经尿道输尿管肾镜钬激光碎石术治疗上尿路结石

目的探讨经输尿管肾镜联合钬激光腔内治疗输尿管结石的有效性及安全性。方法分析2005年1月～2006年12月收治的经输尿管肾镜钬激光治疗输尿管结石206例的临床资料。其中181例伴有患侧轻、中度肾盂积水,IVP患肾不显影19例,28例同时合并结石远端输尿管狭窄,57例合并有息肉或肉芽组织包裹,26例为体外冲击波碎石术（ESWL）治疗失败。结果206例中195例单次手术碎石成功,单次手术结石粉碎率达94．7％（195／206）。平均手术时间25min,术中无输尿管穿孔等并发症发生,平均住院日5.5d。10例结石在钬激光碎石过程中移位于肾盏或结石残留,术后再行ESWL治愈;1例双侧输尿管结石,因输尿管狭窄无法人镜,中转开放手术。结论输尿管肾镜联合钬激光碎石术治疗输尿管结石有效、安全,可作为输尿管结石特别是中下段结石首选的治疗方法。     

输尿管软镜联合钬激光碎石治疗肾结石

目的：探讨输尿管软镜联合钬激光碎石对肾结石的疗效与安全性。 方法：回顾分析,采用输尿管软镜联合钬激光碎石治疗肾结石患者103例,包括体外冲击波碎石失败及输尿管上段结石腔内碎石上移的肾盂肾盏结石。     

输尿管软镜下钬激光碎石术治疗上尿路结石——附126例报告

目的探讨输尿管软镜下钬激光碎石术治疗上尿路结石的疗效。方法上尿路结石患者126例,其中右侧结石75例,左侧结石51例。输尿管上段结石33例,输尿管上段合并肾结石29例,肾结石64例。结石大小0．6～2．0cm,平均1．33cm。经输尿管硬镜扩张后留置输尿管扩张鞘寻找结石,采用输尿管软镜下钬激光碎石术治疗,光纤直径200μm,能量0．8～1．0J,频率5～lOHz。结果单次碎石成功117例（占92．86％）,手术时间25～75min,平均48min。术后6例出现低热,无脓肾、输尿管穿孔等并发症。结论输尿管软镜下钬激光碎石术治疗上尿路结石安全有效,尤其适用于输尿管上段、肾盂、肾中盏及肾上盏结石。     

经皮肾造瘘治疗上尿路结石229例分析

目的总结分析经皮肾造瘘治疗上尿路结石的经验和教训,提高结石的治疗水平。方法本组患者229例次,均为上尿路结石。治疗经过:在B超引导下,行患侧穿刺,见有尿液回流后依次扩张形成造瘘通道,置入输尿管镜或肾镜,找到结石,应用钬激光或气压弹道+超声吸引进行碎石、清石,治疗结束后置双J管和引流管,1周后复查,如发现有残余结石可再次清石或经体外碎石治疗。结果本组患者205例,行229例次手术,患侧一次结石清除率为75.1%(172/229),经再次碎石、清石或体外碎石后,202例次治愈,占88.2%(202/229)。术后并发症:发热,69例次,约占36%。气胸1例,术后严重出血1例,经栓塞治疗后痊愈。结论经皮肾造瘘治疗上尿路结石效果好、并发症少。经多次应用后明显提高结石的清除率。     

经尿道输尿管镜联合经皮肾镜碎石术治疗复杂性上尿路结石

 目的 探讨经尿道输尿管镜联合经皮肾镜碎石术治疗复杂性上尿路结石的可行性和应用效果。方法 56例均为肾复杂性结石合并同侧输尿管结石肾积水。先取截石位,经尿道置入输尿管镜到达输尿管结石部位,插入钬激光光纤直视下行钬激光碎石术,然后置入F5输尿管导管至肾盂,退出输尿管镜保留输尿管导管,膀胱内置入导尿管。然后取俯卧位,在B超定位下穿刺,根据结石情况行经皮肾镜碎石术,碎石设备为第四代气压弹道超声清石系统。碎石完成后,通过经皮肾镜置入F6双J管,如有结石下移至输尿管或置入双J管不顺利,可再次通过截石位,经尿道置入输尿管镜行钬激光碎石或放置双J管。结果 56例均成功,无中转开放手术,无一例出现输尿管损伤或结肠损伤,所有输尿管结石均一期清除干净,56例有48例肾脏结石清除干净,结石一期清除率为78.6%（44/56）,二期结石清除率为80.0%（8/10）,结石总清除率为92.8%（52/56）。结论 对于复杂性肾结石合并同侧输尿管结石,术前无须行体外冲击波碎石术。采取经尿道输尿管镜联合经皮肾镜碎石治疗,可同时取出输尿管全程和肾内的结石,结石清除率高,是处理复杂性上尿路结石安全、可靠实用的方法。     

移植肾结石临床处理经验总结

目的总结移植肾并发尿路结石的诊断及治疗经验。方法回顾分析我院7例肾移植术后并发移植肾上尿路结石患者的临床资料。结果 2例移植肾输尿管结石患者,行输尿管镜下钬激光碎石取石术;5例移植肾肾盂结石及输尿管上段结石患者行经皮移植肾穿刺钬激光或超声弹道碎石术;术后肾功能恢复情况良好。结论微创碎石取石技术对于移植肾上尿路结石的治疗有确切疗效。     

体外冲击波碎石治疗上尿路结石362例分析

目的讨论体外冲击波碎石对对上尿路结石的治疗价值。方法对2011-02-2013-02就诊、行体外冲击波碎石治疗的362例上尿路结石患者病例回顾性分析总结。结果本组一次性结石粉碎率89．50％（324例）,1个月内总的排净率为92．82％（336例）。治疗过程中无肾破裂,‘肾功能衰竭,输尿管穿孔,胃肠道损伤等严重病发症。结论上尿路结石系泌尿外科常见疾病,体外冲击波碎石治疗上尿路结石所需费用低廉,可多次反复治疗,副作用少、安全、可靠、并发症较少,为治疗上尿路结石的理想方法。在基层医院可以广泛开展。     

体外冲击波联合膀胱镜输尿管插管治疗上尿路结石的疗效观察

目的:探讨体外冲击波联合膀胱镜输尿管插管治疗上尿路结石的疗效.方法:对我院2010年收治的泌尿系上尿路结石594例患者采用体外冲击波联合膀胱镜输尿管插管联合治疗组治疗患者436例;使用药物治疗或单一方法治疗组158例.方法治疗的临床资料进行分析总结.结果:0.6 cm～1.2 cm以内的上尿路结石治疗组与对照组有显著可比性.结论:体外冲击波碎石联合膀胱镜输尿管插管术是基层医院治疗0.6 cm～1.2 cm以内的上尿路结石的有效治疗手段.     

铂立组合式输尿管软镜钬激光碎石治疗上尿路结石体会(附263例报告)

目的:探讨铂立组合式输尿管软镜钬激光碎石治疗上尿路结石的方法与疗效。方法:回顾性分析2014年1月至2017年10月,使用铂立组合式输尿管软镜治疗上尿路结石病例。镜体外径8 F,末端单向弯曲250°;Cook输尿管扩张鞘12/14 F;钬激光碎石功率35～60 W,200～260μm钬激光光纤。患者年龄25～68岁。肾结石131例,其中双侧肾结石5例,解剖性或功能性孤立肾结石2例,肾下盏结石74例;肾结石合并输尿管结石69例;输尿管结石63例,其中上段结石47例,中段结石16例。结石直径0.6～5.8 cm。先行置入8/9.8 F输尿管硬镜观察患侧输尿管了解管径大小,弯曲程度及有无病变等情况,结石上移入肾盂、肾盏用软镜处理;对于输尿管硬镜置入困难的患者用软镜处理。放入0.035英寸导丝,循导丝置12/14 F输尿管扩张鞘至UPJ处,组装输尿管软镜,在输尿管扩张鞘内置镜入肾盂,观察肾盂和各肾盏,寻找到结石后用钬激光(30～35 W功率下)予以击碎。术后1周复查KUB和B超判定碎石效果。结果:2例下盏结石能见到但软镜下钬激光难以达到,留置双J管后体外碎石。12例肾下盏结石因下盏漏斗-肾盂夹角过小和肾盂狭长未能一次碎石,行2次输尿管软镜碎石(2次手术后残留结石1例)。本组平均碎石时间20.2(15～45)min,术后败血症2例,肾周血肿1例,经积极治疗后痊愈;无围手术期大出血;无输尿管断裂、术后狭窄病例;无中转开放手术病例。对于结石大小为1～2 cm而无明显积水的肾结石,输尿管软镜钬激光碎石具有优势;2 cm的肾下盏结石输尿管软镜下钬激光碎石可选;直径3 cm的结石可考虑分次手术或配合ESWL。结论:组合式输尿管软镜钬激光碎石术是治疗上尿路结石,特别是肾盏结石,安全,有效的方法之一。     

胃镜下激光引爆微爆破碎石术与钬激光碎石术治疗胃石症的疗效比较

目的 评价并比较胃镜下Nd：YAG激光引爆微爆破碎石术和钬激光碎石术治疗胃石症的疗效及安全性，探讨胃石症的有效治疗手段。方法 对368例胃石症患者的402块胃石进行了胃镜下碎石治疗。Nd：YAG激光引爆微爆破碎石术组260例共285块胃结石，男性177例，女性83例，年龄5～78岁，平均37．6岁。钬激光碎石术组，108例共117块胃结石，男性61例，女性47例，年龄8～67岁，平均36．8岁。结果 全部患者均获得治愈，仅Nd：YAG激光引爆微爆破碎石术组1例患者发生胃穿孔，经手术治愈，其余患者未发生任何术中及术后并发症。Nd：YAG激光引爆微爆破碎石术组260例经1次治疗治愈220例占84．6％，其余患者经2次治疗均获得治愈，每次治疗平均耗时8min。钬激光碎石术组108例患者1次治疗治愈62例占57％；经2次治疗治愈41例占38％；5例经3次治疗治愈，治愈率达100％，每次治疗平均耗时15min。结论 胃镜下Nd：YAG激光引爆微爆破碎石术和钬激光碎石术两种方法治疗胃石症均安全有效。Nd：YAG激光引爆微爆破碎石术由于碎石效率高比钬激光碎石术耗时更短，操作更快捷，患者痛苦更小；而钬激光碎石术则更加安全，但钬激光机价格昂贵，不如前者容易普及。     

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。     

ESWL型矿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     

Complications of renal extracorporeal shock wave lithotripsy reviewed

Renal extracorporeal shock wave lithotripsy (ESWL) is a noninvasive and effective method for the treatment of a variety of urinary tract calculi with significantly lower morbidity than both surgical procedures for stone removal (pyelolithotomy/ureterolithotomy) and percutaneous nephrostolithotomy. Though significant, severe complications are rare, ESWL therapy can result in a wide spectrum of tissue injury. This article serves to review the currently known complications of ESWL, which radiologists may encounter, providing an understanding of the potential effects of shock waves on body organs and the resultant functional and morphologic changes that may result.     

Complications of renal extracorporeal shock wave lithotripsy reviewed.

Renal extracorporeal shock wave lithotripsy (ESWL) is a noninvasive and effective method for the treatment of a variety of urinary tract calculi with significantly lower morbidity than both surgical procedures for stone removal (pyelolithotomy/ureterolithotomy) and percutaneous nephrostolithotomy. Though significant, severe complications are rare, ESWL therapy can result in a wide spectrum of tissue injury. This article serves to review the currently known complications of ESWL, which radiologists may encounter, providing an understanding of the potential effects of shock waves on body organs and the resultant functional and morphologic changes that may result.     

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。     

Comparison of percutaneous and endoscopic retrograde removal of postoperatively retained bile duct stones

Forty-one patients underwent nonsurgical removal of postoperatively retained bile duct stones in two nonrandomized groups. The endoscopic-retrograde technique was used in 21 patients, and succeeded in 19. The percutaneous approach through the T-tube tract was used in 22 patients, including the two in whom endoscopic stone removal had failed, and was successful in 21 patients. Individual preferences and prior history introduced a selection bias against the percutaneous technique. Auxiliary extracorporeal shockwave lithotripsy (ESWL) was used in 2 patients whose stones could not be fragmented mechanically by the percutaneous basket technique. ESWL was successful in one patient but failed in the second. Because endoscopy had also failed in this case, the patient subsequently underwent repeat surgery. Procedure-related complications were minor with both techniques and were readily treated by conservative measures. We conclude that both the retrograde and the percutaneous approaches are effective and safe. The endoscopic approach appears convenient because there is no need to await maturation of the percutaneous tract, but sphincterotomy carries a small but distinctive risk. Because the percutaneous approach uses an existing tract, is only minimally invasive and leaves the sphincter of Oddi intact, it is preferable in those patients who have T-tubes of approapriate size and position in place.     

Computerized tomography follow-up after percutaneous renal lithotripsy]

Even though extracorporeal shock wave lithotripsy (ESWL) is nowadays considered the treatment of choice for the majority of upper urinary tract calculi, percutaneous stone removal will continue to be an alternative treatment method in selected cases. Therefore, percutaneous techniques must not be forgotten by the interventional radiologist. In order to assess the effects and the potential damage caused by this interventional procedure to kidney and perirenal tissues, CT was performed on 20 patients before and after percutaneous nephrolithotripsy. In the cases where no complications occurred during the maneuver, post-nephrolithotripsy scans demonstrated low incidence of significant renal abnormalities. Thickening of pararenal fascia (8 patients) and irregular renal outline (10 patients) were our most frequent findings. In 5 patients we found edema of the pyelo-ureteral junction, in 3 thickening of the bridging perinephric septa and retained stone fragments, in 2 perirenal hematomas, in one a subcapsular fluid collection. Urinoma with pelvic laceration was demonstrated in the only patient in whom the maneuver presented marked technical problems. On the basis of this series of pre- and post-nephrolithotripsy CT scans of treated kidneys, the authors conclude that this percutaneous technique is quite atraumatic.     

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。     

输尿管镜下钬激光治疗上尿路疾病293例

目的探讨输尿管镜下钬激光治疗上尿路疾病的方法与疗效。方法中下段输尿管结石及输尿管狭窄经尿道逆行输尿管镜下钬激光治疗;上段输尿管结石、肾结石及输尿管狭窄经皮肾穿刺建立工作通道后,顺行输尿管镜下钬激光治疗。结果输尿管结石单次碎石成功率为92.6%（150/162）,肾结石碎石成功率为93.8%（61/65）。52例输尿管狭窄中,35例狭窄段消失;10例较治疗前狭窄处管腔增宽;4例狭窄段无变化;3例较治疗前狭窄加重输尿管扩张或肾积水加重,患者临床症状无明显改善,行Ⅱ期输尿管狭窄段切除、端端吻合或离断式肾盂输尿管成型术,术后无输尿管狭窄。单纯输尿管息肉14例均一次治愈。发生并发症9例。结论输尿管镜下钬激光治疗上尿路疾病安全、微创、有效、并发症少。