８８～１９９７年共１９７０例输尿管结石的治疗经验，其中，１５８０例行ＥＳＷＬ，结石粉碎率为７１％，排净率为４９９％，４８４例行输尿管镜体内碎石（包括ＥＳＷＬ失败病例），体内碎石病人中，３１１例（占６４３％）用ＵＳＬ，１４０例（２８９％）用ＰＬ，３３例（６８％）用ＥＨＬ，其结石粉碎率分别为８９…     

ESWL治疗输尿管结石失败原因分析

采用ＤｏｒｎｉｅｒＨＭ３型碎石机治疗输尿管结石２６００例，其中５８例未获成功，改行输尿管切开取石术及输尿管镜取石术。术中发现结石已粉碎或部分粉碎，但未能全部排出。输尿管明显病变５２例，其中粘连狭窄１５例，管壁增厚１２例，息肉１１例，肉芽组织包裹９例，结石嵌顿４例，输尿管扭曲畸形１例。５８例患者经ＥＳＷＬ治疗共９８次，平均为１６９次。在输尿管结石行ＥＳＷＬ之前应慎重考虑，如结石在输尿管同一部位停留时间过久、结石过大、肾功能较差时，都不宜贸然行ＥＳＷＬ治疗。输尿管结石在行ＥＳＷＬ治疗１～２次无效时，应及时改用其它方法。     

逆行插管与静脉造影定位ESWL治疗上尿路阴性结石的比较

为探讨不同部位上尿路阴性结石定位方法的选择，对９８例上尿路阴性结石患者采用大剂量静脉尿路造影（ＩＶＵ）和逆行插管（ＲＧＰ）定位法行体外冲击波碎石术（ＥＳＷＬ），并根据其疗效进行比较。结果：２０例肾阴性结石中，８例行ＩＶＵ定位下ＥＳＷＬ碎石，治愈率为１２．５％；１２例行ＲＧＰ定位下ＥＳＷＬ碎石，治愈率为８．３％；认为对此类患者不宜行Ｘ线定位碎石。５８例输尿管上、中段阴性结石中，２８例行ＩＶＵ定位碎石     

钬激光粉碎输尿管结石

输尿管结石的治疗自８０年代以来发生了革命性变化，体外冲击波碎石（ＥＳＷＬ）和输尿管镜体内碎石使传统开放手术取石变得极少施行。体内碎石的能源又可分为超声、液电，激光和气压弹道。作者报道用钬激光（ＨＯ：ＹＡＧ）治疗１５０例各种输尿管结石的经验，其中１３２例首选输尿管镜下钬激光碎石，１８例是ＥＳＷＬ失败病例，结石位于下１／３输尿管８１例，中１／３４７例，上１／３２２例，病人年龄３～７９岁，平均４６７岁，结石长径５～２４ｍｍ，根据患者的年龄和输尿管口的大小选用不同大小和型式的输尿管镜，从Ｆ４８号到Ｆ…     

体外震波碎石致腹主动脉瘤破裂

体外震波碎石致腹主动脉瘤破裂［英］／Ｔａｙｌｏｒ　ＪＤ…／／Ｂｒｉｔ　Ｊ　Ｕｒｏｌ－１９９５．７６．－２６２～２６３例１，７７岁男性，７年前行右肾盂取石术，残留结石引起输尿管绞痛几次入院，１９９０年右肾结石体外震波碎石（ＥＳＷＬ）后回家感到疼痛，ＥＳ...     

ESWL治疗输尿管结石致肾绞痛44例报告

本院自１９８７年以来，应用体外冲击波碎石术（ＥＳＷＬ）治疗输尿管结石引起的肾绞痛（平均肾绞痛时间５．５小时）４４。４４蝇有２９例曾用解痉镇痛剂无效，１５例未用任何药物，均在ＫＵＢ平片上示输尿管径路有结石影。采用Ｘ线二重定位，冲击波剂量１３．９－１６．２ｋＶ，平均冲击次数８２５次。在冲击治疗５００次时因石碎或结石移动，肾绞痛缓解。作者认为，用本法治疗肾绞痛应选择小结石，以低能量、高频率冲击为宜。     

患肾不显影输尿管结石的ESWL治疗

目的　总结由输尿管结石梗阻引起患侧肾脏不显影者行ESWL治疗的临床经验。　方法　输尿管结石致急性绞痛患者 16 8例 ,ESWL术前行KUB和IVU检查明确诊断输尿管结石而患侧肾脏不显影。结石位于髂骨缘以上者采用仰卧位 ,髂骨缘以下者采用俯卧位治疗。对 10 4例病史 <1个月、年龄 <6 0岁者于结石排空后行IVU ,观察其肾功能恢复情况。　结果　 16 8例患者全部于 2周内排空结石 ,其中 10 4例在结石排空后 1周～ 1年复查IVU ,患侧肾均已显影 ,2例仍有肾盂轻度积水。　结论　输尿管结石急性发病时 ,可因肾内压力骤增而引起肾功能受损 ,表现为患侧肾不显影。这种损害是可逆的 ,及时解除梗阻可使患肾功能得到恢复 ,ESWL是有效措施之一     

Prospective randomized evaluation of emergency extracorporeal shock wave lithotripsy (ESWL) on the short-time outcome of symptomatic ureteral stones

OBJECTIVE: Here, we report the results of a randomized controlled trial (RCT) assessing the efficacy of emergency ESWL (eESWL) on the short-term outcome of symptomatic ureteral stones. MATERIAL: The trial enrolled 100 patients admitted in emergency room for renal colic caused by a ureteral radioopaque [corrected] stone. Patients were randomized to medical therapy alone or combined with eESWL. eESWL was performed within 6 hours of the onset of renal colic without specific analgesia on a Lithostar lithotripter (Siemens Medical, Munich, Germany). The primary endpoints were the proportion of patients stone free rate after 48 hours (SF-48) and the cumulative proportion of patients discharged from the hospital after 48 and 72 hours. RESULTS: Ureteral stone's location was proximal and distal in respectively 46% and 54% of the patients; stone's mean size was 5.5 mm (range 2-10 mm). Median hospital stay was 3 days, ranging from 1 to 14 days. SF-48 in the control group varied from 76% for distal stones <5 mm to 28.6% for proximal stones >5 mm, averaging at 61%. On average, eESWL increased SF-48 by 13% (p: 0.126), the gain strictly depending on stone size and location. SF-48 increase ranged from 40% for proximal stones >5 mm to 1.8% for distal stone <5 mm. On average, eESWL increased the median duration of hospital stay by one day. This mean negative impact results from ESWL increasing significantly the duration of hospital stay in case of distal stone, while slightly shortened it for stones located proximally. CONCLUSION: This study demonstrated for the first time that rapidly performed ESWL is a valuable therapeutic option to improve elimination of ureteral stones and shorten duration of hospital stay, proven that the stone is located proximally to the iliac vessels.     

急诊输尿管镜碎石术与ESWL治疗输尿管中下段结石并急性肾绞痛的疗效评价

目的 比较急诊输尿管镜下气压弹道碎石术（ureteroscopic lithotripsy,URSL）与体外冲击波碎石术（extracorporeal shock wave lithotripsy,ESWL）治疗输尿管中下段结石并急性肾绞痛的疗效.方法 回顾性分析本院近3年来45例急诊URSL（URSL组）以及51例急诊ESWL（ESWL组）治疗输尿管中下段结石并急性肾绞痛患者的临床资料,比较其疼痛缓解率、一次性碎石成功率、术后2周结石排净率、并发症发生率等指标.结果 URSL组和ESWL组疼痛缓解率分别为95.56％（43/45）和78.43％（40/51）（P＜0.05）,URSL组一次性碎石成功率和术后2周碎石排净率分别为93.33％ （42/45）、97.78％ （44/45）,明显优于ES-WL组的78.43％ （40/51）、82.35％（42/51）（P＜0.05）;URSL组术后有2例发生尿路感染,ESWL组术后有4例发生肉眼血尿,两组术后均未出现发热、输尿管穿孔、撕裂等并发症（P＞0.05）.结论 对于结石直径＞l0mm的输尿管中下段结石并急性肾绞痛患者,急诊输尿管镜术疗效优于体外冲击波碎石术;首选输尿管镜术治疗此类患者具备一定的临床推广价值.     

急诊输尿管镜治疗输尿管结石并首次肾绞痛的疗效观察

目的 评价急诊输尿管镜治疗输尿管结石并首次肾绞痛的疗效.方法 本院2010年7月至2011年7月期间收治的140例输尿管结石患者纳入本研究范畴,其中60例输尿管结石患者首次肾绞痛时就诊,急诊行输尿管镜钬激光碎石,纳入第一组；80例患者对症处理后立即入院或肾绞痛再次发作入院并常规检查后再行输尿管镜钬激光碎石,纳入第2组.对两组患者的碎石效果、辅助治疗及相关并发症等指标进行比较,行统计学分析,得出结论.结果 140例患者均经输尿管镜检查,第1组结石大小0.80±0.31 cm,结石一次性清除率96.67％,无患者因结石疼痛再次就诊；第2组结石大小0.75±0.35 cm,结石一次性清除率95.00％,因结石疼痛再次就诊次数2.03±1.85,两组患者无严重并发症发生.结论 急诊输尿管镜治疗输尿管结石并首次肾绞痛安全可行,能及时解除疼痛.     

输尿管结石原位ESWL与URL的疗效比较

目的比较输尿管结石的原位ESWL与气压弹道碎石术(URL)的综合疗效。方法对经ESWL治疗1458例和URL治疗1308例的临床资料进行比较分析。结果ESWL总排净率为97.67%,高于URL总的排净率76.15%(P<0.05);ESWL平均治疗时间27min,排净时间4.2天,费用1350元,零住院天数,均低于URL的平均治疗时间35min、排净时间14天、费用4470元和住院天数4.3天(P<0.05)。结论ESWL的有效率和安全性优于URL,是一种高效、安全、痛苦且损伤少、经济负担轻的治疗方法。     

比较保守治疗或手术对急诊输尿管中下段小结石性肾绞痛的治疗价值

目的探讨药物保守治疗或输尿管镜碎石取石术两种方法治疗输尿管中下段小结石性。肾绞痛的临床效果。方法2012年7月至2013年4月间将40例输尿管中下段结石性肾绞痛患者随机分为两组。治疗组20例,应用输尿管镜碎石取石术,对照组20例采用排石、解痉药物保守治疗。结果与对照组相比,治疗组。肾绞痛缓解率较高（P〈0．05）;肾绞痛再发生率较低（P〈0．05）;从入组到肾绞痛缓解所需时间平均较短（P〈0．05）。治疗组清除结石的治愈率（95％,19／20）明显高于对照组（55％,11／20）（P〈O．05）,治疗组仅1例治疗失败,但拔出双J管1周后自行排出;对照组中9例保守治疗失败,其中3例通过体外冲击波碎石术治疗排出结石、6例采取输尿管镜碎石取石术最终取出结石。结论输尿管镜下碎石取石术治疗输尿管中下段小结石性肾绞痛可及早解除疼痛、减轻痛苦,且清除结石治愈率高,值得临床推广应用。     

Efficacy of in situ extracorporeal shock wave lithotripsy for upper ureteral calculi

In contrast to the majority of renal calculi, in situ extracorporeal shock wave lithotripsy (ESWL) for upper ureteral stones is still controversial. Some centers recommend retrograde mobilization of the calculus into the renal pelvis prior to ESWL as a routine procedure (UC + ESWL). To evaluate the efficiency of in situ ESWL for upper ureteric stones, we initiated a prospective clinical trial. From July 1985 to January 1986, 122 patients presented with upper ureteral calculi, necessitating a total of 146 different procedures: 88 in situ ESWL; 31 UC + ESWL; 15 antegrade ureteroscopies (URS); 6 retrograde URS; 2 open surgery (ureterolithotomy, nephrectomy), and 4 patients were managed conservatively. Of all 99 patients treated at the lithotripter, 80 patients received in situ ESWL (no emergency case, no location problems): in 60 patients (75%) the stone could be disintegrated in one session; 8 patients (10%) required a second ESWL session due to partial fragmentation. Retrograde mobilization using a ureteral catheter or URS was necessary in 9 patients due to failure of in situ ESWL (11%) and, in only 3 patients, we had to remove the stone by antegrade URS (4%). In conclusion, 96% of all upper ureteric stones suitable for primary ESWL could be treated by a noninvasive (in situ ESWL) or minimally invasive (UC + ESWL) procedure. Therefore we recommend in situ ESWL for these calculi. Primary retrograde mobilization is only indicated in case of location problems (stone close to the spine, obesity, skeleton deformation) or emergency cases (colic, hydronephrosis). Antegrade URS should be performed if retrograde mobilization fails or in emergency cases (acute pyelonephritis, following percutaneous nephrostomy, after clinical stabilization). The rate of open surgery is below 2%.     

肾绞痛患者体外冲击波碎石术最佳治疗时机探讨

目的 寻找伴有肾绞痛的输尿管结石行体外冲击波碎石术(extracorporeal shockwave lithotripsy,ESWL)的最佳治疗时机.方法 跟踪观察行ESWL的伴有肾绞痛的输尿管结石患者505例,按肾绞痛发作至ESWL的时间间隔分为三组:A组(肾绞痛发作时行ESWL,或急诊ESWL)123例;B组(肾绞痛缓解后3～6d内行ESWL)162例;C组(肾绞痛缓解7d后行ES-WL)220例.观察三组一次碎石成功率、2周结石排净率、再发肾绞痛率及肾内感染发生率并进行比较.结果 A组所有患者经ESWL治疗约5～ 15 min肾绞痛症状明显缓解或消失,绞痛缓解率100％.虽然A组、B组的1次碎石成功率、2周结石排净率均优于C组,差异均有统计学意义(P＜0.05),但A组与B组比较,均无显著差异(P＞0.05).而A组术后再发肾绞痛率和并发肾内感染率分别为50.4％和17.1％,明显高于B组的4.9％和5.6％以及C组的6.8％和5.9％,差异均有统计学意义(P＜0.01).结论 输尿管结石伴有肾绞痛患者应尽早行ESWL治疗,疼痛缓解率高,但应用ESWL的最佳治疗时机为肾绞痛缓解后3～6d内.     

Management of painful caliceal stones by extracorporeal shock wave lithotripsy

One hundred and seven patients with caliceal stones causing flank pain were treated by extracorporeal shock wave lithotripsy (ESWL), followed up and reviewed. The total stone-free rate 3 months after ESWL was 38.8%. The total pain-free rate was 50.5%. The pain-free rate was 85% in the stone-free group and 29% in the group with residual stones. No significant differences between the stone-free rate and the duration of pain or age was noted. Patients with abnormal intravenous pyelography (IVP) had a lower stone-free rate than patients with normal IVP (16 vs. 45%, p less than 0.05). The complications included: 6 cases of stone street formation with spontaneous passage; 1 case of stone street formation needing percutaneous nephrolithotomy for drainage; 1 perirenal hematoma; 9 cases of severe colic pain following ESWL; 3 cases of fever following ESWL, and 4 cases of hydronephrosis due to a stone in the ureterovesicle junction. These results show that ESWL is an effective, noninvasive treatment for painful caliceal stones.     

Emergency extracorporeal shock wave lithotripsy (ESWL) for obstructing ureteral stones

OBJECTIVE: To evaluate emergency treatment of obstructing ureteral stones by in situ extracorporeal shock wave lithotripsy (ESWL) during acute renal colic. PATIENTS AND METHODS: From January 1994 to February 2000, 200 patients (mean age: 42 years) were treated by ESWL (EDAP LT-02) for obstructing ureteral stones causing acute renal colic refractory to medical treatment or recurring within 24hours of such treatment. Stones were visualised by fluoroscopic imaging and/or ultrasound. Follow-up included radiological and/or ultrasound examinations and lasted three months. RESULTS: Mean stone size was 7mm (3-20mm). At three months, 164/200 (82%) patients were stone-free. This rate ranged from 79% to 83% according to the location of the stone, and from 75% to 86% according to the size of the stone. These differences in rate were not significant. Two or three ESWL sessions were required in 79 patients. ESWL was well tolerated in 90% of patients. The only complication was a case of pyelonephritis requiring the placement of a JJ stent, administration of antibiotics, and distant ureteroscopy. The 36 patients, in whom ESWL failed, underwent ureteroscopy (n=23) or lithotripsy with a Dornier machine (n=13). CONCLUSION: Non-deferred ESWL for acute renal colic secondary to obstructing ureteral stones has a satisfactory success rate and very low morbidity.