Analysis of radiolucent gallstones by computed tomography for in vivo estimation of stone components

Successful oral litholytic and other nonoperative therapies of gallstones require exact determination of the stone components. Since computed tomography (CT) provides highly sensitive measurement of density, we performed a study to evaluate whether CT measurement of stone density allows a prediction of the composition of radiolucent gallstones. Twenty-eight patients presenting with 29 radiolucent gallbladder (n = 17) or common bile duct stones (n = 12) were included. Prior to operative or endoscopic therapy the attenuation values (Hounsfield Units, HU) were assessed in vivo by CT under standardized conditions (Somatom II, 125 KV, 130 mAs). After surgical or endoscopic stone removal the concrements were dehydrated, homogenized and then analysed by infra-red spectroscopy. The previously measured Hounsfield units were not known to the investigator. Eighteen cholesterol and 11 pigment stones could be identified. The attenuation values (Hounsfield units) of cholesterol stones amounting to 28-98 HU (48.7 +/- 4.4 HU) differed significantly (P less than 0.001) from pigment stones (90-120 HU/105.5 +/- 2.8 HU). We conclude that computed tomography provides exact discrimination between cholesterol and non-cholesterol stones in vivo. Since only cholesterol stones can be dissolved by cheno- and ursodeoxycholic acid we recommend measurement of the radiodensity of gallstones by CT prior to any litholytic therapy. Furthermore the prediction of the stone composition facilitates the decision on extracorporeal shock wave lithotripsy and the selection of specific solvents for contact lysis via a nasobiliary probe.     

体外冲击波对胆总管术后残留结石的碎石效应

Recentyearswidespreadclinicalinvestigationsandpopulationsurveysoflargeamountsuggestedthattheincidenceandrelativeincidenceofcholedocholithiasisincreased，inwhichbilestonesin６％～１９．５％patientsgotintobileductsandcausesecondarycholedocholith犤１犦．Thepostoperativeresidualbilestonesofcholedo－cholithiasisarecommondiseasesandtheincidenceofthemisin－creasing犤２犦．Andthepostoperativeresidualbilestoneshappenocca－sionally．Thetraditionaltherapyislithotomyortrans－stomachole－dochoscopiclithoto…     

输尿管碎石取石联合体外冲击波碎石治疗输尿管石街

目的探讨输尿管石街高效简便的治疗方法。方法局麻浸润麻醉下输尿管镜碎石取石术(URL)联合体外冲击破碎石术(ESWL)治疗输尿管石街27例。结果27例均成功碎石取石及置入D-J管。随访1￣3个月,25例排尽结石,2例合并脓肾,仍残存结石,ECT检查GRF<12mL/s,行肾切除术。未出现手术并发症。结论URL联合ESWL治疗输尿管石街、高效安全、局部浸润麻醉下可进行,操作简单方便,是有效的治疗手段,合并脓肾者须慎重。     

膀胱结石患者结石定位于膀胱体外侧壁碎石效果观察

目的探索一种能取得最佳体外冲击波碎石效果的膀胱结石定位的解剖部位。方法利用随机数字表将100例膀胱结石患者分为两组,每组50例,单数为观察组,双数为对照组。观察组采用定位于膀胱体外侧壁的侧-俯卧位进行体外冲击波碎石为改进定位组,对照组将结石定位于膀胱顶部的俯卧位进行体外冲击波碎石为常规定位组。观察碎石后两组结石破碎颗粒的大小、全部碎石排净时间及排尿顺畅和碎石嵌顿的情况。结果改进定位组排出的碎石颗粒全部<4mm,常规定位组有14例>4mm,碎石效果明显高于常规定位组(P<0.01)。两组碎石颗粒经t检验,P<0.001,有显著性差异,改进定位组碎石颗粒比常规定位组小。碎石排净时间:改进定位组50例2d内全部排净,常规定位组有10例在3～12d排净,两组碎石排净时间比较有显著性差异(P<0.01)。改进定位组碎石后排尿顺利,无1例出现碎石嵌顿,常规定位组有10例碎石嵌顿。结论膀胱结石患者采用结石定位于膀胱体外侧壁碎石效果优于定位于膀胱顶部。     

Goodpasture's disease following extracorporeal shock wave lithotripsy: a case report & literature review

Shock wave lithotripsy may unmask epitopes within the glomerular basement membrane, leading to the formation of anti‐glomerular basement membrane (GBM) antibodies and clinical disease in susceptible individuals. Although rare, our case highlights the need for vigilant monitoring of renal function following extracorporeal shock wave lithotripsy. This may allow for early recognition, treatment and improved outcome of anti‐GBM disease.     

体外冲击波碎石术治疗经皮肾镜或输尿管镜碎石术后上尿路残余结石的效果

摘要： 目的 探讨经皮肾镜(percutaneous nephrolithotomy,PNL)及输尿管镜碎石术(ureteroscopic lithotripsy,URL)后上尿路残余结石行体外冲击波碎石术（extracorporeal shock wave lithotripsy，ESWL)的疗效和安全性。方法 回顾性分析2018年8月至2020年6月于我院行PNL或URL，术后存在上尿路残余结石并接受术后ESWL的235例患者。其中男性144例，女性91例，平均年龄（47.2±8.6）岁，结石位于左侧124例、右侧111例，输尿管上段结石114例，结石最大径（0.7±0.3）cm，肾结石121例，结石最大径（1.4±0.6）cm。结果 86例PCNL术后患者中有55例行ESWL1次、21例行ESWL2次后复查无临床有意义残石(significant residual fragments，SIRF)，10例行ESWL2次后仍有大于4mm残余结石，其中8例结石形状改变，2例结石形状无明显变化；149例输尿管镜碎石术后患者中有96例行ESWL1次、28例行ESWL2次后复查无SIRF，25例行ESWL2次后仍有大于4mm残余结石，其中18例结石形状改变，7例结石形状无明显变化。结石总碎石率96.2%（226/235），总清除率85.1%（200/235）；肉眼血尿发生率17.9%（42/235），肉眼血尿症状在患者增加饮水量1-3天后均消失。疼痛发生率10.6%（25/235），均为可忍受，无需特殊治疗。泌尿系感染发生率0.9%（2/235），予以抗炎治疗3天后两位患者均痊愈。结论 ESWL治疗经皮肾镜及输尿管镜碎石术后的上尿路残余结石有明显疗效，安全性高，可行性强，且病患创伤小、痛苦少、治疗费用低。     

复式脉冲体外冲击波碎石术治疗PCNL术后残留肾结石

目的总结复式脉冲体外冲击波碎石(ESWL)在PCNL术后残留肾结石治疗的应用体会。方法回顾性分析我中心3265例行复式脉冲体外冲击波碎石术治疗的肾结石患者的临床资料,实验组为微创经皮肾镜碎石术后残留肾结石患者,共计896例,对照组为单纯ESWL治疗肾结石患者,共计2369例。分析两组患者结石治疗的有效率、治愈率及术后并发症等因素。结果实验组患者进行2次以上ESWL治疗的比例较单纯ESWL治疗组低,结石排出率较单纯ESWL治疗组高。在并发症方面,两组患者术后发生肉眼血尿、术后感染、肾脏包膜下或实质内血肿及肾功能不全的比例相当。但是,实验组患者其治疗后发生肾绞痛及形成石街的比例较单纯ESWL治疗组低。结论复式脉冲体外冲击波碎石术对PCNL术后残留结石患者的治疗创伤小、成功率高、严重并发症少,是处理上尿路残留结石有效治疗手段之一。     

Ultrasound-guided piezoelectric extracorporeal shock wave lithotripsy of parotid gland calculi

PURPOSE: The introduction of piezoelectric extracorporeal shock wave lithotripsy (ESWL) has changed therapy for salivary calculi. This method seems especially suitable for treating calculi in the parotid gland. The purpose of this study was to evaluate ESWL in patients with such calculi. METHODS: From November 1990 to November 1999, all patients with sialolithiasis of the parotid gland were treated with piezoelectric ESWL. Three different lithotriptors were used over the 9-year study period. Results were analyzed according to both the patients' clinical status and follow-up sonograms. RESULTS: In total, 42 patients (21 women, 21 men; mean age, 59 years) were treated with ESWL. The mean follow-up period for all patients was 63 months (range, 7-96 months). After ESWL had been performed, 71% of the patients were completely free of symptoms, and 21% had marked improvement of their symptoms. Sixty-seven percent were completely free of calculi, and 27% had a marked reduction in the size of their calculi. Adverse effects of ESWL included temporary glandular swelling (4 patients), blood-tinged salivary secretions (9 patients), petechiae on the skin surface (3 patients), and parotid abscess (1 patient). CONCLUSIONS: ESWL is an outpatient procedure that can be performed without anesthesia and with scarcely any discomfort for patients. Conventional surgical procedures such as subtotal parotidectomy may be almost entirely replaced by ESWL because of the excellent treatment results and a very low rate of complications associated with ESWL. ESWL should be considered the treatment of choice for parotid calculi.     

Acute complications following extracorporeal shock‐wave lithotripsy for renal and ureteric calculi

Extracorporeal shock‐wave lithotripsy remains a widely utilized treatment modality for renal and some ureteric calculi. The treatment is generally considered very safe. However, minor complications occur in a significant number of patients. Serious complications, causing ongoing morbidity or mortality, are rare, affecting less than 1% of patients. A review of the literature on the adverse effects of the treatment, with an emphasis on those which might present to ED is presented.     

微爆破碎石在腹腔镜胆总管探查术治疗胆总管远端结石嵌顿中的应用效果

目的探讨微爆破碎石在腹腔镜胆总管探查术(LCBDE)治疗胆总管远端结石嵌顿中的应用效果。方法回顾性分析LCBDE中应用体内微电极碎石仪iMES-I-C治疗胆总管远端结石嵌顿的28例患者临床资料。结果28例患者均碎石成功,术中取净结石27例,1例残留小结石,术后7周胆道镜取石成功。碎石过程中未见胆道损伤及出血等并发症。结论LCBDE中采用微爆破碎石治疗胆总管远端结石嵌顿操作简单安全、效果可靠。     

体外冲击波碎石术对肾细胞内钙水平和肾细胞凋亡的影响

目的探讨体外冲击波碎石术(ESWL)对肾细胞内游离钙([Ca2+]i)水平及肾细胞凋亡的影响与钙通道阻滞剂的干预作用。方法30只家兔制成单肾模型,随机等分为对照组、ESWL组和ESWL+维拉帕米预处理组。ESWL后24h获取肾脏,采用Fura-2/AM荧光指示剂测定肾细胞内[Ca2+]i浓度,原位缺口末端标记法(TUNEL)和流式细胞计数法检测凋亡细胞。结果ESWL组肾细胞内[Ca2+]i增高、肾细胞凋亡率增加(P<0.01);维拉帕米预处理组上述改变明显改善(P<0.01)。ESWL后肾细胞内[Ca2+]i增高与细胞凋亡率有相关趋势(r=0.63,P<0.05)。结论ESWL所致肾细胞内[Ca2+]i超载和肾细胞凋亡增加,可能是ESWL肾损伤的重要机制;钙通道阻滞剂有拮抗细胞内[Ca2+]i超载和肾细胞凋亡增加的作用。     

复杂肾结石在经皮肾术前1天行体外碎石的对比研究

目的探讨术前行体外冲击波碎石(ESWL)是否可以提高复杂性肾结石行经皮肾镜取石术(PCNL)的疗效。方法选择复杂性肾结石病患160例,随机分为观察组和对照组,每组80例,对照组采取常规PCNL治疗,而观察组在常规PCNL术前1天行ESWL治疗,记录两组患者的手术时间、术中失血量、术后结石清除率、并发症、治疗费用和住院时间,对比两组疗效。结果两组比较,手术时间、术中失血量、术后结石清除率、并发症、治疗费用和住院时间差异均有统计学意义(P0.05),观察组较对照组全部具有明显优势。结论对于复杂性肾结石,PCNL术前行ESWL治疗与常规PCNL比较,在残石率、手术时间、手术次数、并发症、治疗费用和住院时间方面均有明显优势,是一种经济安全而效果好的治疗方法。     

体外震波碎石前后生化指标的检测

目的对体外震波碎石术（ESWI．）治疗的泌尿系结石患者．进行碎石前后生化指标的检测,为判断肾损伤及修复情况提供实验室依据。方法对桂林市第二人民医院泌尿外科2008年5月至2010年12月ESWL治疗的泌尿系结石患者235例进行碎石前后β2-微球蛋白（β2-MG）、尿微量清蛋白（mAlb）、尿素氮（BUN）和肌酐（Cr）、胱抑素C（CysC）的检测,并进行统计学分析。结果血清β2-MG、CysC及尿mAlb治疗后第1～2天显著升高,第2天达峰值,分别为（16．09±3．49）、（42．15±4．50）、（1．75±0．42）mg／L,治疗前后比较差异有统计学意义（P〈0．01）;第6天恢复至正常水平,与治疗前差异无统计学意义（P〉0．05）。治疗后BUN及Cr虽略有升高,但与治疗前比较差异无统计学意义（P〉0．05）。结论对ESWL治疗的泌尿系结石患者进行治疗前后β2-MG、尿mAlb、CysC的检测．有助于肾功能的监测。     

Electromagnetically generated extracorporeal shock waves for gallstone lithotripsy: in vitro experiments and clinical relevance

First generation shock wave sources have been proved to disintegrate gallstones effectively, but they require the immersion of the patient's body in a tank of water. A recently developed second generation shock wave source (Siemens-Lithostar, Erlangen, FRG) generates shock waves electromagnetically. It presents several novel features. In particular the waterbath can be omitted and due to lower shock wave pressure general anaesthesia is not required. In vitro studies showed that 36 out of 38 gallstones (11-30 mm in diameter) could be disintegrated. Two concrements resisting lithotripsy were pure white cholesterol stones. Independent of shape, size, and composition (cholesterol or pigment) the maximum diameter of remaining fragments after lithotripsy was between 1 and 8 mm. For sufficient disintegration precise focusing (+/- 1 cm) of the stones and maximum power of the shock wave generator were required.     

舒适护理在输尿管结石体外碎石术护理中的应用

目的:探讨舒适护理在输尿管结石体外碎石术护理中的应用效果。方法:将60例输尿管结石体外碎石术病人随机分为干预组和对照组,各30例。对照组采用传统护理,干预组除采用传统护理外还增加舒适护理。比较两组病人术后1周碎石清除率、平均结石排净时间、术后住院时间和术前、术后4周病人的焦虑水平以及病人的满意程度。结果:两组病人术后1周碎石清除情况无统计学意义(P=0.07),干预组病人平均结石排净时间及术后住院时间均明显少于对照组(P=0.00,P=0.00)。两组病人术前焦虑水平无统计学意义(P=0.922),但术后4周的焦虑水平有显著性差异(P=0.000)。两组病人的满意程度有显著性差异(P=0.00)。结论:舒适护理能有效减少输尿管结石体外碎石术病人平均结石排净时间及术后住院时间,减轻病人的焦虑程度并提高护理服务满意度。     

Scanning electron microscopy in analysis of urinary stones

Urolithiasis is a frequent and in many cases serious disease. Proper analysis of kidney stone composition is crucial for appropriate treatment and prevention of disease recurrence. In this work, scanning electron microscopy (SEM) coupled with energy-dispersive spectroscopy was applied for a study of 30 samples covering the most common types of human kidney stones. The results are analyzed and evaluated in terms of applicability of the method for both routine kidney stone analysis as well as collecting of specific data. The method provides complex information about studied samples including morphology of the stones and of the present crystals or their aggregates. It also brings information on elemental composition of the phases. After application of standardization, quantitative microanalysis with detection limits of 400?ppm (Mg, P, S, Cl, K, Ca), 500?ppm (Na) and 1200?ppm (F) was obtained. Compositional mapping with EDS shows the elemental distribution within a sample. This study demonstrated that information on morphology and chemistry acquired by these methods was highly reliable for identification of phases, even when present in small amounts. It provided information on kidney stone structure, relationships between phases, major and minor element content, and variations in chemical composition related to the growth of the stones. SEM represents a powerful tool in urinary stone analysis, since a single facility can produce a wide spectrum of information. It can be suggested as a basic method used for routine urinary stone identification, whilst bringing additional detailed information that cannot be obtained by other methods.     

Effects of Extracorporeal Shock Wave Lithotripsy on Cardiac Pacemakers and its Safety in Patients with Implanted Cardiac Pacemakers

Ejects of extracorporeal shockwave lithotripsy (ESWL) were studied on 15 pacemakers (standard single chamber n = 5, dual chamber n = 6, rate responsive single chamber [Activitrax] n = 4). In-vitro testing involved suspending the pacemakers in a bath of degassified, deionized water firmly taped to a platform at the point of maximal pressure, i.e., second focal point (F2), where they received pressure shocks (x?= 1300) from the HM3 Dornier lithotriptor. The pacemakers, programmed to their most sensitive setting, were continuously pacing at nominal outputs (atria) and ventricular pacing in the DDD mode). All units were assessed by a pacing system analyzer before and after the study, then underwent destructive analysis. During standard single chamber pacing (VVI) the pacing stimulus triggered ESWL. For dual chamber devices, ESWL was triggered by the atrial paced event which induced inhibition of the ventricular output in two pacemaker. This was eliminated by reprogramming to a less sensitive setting. The pacemaker can, hermetic seal and internal circuitry were undamaged in all units. Two rate responsive single chamber pacemakers had their activity sensing piezoelectric elements shattered when placed at F2. Two other units placed 5 cm from F2 were stimulated to their maximum upper programmed pacing rate with ESWL therapy, but were otherwise unaffected. Subsequent to this study, six patients with pacemakers programmed to the VVI (five), DDD (one) modes implanted in the thorax underwent successful ESWL without pacemaker or arrhythmic event. Conclusions: (A) It is generally safe for patients implanted with standard single chamber devices in a ventricular application to undergo ESWL without modifying the pacing/sensing parameters. (B) Patients implanted with dual chamber devices who pace in the atrium should be reprogrammed to the VVI mode during ESWL. (C) Patients with piezoelectric activity sensing rate responsive single chamber pacemakers should have this feature programmed off during ESWL and, if implanted in the abdomen, probably should not undergo ESWL.     

Association between renal urolithiasis after extracorporeal shock wave lithotripsy therapy and new-onset hypertension: an updated meta-analysis

ObjectiveThe long-term effect of extracorporeal shock wave lithotripsy (SWL) is still controversial. A previous meta-analysis showed no association between new-onset hypertension and entire upper urinary urolithiasis after SWL. Recently, there have been some reports on this topic. Therefore, we aimed to examine the association between new-onset hypertension and nephrolithiasis after SWL therapy.MethodsEmbase, the Cochrane Central Search Library, and PubMed were used to search for reports on new-onset hypertension and patients with nephrolithiasis after SWL. A meta-analysis of the association between new-onset hypertension and nephrolithiasis after SWL was carried out. The data of relevant research were synthesized and the relative risk was computed.ResultsSeven eligible studies were included in our meta-analysis. There was a significant association between nephrolithiasis after SWL and new-onset hypertension. The overall relative risk with a 95% confidence interval was 1.21 (1.11–1.31) in a fixed-effects model.ConclusionOur meta-analysis suggests an association between new-onset hypertension and patients with nephrolithiasis after SWL, which is in contrast with the finding of a previous meta-analysis.     

护理延伸服务对尿路结石患者体外冲击波碎石疗效的影响

目的研究护理延伸服务对尿路结石患者体外冲击波碎石疗效的影响。方法便利抽样法选取2010年5月至2011年5月在浦东新区公利医院首次行体外冲击波碎石术的400例尿路结石患者为研究对象,按照随机数字表法将其分为观察组和对照组,每组200例。对照组患者采用常规护理宣教,观察组患者在常规护理宣教的基础上加上出院后护理延伸服务。两组患者均进行定期随访,比较两组患者出院后的治疗效果(结石排净时间、结石碎片直径、疼痛缓解情况)、并发症发生情况、预后情况[生活质量(quality of life,QOL)评分和BI评分]及随访情况(预防结石知识的掌握程度、遵照医嘱改善生活行为、定期随访率、复发率)。结果观察组患者结石排净时间、结石碎片直径均明显低于对照组,疼痛缓解程度明显优于对照组,差异均有统计学意义(均P<0.05);观察组患者并发症的发生情况明显少于对照组,差异有统计学意义(P<0.05)。观察组QOL及BI评分均明显高于对照组,差异均有统计学意义(均P<0.05)。两组患者在随访的四项指标上的差异均有统计学意义(均P<0.05)。结论护理延伸服务能显著提高体外冲击波碎石的疗效,明显改善患者预后,提高患者术后生活质量,值得临床推广应用。     

鹿角形肾结石采用体外冲击波碎石术后的临床观察和护理

目的：探讨鹿角形肾结石采用体外冲击波碎石术后的临床观察及护理。方法：对68例鹿角形肾结石患者行体外冲击波碎石治疗,回顾性分析其并发症的发生情况及所采取的护理措施。结果：本组68例患者均出现不同程度的石街、疼痛、血尿及尿路感染等并发症,经合理的治疗和精心的护理,其中60例完全治愈,6例于肾盏中有少量残余结石,2例碎石不成功,改用其他方法治疗。结论：体外冲击波碎石治疗鹿角形肾结石是一种安全、经济、有效的方法,通过护理人员精心的护理能减少并发症带来的损害,促进患者早日康复。