输尿管结石肾绞痛期行体外冲击波碎石术并发肾内感染的探讨

 目的 探讨输尿管结石患者行体外冲击波碎石术(extracorporeal shock wave lithotripsy,ESWL)并发肾内感染的相关因素.方法 选择2006-06至2009-06于我院行ESWL的输尿管结石278例,根据行ESWL前是否有肾绞痛分为绞痛组128例及非绞痛组150例.对两组行ESWL后发生肾内感染的情况进行比较.结果 绞痛组行ESWL后发生肾内感染率与非绞痛组比较,差异有统计学意义(P<0.01);绞痛组中、下段结石与上段及中段结石行ESWL后发生肾内感染率相比差异有统计学意义(P=0.02).结论 行ESWL前有肾绞痛的输尿管结石患者术后并发肾内感染率高.输尿管下段结石的肾绞痛患者行ESWL后发生肾内感染率较高.     

Radionuclide evaluation pre- and postextracorporeal shock wave lithotripsy for renal calculi

Forty-two patients were evaluated pre- and postextracorporeal shock wave lithotripsy (ESWL) using [99mTc]DTPA renography. A quantitative evaluation showed that the relative renal function decreased 2-3 days post-ESWL on the treated side, and the parenchymal transit time index (PTTI) increased 2-3 days post-ESWL (p less than 0.001) on the treated side and returned to the pretreatment level by 3 wk post-ESWL. The untreated side showed an increase in PTTI 2-3 days post-ESWL (p less than 0.01), which returned to normal by 3 wk post-ESWL. A significantly greater increase in PTTI was seen in patients who received greater than 1,000 shocks as compared with those who received less than 1,000 shocks. Five patients developed obstructing uropathy post-ESWL, when stone fragments caused ureteric obstruction.     

体外震波碎石治疗小儿上尿道结石：（附14例报告）

应用国产ＪＴ－ＥＳＷＬ－Ⅲ型碎石机治疗小儿上尿道结石１４例，其中双肾结石２例，输尿管结石４例；结石大小５ｍｍ×４ｍｍ～５０ｍｍ×３５ｍｍ；７８％患者在肌注安定镇痛药下行碎石治疗，避免了全麻的副作用。所有结石均完全粉碎，无严重并发症，１个月结石排空率为９２％。认为体外震波碎石不仅可用于门诊小儿上尿道结石的碎石治疗，而且可用于治疗小儿复杂性、多发性肾结石。     

Renal stone disease treated with extracorporeal shock wave lithotripsy: short-term observations in 100 patients

The immediate posttreatment findings are described for 100 patients who underwent extracorporeal shock wave lithotripsy (ESWL) for renal stone disease. Excretory urography was performed both before and 24-72 hours after ESWL. In 21 patients, stones were completely disintegrated, and stone fragments were passed rapidly. Stones were fragmented but not passed entirely within 24-72 hours in 76 patients. There was no appreciable effect on stones in three patients. In nine of 27 patients who had mild to severe ureteral obstruction caused by stone fragments, relief procedures (retrograde ureteral manipulation or percutaneous stone extraction) were necessary. Overall, 70 patients experienced successful stone disintegration without complications. Continued investigation is needed to determine prevalence of residual calculi, reversibility of acute effects of ESWL on the kidney, and possible development of late hypertension.     

Renal calculi: sensitivity for detection with US

The sensitivity of sonography in the detection of renal calculi was tested in a three-phase study in 100 patients. In phase 1, ultrasonographic (US) scanning was performed after review of abdominal radiographs and renal tomograms in 30 patients who had undergone extracorporeal shock wave lithotripsy (ESWL). In this group the sensitivity of US for detecting stones was 98%. In phase 2, scanning was performed in 30 post-ESWL patients without prior review of radiographs or tomograms. The sensitivity of US for stone detection in this group was 95%. In phase 3, sonography was performed in a blinded fashion on a random mix of post-ESWL patients and patients who had undergone urography for reasons unrelated to nephrolithiasis. The sensitivity of US for stone detection in this group of 40 patients was 91%. The overall sensitivity in all three groups was 96%, which was superior to the performance of abdominal radiography and slightly inferior to the combination of abdominal radiography and renal tomography. The ability to detect kidney stones with US depended on stone size but was independent of stone location or patient size. The study findings suggest that US is an effective means for detecting kidney stones in patients with suspected nephrolithiasis.     

Choledocholithiasis: treatment with extracorporeal shock wave lithotripsy

In a patient with choledocholithiasis, a duodenal diverticulum precluded endoscopic retrograde bile duct cannulation. A transhepatic catheter was used to opacify the bile ducts and to guide the endoscopic sphincterotome into the major duodenal papilla. Because limited sphincterotomy did not allow extraction or spontaneous passage of the common duct stones, extracorporeal lithotripsy was performed. Following fragmentation, the stones passed spontaneously and without complications.     

Renal cyst pseudoenhancement: evaluation with an anthropomorphic body CT phantom

PURPOSE: To evaluate the feasibility of using a retrievable urethral stent and to evaluate whether granulation tissue resolves after stent removal in a canine urethra. MATERIALS AND METHODS: Polyurethane-covered retrievable 0.10-mm-thick (n = 11) or 0.15-mm-thick (n = 10) nitinol wire stents were placed in the urethras of 20 dogs. In one dog, a second stent was placed in the urethra because of complete migration of the first stent into the urinary bladder. The stents were removed with retrieval hook wires 4 weeks (n = 10) and 8 weeks (n = 10) after placement. Fourteen dogs were sacrificed just after stent removal, and the other six dogs were sacrificed 2 weeks after stent removal. Information concerning procedure success, stent migration, and tissue response was obtained. RESULTS: Stent placement was technically successful in all dogs. Follow-up urethrograms showed partial (n = 4) or complete (n = 1) stent migration. Stent removal failed in two dogs due to partial or complete migration. Granulation tissue was observed at both ends of the stent in 17 dogs. Urethrograms and urethral specimens obtained 2 weeks after stent removal showed diminished granulation tissue and decreased thickness of the papillary projections of the epithelium compared with results obtained immediately after stent removal. CONCLUSION: Although some design modifications are necessary to reduce current complications, the polyurethane-covered retrievable nitinol stent seems feasible for use in the urethra. Stent-induced granulation tissue formation improved after stent removal.     

体外冲击波碎石术治疗尿路结石13359例回顾分析

 目的回顾分析我院13 a来体外冲击波碎石术(Entrocorporeal shock wavelitholripsg,ESWL)治疗结果,比较不同碎石机的碎石效果.方法1988年1月～2001年12月,由3名泌尿科医师用不同型号碎石机,按相同协议书要求对7 719例肾结石和5 640例输尿管结石进行体外冲击波碎石治疗.结果总碎石成功率(结石碎片≤4 mm的无症状者)87.6%,结石排净率78.1%,复震率19.1%.碎石效果与结石位置关系不密切(P＞0.05).随着结石体积的增大,成功碎石所需震波次数增加,而其碎石成功率及结石排净率反而减少.各型碎石机之间碎石效果无明显差异(P＞0.05),JT-ESWL-Ⅱ型复震率最低.结论不是所有的尿结石都是ESWL的理想适应症.低能量ESWL安全、有效,但有局限性和潜在危险.     

体外冲击波碎石不规范治疗引起肾衰竭1例

1病例报告 患者,女,46岁,因右侧腰部胀痛2周来我院门诊就诊,经超声、腹X线片及静脉泌尿系造影检查均诊断为右肾盂结石,大小约2．3cm×1．8cm。门诊医师建议行体外冲击波碎石治疗。2008—06—24患者至我院碎石中心,医师再次审阅患者各项检查后,于膀胱镜下右侧输尿管放置一根F6D—J管,     

Extracorporeal shock wave lithotripsy: Clinical results

The uroradiological experience with extracorporeal shock wave lithotripsy (ESWL) treatment of over 1,500 urinary calculi is summarized. Percutaneous nephrostomies were needed in 5-50% of ESWL patients depending upon the size and location of stone being treated. Over 25% of percutaneous nephrostomy tracts were subsequently used for other procedures. When staghorn calculi were treated by ESWL, the collaborative efforts of uroradiologists and urologists is mandatory.     

Kidney changes after extracorporeal shock wave lithotripsy: appearance on MR imaging

The occurrence of changes in the kidneys after extracorporeal shock wave lithotripsy (ESWL) was evaluated with magnetic resonance (MR) imaging in 34 patients, utilizing T1-weighted spin-echo pulse sequences. Five of the 34 patients underwent bilateral ESWL therapy before MR imaging. Of the 39 kidneys studied, 29 (74%) showed one or more changes on MR imaging: subcapsular or perinephric fluid (n = 10), focal (n = 16) or diffuse (n = 8) loss of the corticomedullary junction (CMJ), and focal areas of increased (n = 7) or decreased (n = 3) signal intensity. The CMJ changes were more prominent with increasing numbers of shock waves administered during the procedure. These relatively subtle changes detected on MR imaging may not be apparent with other imaging techniques. The long-term clinical significance of these findings is not yet known, although no apparent serious renal pathologic condition was detected.     

Clinical experience with biliary extracorporeal shock wave lithotripsy

Biliary lithotripsy is a new and important development in the nonsurgical management of gallbladder, cystic duct, and bile duct stones. Most patients do not require general or epidural anesthesia with newer second-generation machines. Patient selection and the use of adjuvant therapy to aid fragment clearance are important issues that are discussed. Results from different centers are compared but few long-term results are yet available, i.e., longer than 18 months.     

Renal obstruction from persistent struvite stone matrix: a complication of extracorporeal shock wave lithotripsy

Struvite calculi occurring in patients with chronic urinary tract infections consist of an inorganic component of magnesium ammonium phosphate crystals and an underlying organic mucopolysaccharide matrix. Shock waves used to destroy these stones during extracorporeal shock wave lithotripsy (ESWL) therapy may affect the inorganic and organic components of the stone differently. In a 26-year-old woman, renal obstruction resulted from retained struvite stone matrix after ESWL therapy.     

Radiation doses in extracorporeal shock wave lithotripsy

Patients undergoing lithotripsy on the Siemens Lithostar system are exposed to radiation in three modes: film radiography, electronic radiography and fluoroscopy. Radiation exposure techniques (kVp, field size, number of exposures and projection) were recorded for the first 125 patients undergoing treatment on a recently installed Lithostar unit at a Winnipeg hospital. These data were then used in conjunction with phantom-based radiation dose measurements to calculate entrance skin dose and total energy imparted for each patient. Values of 142 mGy and 53 mJ, respectively, were found. In the case of energy imparted, 20% of the total arose from film radiography, 30% from electronic radiography and the remaining 50% from fluoroscopy. The estimated effective dose-equivalent, HE, to the average patient undergoing lithotripsy was 0.75 mSv. This corresponds to an estimated radiation risk for the induction of fatal cancers and genetic defects (in the first two generations of offspring) of between 5 and 11 per million.     

Massive retroperitoneal haemorrhage after extracorporeal shock wave lithotripsy (ESWL)

A 76-year-old male suffering from nephrolithiasis developed a shock syndrome 5 days after extracorporal shock wave lithotripsy (ESWL). CT scan of the abdomen showed massive haemorrhage around the right kidney. Although nephrectomy was performed immediately, the haemorrhage could not be controlled. Numerous units of erythrocytes were transfused, but the patient died. The autopsy revealed massive retroperitoneal haemorrhage around the right kidney. The kidney showed a subcapsular haematoma and a rupture of the capsule. The right renal artery was dissected. The inferior vena cava was lacerated. Accordingly, a hemorrhagic shock as the cause of death was determined, which might mainly have resulted from the laceration of the inferior vena cava due to ESWL. ESWL seems to be a relatively non-invasive modality, but one of its severe complications is perirenal hematoma. The injuries of the blood vessels might have been caused by excessive shock waves. Subsequently, anticoagulation therapy had been resumed 3 days after EWSL, which might have triggered the haemorrhage. Physicians should note that a haemorrhage after an ESWL can occur and they should pay attention to the postoperative management in aged individuals especially when they are under anticoagulation therapy.     

体外震波碎石术治疗植物性胃石

应用体外震波碎石术对植物性胃石进行离体实验及动物实验取得成功后,于1989年12月应用于临床,治疗12例胃石病人,全部治愈,无并发症。并对胃石的分类,植物性胃石的形成机理,主要并发症及治疗进行了讨论。