电磁式碎石机与液电式碎石机治疗输尿管结石疗效比较

目的 :比较一种新型电磁式碎石机与常用的液电式碎石机的疗效及副作用。方法 :分别使用电磁式碎石机和液电式碎石机治疗输尿管结石各 10 0例 ,治疗后应用X线腹部平片、静脉肾盂造影或B超评估其疗效 ,并随访 3个月 ,了解其结石清除率 ;观察并记录治疗后并发症。结果 :应用电磁式碎石机治疗的患者总有效率为95 % ,明显高于应用液电式碎石机治疗者的 6 5 % (P <0 .0 5 ) ;而其肾绞痛、恶心、呕吐、发热等并发症则低于后者。结论 :对于输尿管结石的治疗 ,电磁式碎石机的疗效优于液电式碎石机 ,它是一种更为安全有效的方法。     

"宽焦斑-低压力"电磁式冲击波碎石术治疗上尿路结石

目的观察"宽焦斑-低压力"电磁式体外冲击波碎石术(ESWL)治疗肾、输尿管结石的疗效及并发症.方法B超定位,应用CS-2012A型碎石机"宽焦斑-低压力"治疗泌尿系结石525例,工作电压6.5～9.0 kV,平均冲击剂量(1291±190)次.结果一次碎石后排净率51.5%,3个月后总排净率85.8%,碎石成功率97.9%,无严重副反应发生.结论"宽焦斑-低压力"电磁式体外冲击波碎石机治疗泌尿系结石安全性大,疗效满意.     

电磁式体外冲击波碎石的应用体会和输尿管镜碎石治疗输尿管结石的差别

目的比较电磁式体外冲击波碎石与输尿管镜碎石治疗输尿管结石的效果。方法选择我科室2015年7月至2017年10月就诊的150例输尿管结石患者,随机分为2组,体外冲击波组75例采用电磁式体外冲击波碎石术治疗,输尿管镜组75例采用输尿管镜碎石术治疗,对比两组临床疗效、结石大小、手术时间及并发症发生情况。结果体外冲击波组结石直径1 cm碎石成功率为95.24%,输尿管镜组结石直径1 cm为73.33%,差异具有统计学意义(P0.05),结石直径≥1 cm且2 cm和结石直径≥2 cm两组差异无统计学意义(P0.05),体外冲击波组总碎石成功率合计88.00%,输尿管镜组为72.00%,两组差异具有统计学意义(P0.05);体外冲击波组术后并发症发生率为9.33%,输尿管镜组为21.33%,差异具有统计学意义(P0.05)。结论电磁式体外冲击波碎石治疗对于1.0 cm的输尿管结石效果较好,且减少并发症发生。     

气压弹道碎石术在输尿管结石膀胱结石中的应用

目的:探讨气压弹道碎石术在输尿管结石、膀胱结石中的应用。方法:应用输尿管镜及气压弹道碎石机在硬膜外麻醉或局麻下行输尿管结石或膀胱结石碎石术。结果:共256例患者,碎石成功244例,总成功率95.7％。结论:气压弹道碎石术是治疗输尿管结石、膀胱结石的有效方法,成功率高,患者痛苦小。     

输尿管镜、肾镜治疗输尿管结石(附226例报告)

目的探讨应用输尿管镜、肾镜治疗输尿管结石的疗效。方法应用输尿管镜、肾镜配合瑞士产EMS三代超声气压弹道碎石机治疗226例输尿管结石。上段结石58例采用经皮肾镜超声气压弹道碎石机碎石,其余168例中下段结石采用输尿管镜逆行气压弹道碎石。结果一次碎石成功211例,结石排净时间1周-3个月。术中无输尿管穿孔和撕脱。15例结石上冲至肾盂,放置双J管后行ESWL治疗,3个月结石排净。结论输尿管镜、肾镜配合瑞士产EMS三代超声气压弹道碎石机治疗输尿管结石高效,微创,安全可靠。     

国产与德产电磁式碎石机治疗上尿路结石的疗效比较

目的:比较国产HK-V-ESWL-5型电磁式碎石机(国产机)和德产Dornier Compact S型电磁式碎石机(德产机)治疗上尿路结石的临床疗效。方法:将收治的1 421例上尿路结石患者按碎石机的产地分为国产机组784例和德产机组637例,然后按结石大小和结石部位进行疗效对比。结果:国产机组的3周碎石成功率、复震率及辅治率依次为75%、25%和17%,较德产机组的89%、11%和4%差异有统计学意义(P<0.05)。国产机的EQ值为0.69,低于德产机的0.86。结论:使用国产机和德产机行ESWL治疗均为有效、安全和非侵袭性,但前者的碎石成功率较后者低。     

复式脉冲体外碎石机治疗泌尿系结石1206例小结

目的:总结新碎石设备-复式脉冲体外碎石机治疗泌尿系结石的经验.方法:应用该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4.0～8.5 kV,放电次数2 000～3 000.结果:肾结石治愈率达58.3%,输尿管结石为72.7%,膀胱结石82.4%.其中986例(81.8%)ESWL后有不同程度的肉眼血尿,164例(13.6%)出现肾绞痛,14例出现高热,2例出现肾被膜下血肿,经对症处理均消失.结论:体外复式脉冲碎石技术仍然是泌尿系结石的首选治疗方法.     

输尿管镜下气压弹道碎石术治疗上尿路结石3000例

目的 总结输尿管镜下气压弹道碎石术治疗上尿路结石的临床经验.方法 回顾分析1995年4月～2005年5月输尿管镜配合气压弹道碎石机对3000例上尿路结石进行腔内碎石处理的临床资料.结果 输尿管镜下一次碎石成功率:肾盂100%(44/44),输尿管上段83.2%(810/974),中下段97.0%(1922/1982).2例发生输尿管穿孔,1例输尿管撕裂(金属导丝穿通1例当即留置双J管,输尿管镜戳孔1例观察2天后开放手术,输尿管镜断裂1例当即转开放手术).810例碎石成功的上段输尿管结石及44例肾盂结石3个月内结石排净839例(98.2%);1922例碎石成功的中下段结石3个月内结石排净1919例(99.8%).结论 使用输尿管镜下气压弹道碎石治疗上尿路结石安全有效,创伤小,对中下段输尿管结石处理最为适宜.     

体外震波治疗肾输尿管结石：附923例疗效观察

报告应用国产JI-ESWL-Ⅲ型水囊式体外震波碎石机治疗923例肾、输尿管结石,肾结石碎石成功率为99.3%,输尿管结石为96.5%。并对巨大肾结石的治疗、泌尿内腔技术的配合使用、碎石并发症的处理等进行讨论。     

输尿管结石碎石治疗中输尿管支架及导管的作用：Lithostar碎石机治疗18 825例输尿管结石病人的结果

输尿管结石碎石治疗中输尿管支架及导管的作用：Ｌｉｔｈｏｓｔａｒ碎石机治疗１８　８２５例输尿管结石病人的结果［ＭｏｂｌｅｖＢ，ｅｔａｌ．ＪＵｒｏｌ，１９９４，１５２：５３］作者报告了在１９８８～１９９４年之间１８８２５例输尿管结石碎石治疗的结果。所用碎...     

Extracorporeal shock wave lithotripsy for distal ureteral calculi: what a powerful machine can achieve

PURPOSE: We assessed the efficacy of extracorporeal shock wave lithotripsy (ESWL, Dornier Medical Systems, Inc., Marietta, Georgia) for distal ureteral calculi with the HM3 (Dornier Medical Systems, Inc.) lithotriptor. MATERIALS AND METHODS: A total of 585 consecutive patients with distal ureteral calculi were treated with ESWL using an unmodified HM3 lithotriptor. Of these patients 67 referred for treatment only for whom no followup was available were excluded from further analysis. The remaining 518 cases were followed until they were radiologically documented to be stone-free or considered treatment failures. Before ESWL additional procedures were performed in 144 patients, including stone push back, ureteral catheter or Double-J (Medical Engineering Corp., New York, New York) stent placement, percutaneous nephrostomy, ureteral endoscopic maneuvers or stone basket manipulation. A total of 374 patients needed no preliminary treatment before ESWL. RESULTS: Of the 518 patients 469 (91%) were successfully treated with 1 ESWL session, while 49 (9%) needed 2 or 3. Manipulation after ESWL was performed in 22 cases, including stent placement, percutaneous nephrostomy, ureteral endoscopic stone removal and a stone basket procedure. On day 1 after ESWL 327 patients (63%) were stone-free, 158 (30%) had less than 5 mm. fragments and 33 (7%) had more than 5 mm. fragments. At 3 months the stone-free rate increased to 97%. CONCLUSIONS: These data show that ESWL for distal ureteral calculi with the powerful unmodified HM3 lithotriptor has a high success rate with a low rate of minimally traumatic manipulations before and after intervention. Results in terms of the re-treatment and stone-free rates are superior to those of any other second or third generation lithotriptor and comparable to the results of the best ureteroscopic series.     

Urolithiasis update: clinical experience with the Swiss LithoClast

This article describes the authors' first experience using the EMS Swiss LithoClast pneumatic lithotriptor in the management of middle and distal ureteral calculi. Also presented is a review of the literature comparing different modalities of intracorporeal lithotripsy. A retrospective analysis was performed on 11 patients treated with the Swiss LithoClast using the Circon ACMI MR6 Rigid Mini-ureteroscope (7 patients with distal calculi and 4 patients with midureteral calculi). The lithotriptor successfully fragmented 91% of the calculi, independent of stone composition. Complete failure of fragmentation was only encountered in one patient, and this was secondary to the lithotriptor's inherent ballistic force causing retrograde passage of the calculus. One patient had postoperative radiographic evidence of stone fragments along the ureteral stent. There was no intraoperative morbidity or long-term complications encountered with use of the pneumatic lithotriptor. Additionally, patients' overall satisfaction was 91% with respect to the procedure itself and relief of preoperative pain. The only significant postoperative complaint was ureteral stent discomfort in one patient. The authors conclude that the EMS Swiss LithoClast pneumatic lithotriptor is a safe and effective tool in the management of middle and distal ureteral calculi. However, as noted with one patient, there is always a risk of stone push from the ballistic force of the lithotriptor.     

Intracorporeal Lithotripsy with the Swiss Lithoclast

Background: In addition to currently available modalities of intracorporeal lithotripsy (ultrasonic, electrohydraulic, and laser), a new ballistic lithotriptor known as the Swiss Lithoclast has recently gained attention. This study reports our experience with the Swiss Lithoclast in the endoscopic management of urinary calculi.
Methods: A total of 51 patients with urinary calculi were treated with the Swiss Lithoclast; one patient with a renal calculus, 28 with ureteral calculi, and 22 with lower urinary tract (bladder, urethra and Kock pouch) calculi.
Results: The Lithoclast successfully fragmented 94% of the calculi, independent of stone composition. Complete failure of fragmentation was not encountered. In six of the 10 upper ureteral calculi, stone fragments were pushed up into the calyces. Adjunctive extracorporeal shock wave lithotripsy for residual fragments was performed in six cases. The stone-free rate at one and three months was 84% and 88%, respectively. There were no intraoperative or long-term complications directly related to the use of this device.
Conclusion: The Swiss Lithoclast is a safe and effective means of intracorporeal lithotripsy. Although suitable for mid and lower ureteral stones, the device has a risk of stone push-up in patients with upper ureteral stones.     

Treatment of upper urinary tract calculi using Siemens Lithostar Multiline, and comparison with previous machine: Lithostar

PURPOSE: We compared the efficacy, safety and conveniency of previous and present lithotriptors for the treatment of upper urinary tract calculi. PATIENTS AND METHOD: 691 patients with renal calculi and 2,294 patients with ureteral calculi were treated using a 2nd generation electromagnetic fluoroscopic guided lithotriptor, the Lithostar (L group), and 153 with renal calculi and 486 with ureteral calculi were treated using a 3rd generation lithotriptor, the Lithostar Multiline (M group). The success rates, defined as stone-free or residual fragments that were 4 mm or less on three months later, were calculated and compared. RESULTS: The percentage of outpatient were 85.3% (L) and 95.1% (M). The success rates of the L group for the overall and the ureteral calculi patients were indicated significantly better than the M group (89.6% vs 81.4%, 92.2% vs 82.7%, respectively). Mean number of treatment of the L group (1.62) for the ureteral calculi were significantly less than the M group (1.64). For the renal calculi, no significance of the success rates were observed (L : 81.0% vs M : 77.1%). Mean fluoroscopy time of the M group (2.8 min.) were significantly shorter than the L group (3.7 min). Less percentage of pentazocine required in the M group (34.7%) than in the L group (50.8%). CONCLUSION: This study shows that the success rate of the Multiline does not exceed the previous machine, however, the Multiline achieved shorter fluoroscopy time and decreased rate of adapting analgesia. The Lithostar Multiline is useful, safe and convenient on an outpatient basis.     

Transurethral ureteroscopic removal of ureteral calculi

Rigid ureteroscopy was used for transurethral removal of ureteral stones. Calculi were extracted under direct vision using flexible grasping forceps or a stone basket. If the size of the stone precluded the use of these techniques, we disintegrated the stone using an electro-hydraulic lithotriptor (EHL) or ultrasonic lithotriptor (USL). Between January, 1985 and October, 1985, 35 ureteroscopic procedures were performed for removal of ureteral stones. In 27 cases (77%) the stone was removed successfully. All stones could be removed in mid and lower ureter. However, in upper ureter, the success rate was only 50%. In 8 instances, ureteroscopy failed to remove the ureteral calculus and 6 underwent percutaneous nephrolithotomy, 2 open surgery. Of the ureteral stones, 12 were removed with grasping forceps or a basket manipulation. EHL and USL were used successfully to remove calculi in 15 cases. To make smooth passage of the ureteroscope, a 6F UPJ occlusion balloon catheter was introduced into the ureter and the balloon was inflated in the intramural ureter for 24 hours preoperatively. We have found this to be a useful procedure for smooth passage of the ureteroscope. Most common complication of ureteroscopic stone removal was fever (29%). In 1 case, the ureter was penetrated by the scope. The patient was treated with an indwelling ureteral catheter for 2 weeks. After the catheter was removed, an excretory urogram demonstrated normal ureter without extravasation or obstruction. We conclude that ureteroscopic stone removal can be done safely with careful passage of the scope and careful manipulation of calculi.     

钬激光治疗泌尿系结石(附155例报告)

目的：探讨钬激光治疗泌尿系结石的疗效。方法：总结利用Versa Pulse Select钬激光机经输尿管镜或膀胱镜治疗155例泌尿系结石患者的临床资料。结果：8例肾结石和7例膀胱结石均1次碎石成功;140例输尿管结石患者单次手术结石粉碎率为95．7％（134／140）,平均结石排净时间2．5周;平均手术时间25min、平均术后住院天数2．5d。术中无输尿管穿孔、撕裂等并发症。结论：钬激光治疗泌尿结石是一种有效的腔道泌尿外科碎石方法。     

输尿管镜取石术治疗小儿输尿管结石26例报告

目的:探讨输尿管镜取石术治疗小儿输尿管结石的临床效果。方法:对26例小儿输尿管结石患者采用输尿管镜下气压弹道碎石或钬激光碎石进行治疗。结果:输尿管镜直视下1次操作成功24例,成功率84.5%,4~6周内结石全部排净。发生并发症4例,其中输尿管穿孔2例,采取保守治疗痊愈,随访10~12个月未发现输尿管狭窄;泌尿系感染2例。结论:输尿管镜取石术是治疗小儿输尿管结石理想、安全、有效的方法之一。     

Extracorporeal shock-wave lithotripsy with Lithostar lithotriptor.

Initial experience of extracorporeal shock-wave lithotripsy (ESWL) using the Lithostar lithotriptor is reported; 193 patients underwent 248 treatments for 210 stones. A total of 139 renal calculi (126 patients) and 71 ureteral stones (67 patients) were analyzed. Treatments were performed without anesthesia in 65 calculi (27.6%), with intravenous sedation in 91 (42.5%), and under epidural anesthesia in 34 calculi (29.9%). A three-month follow-up showed a success rate of 88.0 percent for renal calculi and 95.5 percent for ureteral calculi treated in situ. Renal stone fragmentation was achieved with a mean of 4,890 shocks at 17.4 kV and ureteral calculi were fragmented with a mean number of 4,798 shocks at a mean of 18.3 kV. Auxiliary procedures after ESWL were required in 2 patients with renal stones and in 1 with ureteral calculi. A comparison between stone size and number of shock waves required to achieve stone fragmentation revealed a linear relationship. Hospitalization was not necessary in 84.4 percent of renal calculi and 89.6 percent of ureteral calculi. Retreatments were necessary in 22 (15.8%) of the renal calculi (18 had 2 sessions, 3 had 3 sessions, and 1 had 4 sessions). Of the ureteral calculi, 8 (11.3%) underwent retreatment (6 had 2 sessions, 1 had 3 sessions, and 1 had 4 sessions). The low morbidity with a large number of patients treated on an outpatient basis, minimizing the need for anesthesia, demonstrated a favorable initial successful experience with the Lithostar.     

输尿管镜下气压弹道碎石疗效的影响因素附126例报告

目的　探讨影响输尿管镜下气压弹道碎石术疗效的因素。　方法　回顾分析采用输尿管镜下气压弹道碎石术治疗输尿管结石 12 6例的临床资料。　结果　一次性碎石成功率 93 7% (118/ 12 6 )。 11例术中取净结石 ,87例 1d～ 7d结石排净 ,2例输尿管穿孔 ,4例结石上移肾盂。结论　输尿管镜入镜是否成功是碎石的前提 ,结石适当固定是碎石成功的关键 ,而结石被上推是导致失败的主要原因     

Comparison of the effectiveness and safety of MPL 9000 and Lithostar Modularis shockwave lithotriptors: treatment results of 263 children

In this study, we aimed to compare the treatment results of two different shock wave lithotripsy (SWL) machines used in the management of pediatric urolithiasis. Between January 1993 and October 2004, Dornier MPL 9000 (electrohydraulic) had been used, and since then Siemens Lithostar Modularis (electromagnetic) has been used. The last evaluation was done 3 months after SWL treatment in terms of the success rate, use of anesthesia and complications. A total of 263 children (171 boys and 92 girls), with an age range of 9 months–14 years (mean age 8.1 ± 3.8 years) were included in this study. Of the patients treated with the Dornier MPL 9000, 60.1% (173/104) required general anesthesia and 69 needed sedation. In contrast, for all patients treated with the Lithostar Modularis necessitated only sedo-analgesia (90 children). The hospital stay was shorter for Siemens Lithostar Modularis than those of Dornier MPL 9000 (26.2 vs. 35.5 h, P = 0.03). The success rate for the electromagnetic unit (86.5%) was almost identical that achieved with the electrohydraulic unit (85.2%) in the stones for the different location. Success rates were compared for stone burden subsets, the differences were insignificant for both lithotriptors (P > 0.05, for all). The electromagnetic unit had a significantly higher success rate for distal ureteral calculi (86.2 vs. 54.5%, P = 0.034). The efficiency quotients (EQ) for distal ureteral calculi were significantly different in favor of electromagnetic machine (56 vs. 40%). The complication rates for SWL were not significantly different for electrohydraulic and electromagnetic lithotriptors (8.7 and 6.2%, respectively). This study showed that SWL treatment was effective and safe in pediatric urolithiasis using both electrohydraulic and electromagnetic machines. Electromagnetic machine was more effective than electrohydraulic one for distal ureteral calculi. Additionally, the electromagnetic lithotriptor has significant clinical advantages over the electrohydraulic lithotriptor in terms of anesthesia requirements, hospitalization duration and fluoroscopic targeting.