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。     

急诊ESWL治疗输尿管结石疗效观察

为论证体外冲击波碎石术（ＥＳＷＬ）治疗输尿管结石绞痛的临床效果，对１０９例输尿管结石绞痛患者行急诊ＥＳＷＬ治疗，结果经１次ＥＳＷＬ治疗成功者９６例（８８．１％），余经第２次ＥＳＷＬ治疗全部碎石成功。经１次ＥＳＷＬ治疗后绞痛缓解者９５例（８７．１％）。认为出现输尿管结石绞痛时应及早施行ＥＳＷＬ，以求尽早解除患者痛苦；结石定位诊断应遵循简单、快捷的原则，综合分析，防止误诊；施行ＥＳＷＬ时应尽可能采用仰     

输尿管肾镜气压弹道碎石术疗效观察

采用输尿管肾镜气压弹道碎石术治疗输尿管结石８１例，结果１次碎石取石成功率为７９．０％，其中输尿管上段结石６５．６％，中段为７７．７％，下段为９０．０％，认为输尿管肾镜气压弹道碎石术具有成功率高，安全，创伤小等优点，是治疗输尿管中，下段结石的首选治疗方法，对于有粘连包裹的上段结石，应用此术并配合ＥＳＷＬ可明显提高碎石排石率。     

NTrap网篮在输尿管镜钬激光碎石术治疗输尿管上段结石中的应用研究

目的：对比单独使用钬激光与配合钬激光使用NTrap网篮在输尿管镜碎石术治疗上段输尿管结石中的临床疗效。方法：诊断患有输尿管上段结石的患者共106例115侧,住院期间均采用输尿管镜下钬激光碎石术进行治疗。其中对照组70侧,观察组45侧,对照组在术中单独使用钬激光碎石,观察组在术中同时胃己合钬激光使用NTrap网篮。比较对照组和观察组术中结石上移率、手术成功率,术后1个月结石排净率及术中术后并发症的发生情况。结果：术中对照组和观察组结石上移率分别为24．29％（17／70）和6．67％（3／45）,碎石成功率分别为80．00％（56／70）和95．56％（43／45）,手术成功的两组术后1个月结石排净率分别为82．14％（46／56）和95．35％（41／43）,两组术中结石上移率、手术成功率和术后结石排净率相比较差异有统计学意义（P〈0．05）。对照组术中发生输尿管穿孔2侧,观察组发生输尿管穿孔1侧。术后对照组有2例患者出现严重血尿,观察组1例出现严重血尿。对照组与观察组术后各有4例患者出现发热。两组术中术后相关并发症的发生率相比较差异无统计学意义（P〉0．05）。结论：在输尿管镜碎石术治疗输尿管上段结石时,使用NTrap网篮配合钬激光碎石可以显著降低结石的上移率,提高手术成功率和术后1个月结石排净率,是一种安全、有效的方法。     

输尿管镜下气压弹道碎石术治疗输尿管结石378例

目的探讨输尿管镜下气压弹道碎石术治疗输尿管结石的临床效果。方法采用Wolf F8/9.8硬性输尿管镜，瑞士产第二代EMS气压弹道碎石机，治疗378例输尿管结石。左侧213例，右侧158例，双侧7例。输尿管上段81侧，中段146侧，下段158侧。结果313例（320侧）单次碎石成功，输尿管上、中、下段结石碎石成功率分别为60．5％（49／81）、84．2％（123／146）、93．7％（148／158），1～8周内结石全部排净，结石排净率82．8％（313／378）。15例改开放手术。置镜失败3例。主要并发症有输尿管穿孔8例、发热13例。结论输尿管镜气压弹道碎石治疗输尿管结石安全、微创、效果确切，是治疗输尿管中、下段结石的首选方法。     

输尿管硬镜下气压弹道碎石285例报告

目的：探讨输尿管镜下气压弹道碎石术治疗输尿管结石的操作方法和临床疗效。方法：自2001年1月-2005年2月采用输尿管镜下气压弹道碎石术治疗输尿管结石285例。结果：一次性结石粉碎率92．9％（265／285）,3个月结石排净率100％;术中发生输尿管穿孔3例,发生率为1．1％（3／285）,未发现术中及术后严重并发症。结论：采用输尿管镜下气压弹道碎石术治疗输尿管结石成功率高,安全可靠,可作为治疗男性输尿管中下段结石和女性全程输尿管结石的首选方法。     

输尿管镜下气压弹道碎石术治疗泌尿系结石

目的 探讨输尿管镜下气压弹道碎石术泌尿系结石的临床疗效。方法 自１９９４年８月至１９９７年１２月，采用输尿管镜下气压弹道碎石术治疗输尿管结石１４５例，吉石５例。结果 一次性结石粉碎率为７９．３％，并发症发生率为５．３％，主要是输尿管穿孔及感染。结论 此碎石方法安全、效果确切、损伤小，如与ＥＳＷＬ等体外碎石方法结合应用疗效更佳。     

输尿管镜钬激光碎石术治疗输尿管结石

目的：探讨输尿管镜钬激光碎石术治疗输尿管结石的有效性和安全性。方法：回顾性分析216例应用经输尿管镜钬激光碎石术治疗的输尿管结石患者资料。男133例,女83例;年龄20～68岁,平均49岁。上段结石48例,中段58例,下段110例。结石直径0．7～2．6cm,平均1．4cm。结果：单次碎石成功率为98．1％（212／216）,其中上段结石单次碎石成功率为91．6％（44／48）,中、下段为100％（168／168）。平均手术时间29min,212例术后平均住院3．5天。术后随访2周～3个月,结石排净率99％（210／212）。结论：输尿管镜钬激光碎石术治疗输尿管结石高效、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。     

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.     

Extracorporeal shock-wave versus pneumatic ureteroscopic lithotripsy in treatment of lower ureteral calculi

Aim: To compare the efficacy and complications of extracorporeal shock-wave lithotripsy (SWL) and pneumatic ureteroscopic lithotripsy (URS) in the treatment of lower ureteral calculi. Methods: From August 1997 to June 1999, 210 patients with calculi in the distal third of the ureter were treated with SWL and the other 180 with URS. The stones were fragmented with either HB-ESWL-V lithotripter or JML-93 pneumatic lithotripter through Wolf 7.5～9.0 Fr ureteroscope. The outcome was assessed in terms of stone clearance rate, re-treatment rate and complication incidence. Results: The stone clearance rate was 78.1% with SWL and 93.3 % with URS (P<0.05). SWL had a re-treatment rate of 11.9 %, vs 2.2 % in the URS group (P<.05). URS caused ureteral perforation in 3.3% of patients, while it was 0 with SWL (P<0.05). The differences in the incidence of other complications such as infection and stricture between the two groups were insignificant. Conclusion: Though the selection of these two options depends on equip     

Ureteroscopy (URS) for ureteric calculi

Distal ureteral calculi (<5 mm) usually pass the ureter spontaneously. Ureteroscopic lithotripsy of distal ureteral calculi shows high stone-free rates with a low complication rate (4%) and is equal to extracorporeal shock wave lithotripsy (ESWL), while ESWL is the primary choice for proximal ureteric stones. Flexible endoscopes are more difficult to handle and should be used only under fluoroscopic control. They are generally used in combination with the holmium:YAG laser and the flexible Lithoclast in the proximal ureter or the renal collecting system. Overall the complication rate of URS is 9-11% with avulsion of the ureteric urothelium being the most common complication. Ureteral perforation, stricture (<1%), impaction of the instrument in the ureter with consequent ureteral laceration, extravasation of stones, and bleeding in the urogenital tract are complications of URS but are minimal in the hands of a well-trained and skilled surgeon.     

Extracorporeal shock-wave lithotripsy or ureteroscopy as primary treatment for ureteric stones: a retrospective study comparing two different treatment strategies

OBJECTIVE: Our extracorporeal shock-wave lithotripsy (ESWL) lithotripter with ultrasound localization technique was replaced in 1999 by a Storz SLX-MX lithotripter with both X-ray and ultrasound detection possibilities. Before replacing our lithotripter, most ureteric stones were treated with ureteroscopy (URS); subsequently, almost all patients underwent ESWL as primary treatment. The aim of this retrospective study was to compare the results of these two treatment strategies in all consecutive patients attending our hospital in 1998 and 2000 for ureteric stone treatment. MATERIAL AND METHODS: The medical records of all patients treated for ureteric stones in 1998 and 2000 were reviewed. In 1998, 173 ureteric stones were treated. Primary treatment was URS in 124 patients, push back/ESWL in 24, ESWL in 21 and open surgery in four. In 2000, 176 ureteric stones were treated: 158 with ESWL and 18 with URS. ESWL or URS monotherapy was defined as ESWL or URS, respectively as the only stone-treatment therapy, with or without the use of a ureteric catheter or nephrostomy tube. Treatment success was defined as a stone-free ureter. RESULTS: In 1998, the success rate for URS monotherapy was 95%, with a retreatment rate (sessions per stone situation) of 1.06. Corresponding figures for ESWL monotherapy in 2000 were 90% and 1.69. All URS patients received general anaesthesia; ESWL patients received opiods. Complication rates were 6% for URS and 3% for ESWL. In the URS group, 4/8 complications were considered to be major. CONCLUSION: ESWL should be considered the first-line treatment for ureteric stones because of its non-invasive nature, lack of a requirement for general anaesthesia and low complication rates.     

Ureterorenoskopie (URS) bei Harnsteinen

Distal ureteral calculi (<5 mm) usually pass the ureter spontaneously. Ureteroscopic lithotripsy of distal ureteral calculi shows high stone-free rates with a low complication rate (4%) and is equal to extracorporeal shock wave lithotripsy (ESWL), while ESWL is the primary choice for proximal ureteric stones. Flexible endoscopes are more difficult to handle and should be used only under fluoroscopic control. They are generally used in combination with the holmium:YAG laser and the flexible Lithoclast in the proximal ureter or the renal collecting system. Overall the complication rate of URS is 9–11% with avulsion of the ureteric urothelium being the most common complication. Ureteral perforation, stricture (<1%), impaction of the instrument in the ureter with consequent ureteral laceration, extravasation of stones, and bleeding in the urogenital tract are complications of URS but are minimal in the hands of a well-trained and skilled surgeon.     

三种不同术式治疗输尿管结石的Meta分析

目的:对体外冲击波碎石术(ESWL)、输尿管镜碎石术(URS)、经皮肾镜碎石取石术(PCNL)治疗输尿管结石的有效性及安全性进行比较。方法:检索关于输尿管结石治疗的随机对照试验研究文献,数据库包括MEDLINE、EMBASE、Cochrane Library和中国生物医学文摘数据库(CBMDisc)等文摘数据库以及PUBMED、中国期刊全文数据库(CNKI)及维普中文期刊数据库(CQVIP)等全文数据库,按预设的标准筛选纳入研究,对文献质量进行严格评价和资料提取后,采用RevMan5.1软件进行Meta分析。结果:共有15个研究符合纳入标准。Meta分析显示:对于输尿管下段结石,URS组较ESWL组有较高的结石清除率及较低的重复治疗率(P0.01),而在术后并发症及手术时间方面无明显差异(P0.05);对于输尿管上段结石,ESWL组与URS组在结石清除率、术后并发症及重复治疗率方面均无显著差异(P0.05),ESWL组平均治疗时间较URS组短(P0.01);URS组与PCNL组治疗上段结石的对比分析显示PCNL组在结石清除率方面较URS组高(P0.01),两组在术后并发症、平均手术时间及重复治疗方面无明显差异(P0.05)。结论:对于输尿管下段结石的治疗,URS与ESWL相比有结石清除率高及较低的重复治疗率等优点,值得推荐;而对于输尿管上段结石的微创治疗方式的选择则需要进一步分析研究来指导临床实践。     

输尿管镜气压弹道碎石术与ESWL治疗输尿管结石的疗效比较

目的:比较输尿管镜气压弹道碎石术(URSL)与ESWL治疗输尿管结石的疗效及副作用。方法:分别使用URSL与ESWL治疗输尿管结石患者各200例,治疗后应用腹部平片或B超评估其疗效,随访3个月,了解结石清除率,观察并记录治疗后并发症。结果:URSL有效率为91.5%,明显高于ESWL治疗者的总有效率73.5%(P<0.01);其中上段结石有效率87.72%,低于ESWL的93.33%(P<0.05),中下段结石有效率93%,明显高于ESWL的65%(P<0.01);其肾绞痛、恶心、呕吐、发热低于后者(P<0.05)。接受URSL的患者1.5%有输尿管穿孔。结论:URSL治疗输尿管结石的疗效优于ESWL;URSL较适合于输尿管中、下段结石的治疗,而ESWL较适合于输尿管上段结石的治疗。     

What is the optimal treatment for lower ureteral stones larger than 1cm?

PURPOSE: To compare the treatment options for lower ureteral stones larger than 1 cm. METHODS: The records of 449 patients with lower ureteral calculi larger than 1 cm were reviewed retrospectively. Of these patients 342 (76.1%) were treated with extracorporeal shock wave lithotripsy (ESWL) (group 1), 66 (14.7%) with pneumatic lithotripsy (PL) (group 2) and 128 (28.5%) with ureterolithotomy (group 3). Eighty-seven (19.5%) patients underwent any of the two treatment modalities because of unsuccessful primary treatment. RESULTS: The overall stone-free rates were 32.4, 90.9 and 95.3% for ESWL, PL and ureterolithotomy, respectively. These values were 84.4% for primary PL and 96.7% for primary ureterolithotomy. The re-treatment rate (46.4%) and secondary procedures were much more frequent in the ESWL group. There was no difference in the complication rates of the three groups. CONCLUSIONS: Pneumatic lithotripsy with ureteroscopy seems to be an appropriate treatment for larger ureteral stones. While ESWL can be tried as a first treatment option because of its noninvasive nature, lower success and higher re-treatment rates limit its usefulness. Ureterolithotomy is still a reasonable alternative for these large or unfragmented stones.     

Primary in situ extracorporeal shock wave lithotripsy in the management of ureteric calculi: results with a third-generation lithotripter.

OBJECTIVE: To review the results of primary in situ extracorporeal shock wave lithotripsy (ESWL) for the treatment of ureteric stones using a third-generation lithotripter, the Dornier MFL 5000 (Dornier Medizentechnic, Germany). PATIENTS AND METHODS: The study comprised a retrospective review of treatment outcome in 180 patients with 196 stones who were treated with primary in situ ESWL, assessing the success of this approach and establishing reasons for failure. RESULTS: At the 3-month follow-up, 88% of patients were stone-free; 21 patients failed ESWL and were treated by ureteroscopic stone extraction with no complications. Stone-free rates were 90% for upper ureteric, 89% for middle-third and 86% for lower-third calculi. Twenty-one patients required auxiliary procedures in the form of JJ stenting or nephrostomy. Failure of ESWL was associated with stone size (>1.3 cm) but not location or inadequate treatment. CONCLUSION: Where prompt access to ESWL is available, primary in situ ESWL remains an effective form of treatment for all ureteric calculi, although stone-free rates are lower for larger stones.     

Prospective, randomized trial comparing shock wave lithotripsy and ureteroscopy for lower pole caliceal calculi 1 cm or less

PURPOSE: The optimal management of lower pole renal calculi is controversial. We compared shock wave lithotripsy (SWL) and ureteroscopy (URS) for the treatment of patients with small lower pole stones in a prospective, randomized, multicenter trial. MATERIALS AND METHODS: A total of 78 patients with 1 cm or less isolated lower pole stones were randomized to SWL or URS. The primary outcome measure was stone-free rate on noncontrast computerized tomography at 3 months. Secondary outcome parameters were length of stay, complication rates, need for secondary procedures and patient derived quality of life measures. RESULTS: A total of 67 patients randomized to SWL (32) or URS (35) completed treatment. The 2 groups were comparable with respect to age, sex, body mass index, side treated and stone surface area. Operative time was significantly shorter for SWL than URS (66 vs 90 minutes). At 3 months of followup 26 and 32 patients who underwent SWL and URS had radiographic followup that demonstrated a stone-free rate of 35% and 50%, respectively (p not significant). Intraoperative complications occurred in 1 SWL case (unable to target stone) and in 7 URS cases (failed access in 5 and perforation in 2), while postoperative complications occurred in 7 SWL and 7 URS cases. Patient derived quality of life measures favored SWL. CONCLUSIONS: This study failed to demonstrate a statistically significant difference in stone-free rates between SWL and URS for the treatment of small lower pole renal calculi. However, SWL was associated with greater patient acceptance and shorter convalescence.     

Ureteroscopy and pneumatic lithotripsy, followed by extracorporeal shock wave lithotripsy for the treatment of distal ureteral stones

BACKGROUND: We retrospectively reviewed our experience with retrograde ureteroscopy (URS) and a pneumatic lithotriptor in 160 patients with distal ureteral stones to determine whether prior extracorporeal shock wave lithotripsy (ESWL) is a limiting factor in the ureteroscopic procedure. METHODS: From January 1999 to September 2000, we performed URS and pneumatic lithotripsy in 160 patients with distal ureteral stones. Seventy-four patients were treated with URS primarily (Group 1), while the remaining 86 patients received URS only after ESWL had failed (Group 2). For URS and lithotripsy, we used a 9.5 French rigid instrument and vibrolith (Elmed, Ankara, Turkey). RESULTS: In Group 1, 73 of 74 patients (98.6%) were treated successfully by URS alone, as were 81 of 86 patients (94.4%) in Group 2. Impacted stones were also observed in 17 patients from Group 2. In these patients, endoscopic observation revealed edematous inflammation above and below the calculus. Ureteral perforation occurred in one patient from Group 2, which required surgical repair. There was no significant difference in the stone-free rates of the two groups t = 1.4 < 1.96t( infinity,0.05). CONCLUSION: Our data demonstrate that when ESWL fails, URS and pneumatic lithotripsy is as safe and effective as primary URS. Pneumatic lithotripsy also seems to be an effective treatment modality for impacted stones.