Extracorporeal shock-wave lithotripsy for retained common bile duct stones

Retained common bile duct stones (CBDS) become a challenging problem when percutaneous and endoscopic methods fail. Extracorporeal shock-wave lithotripsy (ESWL) is a noninvasive and effective treatment modality, and can be used as an alternative treatment of retained CBDS. We report our experience with 20 patients who had retained CBDS, using a second-generation electromagnetic lithotriptor. Thirteen patients who had cholecystectomy and common bile duct exploration, with stone extraction and T-tube drainage, were in the early postoperative period. Seven patients had undergone previous endoscopic sphincterotomy and nasobiliary drainage. Fourteen patients had only one ESWL session. Stone fragmentation rates were 100% and 57% in patients with T-tube and nasobiliary catheter, respectively. The overall stone fragmentation rate was 85% and complete stone clearance was achieved in all these patients (85%). Complications were mild and relatively infrequent (20%). There was no mortality. We conclude that ESWL for retained CBDS is a safe, effective and minimally-invasive treatment modality. ESWL should be considered as a significant alternative to surgery when endoscopic and percutaneous treatment modalities are not successful.     

超声定位体外冲击波碎石治疗上尿路阴性结石患者

目的探讨超声定位体外冲击波碎石(ESWL)治疗上尿路阴性结石的疗效。方法对42例上尿路阴性结石患者(肾脏结石35例,其中双侧3例,单侧多发结石4例;输尿管上段结石4例,输尿管末端结石3例)采用超声定位行ESWL45例侧。结石最大1.8cm×1.5cm,最小0.5cm×0.3cm。治疗电压上限110kV,电流上限2.0mA;成人治疗能量为6～8级,击打次数3500～4000次;儿童治疗能量3～5级,击打次数不超过2500次。ESWL治疗间隔7～10d。结果对1例肾结石及1例输尿管末端结石患者行ESWL治疗4次以上结石变化不大,放弃ESWL治疗,改为其他治疗。另43例侧中1次碎石成功4例,2次20例,3次15例,4次4例。碎石成功患者中1个月内结石排净率90.7%(39/43)。结论超声定位ESWL治疗上尿路阴性结石是一种值得推广的治疗方法。     

ESWL补救治疗输尿管镜气压弹道碎石失败的输尿管结石28例临床观察

目的探讨输尿管镜下气压弹道碎石术治疗输尿管结石失败后体外冲击波碎石（ESWL）补救的治疗效果。方法回顾性分析2007年5月至2008年12月输尿管结石患者28例,均为输尿管镜下气压弹道碎石术失败,采用ESWL补救治疗,观察碎石的效果。结果28例经体外冲击波碎石治疗,碎石效果良好,碎石逐步随尿液排出体外,1～2周后在膀胱镜下拔除双J管,复查尿路平片示无残余结石。结论输尿管镜下气压弹道碎石对于输尿管下段结石效果较好,上段结石容易因结石上漂造成气压弹道碎石失败,体外冲击波碎石提供了补救治疗的方法,碎石效果好。     

Cavitation detection during shock-wave lithotripsy

A system was built to detect cavitation in pig kidney during shock-wave lithotripsy (SWL) with a Dornier HM3 lithotripter. Active detection using echo on B-mode ultrasound, and passive cavitation detection using coincident signals on confocal orthogonal receivers, were used to interrogate the renal collecting system (urine) and the kidney parenchyma (tissue). Cavitation was detected in urine immediately upon shock-wave (SW) administration in urine or urine plus X-ray contrast agent but, in native tissue, cavitation required hundreds of SWs to initiate. Localization of cavitation was confirmed by fluoroscopy, sonography and by thermally marking the kidney using the passive cavitation detection receivers as high-intensity focused ultrasound sources. Cavitation collapse times in tissue and native urine were about the same, but less than in urine after injection of X-ray contrast agent. The finding that cavitation occurs in kidney tissue is a critical step toward determining the mechanisms of tissue injury in SWL.     

Ultrasonography and biliary extracorporeal shock-wave lithotripsy

The results of shock-wave treatment of gallbladder stones depend to a very high degree on the quality and expertise of ultrasonography applied before, during, and after shock-wave disintegration of the stones. Ultrasonography is decisive in evaluating the inclusion criteria; it is the method of choice for directing the shockwave energy at the stones and monitoring the disintegration process. It is the only diagnostic modality to really demonstrate the gallbladder being free from stones. © 1993 John Wiley & Sons, Inc.     

双J管在体外冲击波碎石术中的应用与比较

目的探讨体外冲击波碎石术(ESWL)治疗肾内较大结石时使用双J管作内引流的可行性及意义。方法该院采用ZL-502型体外碎石机,对616例肾内较大结石患者行ESWL。其中ESWL前经膀胱镜置入双J管243例,未置入双J管373例,并对两组进行比较。结果置入双J管组:并发症少,排石快,对肾功能的保护起着重要作用;未放置双J管组:并发症多(肾绞痛、发热、血尿、呕吐、肾区叩痛、功能受损),碎石次数多,排石时间长,其中改开放手术11例,输尿管镜手术71例。结论肾内较大结石行ESWL术前置入双J管具有内支架和内引流双重作用,对石街梗阻造成的肾功能一过性损害起到保护作用。     

输尿管镜气压弹道与体外震波碎石术治疗输尿管结石疗效比较

目的 比较输尿管镜气压弹道碎石术（URSL）与体外震波碎石（ESWL）治疗输尿管结石的疗效和不良反应。方法分别使用URSL与ESWL治疗输尿管结石患者各120例，治疗后应用腹部平片评估其疗效，随访1-3月。了解结石排净率，观察并记录不良反应和并发症。结果URSL有效率为88．3％，ESWL有效率77．5％。差异有显著性意义（P〈0．05）；URSL上段结石有效率76．3％，ESWL有效率94．9％，差异有显著性意义（P〈0．05）：URSL中下段结石有效率93．9％，ESWL有效率69．1％，差异有显著性意义（P〈0．05）；其肾绞痛、恶心呕吐、发热URSL低于ESWL（P〈0．05），URSL的并发症为1．7％的输尿管穿孔。结论URSL治疗输尿管结石优于ESWL；URSL适用于中下段输尿管结石的治疗，ESWL较适用于上段输尿管结石。     

腔镜时代体外冲击波碎石的地位

尿路结石是泌尿外科常见病,多发病。治疗方法较多,常用的治疗方法包括体外冲击波碎石术(ESWL)、经皮肾镜取石术(PNL)、输尿管镜取石术(URL)、腹腔镜取石术及开放手术。本文结合文献及作20年工作经历探讨腔镜时代体外冲击波碎石的地位,认为目前即使有先进的腔镜取石方法,ESWL仍然是治疗上尿路结石的主要方法。     

Extracorporeal shockwave lithotripsy of pancreatic duct stones

Encouraging results with extracorporeal shockwave lithotripsy (ESWL) for pancreatic duct stones have been reported from Europe. We present our experience with the first two North American patients, treated with excellent results in one and limited clinical improvement in the other patient at 1 year follow-up. Targeting of pancreatic duct stones was achieved with either fluoroscopy or ultrasound.     

体外震波碎石治疗输尿管下段结石1622例临床分析

目的探讨体外震波碎石术用于输尿管下段结石治疗效果。方法运用液电冲击波碎石治疗输尿管下段结石1622例。结果结石消失者1592例，治愈率98．2％。结论定位准确和能量掌握是提高疗效的重要步骤。     

Improvement of stone fragmentation during shock-wave lithotripsy using a combined EH/PEAA shock-wave generator-in vitro experiments

To control the collapse of cavitation bubbles induced during shock-wave lithotripsy (SWL), a piezoelectric annular array (PEAA) shock-wave generator was fabricated and combined with an experimental electrohydraulic (EH) shock-wave lithotripter with a truncated HM-3 reflector. The PEAA generator consists of eight individual transducers of 200-kHz resonant frequency. At a discharge voltage of 15 kV, the PEAA generator produces a shock wave with a peak positive pressure of 8.2 MPa, a positive half cycle duration of 2.9 micros, and a -6-dB beam width of 5 mm. The trigger of the PEAA generator was controlled via fiberoptic link with reference to the spark discharge of the EH generator. Hence, the PEAA-generated shock wave could be used to interact with cavitation bubbles induced by the EH source at various stages of their oscillation. The duration of bubble oscillation during SWL was monitored by a 2.25-MHz focused hydrophone, and this information was used to control the release timing of the PEAA generator. Stone fragmentation tests in vitro were carried out, and demonstrated that stone comminution could be significantly enhanced when the shock wave-bubble interaction occurred during the collapsing phase of the bubbles. A maximum increment of 60% to 80% in stone fragmentation was achieved when the PEAA-generated shock wave arrives near the collapse of the bubbles. Under these conditions, much intensified collapse of the bubbles near the surface of the stone, with strong secondary shock-wave emission and increased stress concentration at the impact site of the solid boundary, was observed using high-speed shadowgraph and photoelastic imaging.     

Extracorporeal shock wave lithotripsy: indications and technique

In spite of some long-term uncertainties, this new method for treating stones has one tenth the morbidity and risk of any comparable method of stone removal, at least in the short term. Extracorporeal shock wave lithotripsy can be used to treat 70% to 80% of stones that would otherwise require surgery to be removed. Using ESWL in conjunction with endoscopic procedures means that less than 1% of patients with stones will need an open surgical procedure. The need for metabolic evaluation and prevention of stone disease should continue to be emphasized, however, despite the lowered morbidity of treatment.