低能量体外冲击波碎石对肾鹿角形结石的疗效观察(英)

目的:研究低能量体外冲击波碎石(extracorprealshockwavelihotripsy,ESWL)治疗边缘性鹿角形结石、部分鹿角形结石、完全鹿角形结石的疗效及副作用。方法:应用MZ-V型低能量体外冲击波碎石机治疗边缘性鹿角形结石77例,部分缘性鹿角形结石49例,完全缘性鹿角形结石6例,ESWL治疗后1,3,6月进行B超、KUB检查和随访。结果:边缘性鹿角形结石完全排净70例(90.9%),残留5例,无效2例;部分缘性鹿角形结石完全排净40例(81.6%),残留6例,无效3例;完全缘性鹿角形结石完全排净2例(33%),残留2例,无效2例。结论:低能量ESWL是边缘性鹿角形结石和部分鹿角形结石的首选疗法。因ESWL疗程长,易发生泌尿系统继发感染,完全鹿角形结石不宜单独采用ESWL治疗。采用小间隙电极低能量多次碎石,预防和延缓石街形成,并在石街形成后及时疏通,是提高ESWL治疗边缘性鹿角形结石及部分鹿角形结石成功率的关键。     

低能量体外冲击波碎石对肾鹿角形结石的疗效观察

目的：研究低能量体外冲击波碎石(extracorpreal shock wave lihotripsy，ESWL)治疗边缘性鹿角形结石、部分鹿角形结石、完全鹿角形结石的疗效及副作用。方法：应用：MZ-V型低能量体外冲击波碎石机治疗边缘性鹿角形结石77例，部分缘性鹿角形结石49例，完全缘性鹿角形结石6例，ESWL治疗后1，3，6月进行B超、KUB检查和随访。结果：边缘性鹿角形结石完全排净70例(90．9％)，残留5例，无效2例；部分缘性鹿角形结石完全排净40例(81．6％)，残留6例，无效3例；完全缘性鹿角形结石完全排净2例(33％)，残留2例，无效2例。结论：低能量ESWL是边缘性鹿角形结石和部分鹿角形结石的首选疗法。因ESWL疗程长，易发生泌尿系统继发感染，完全鹿角形结石不宜单独采用ESWL治疗。采用小间隙电极低能量多次碎石，预防和延缓石街形成，并在石街形成后及时疏通，是提高ESWL治疗边缘性鹿角形结石及部分鹿角形结石成功率的关键。     

输尿管镜气压弹道碎石术结合体外冲击波碎石治疗复杂性输尿管上段结石

目的 总结输尿管镜气压弹道碎石术结合体外冲击波碎石治疗复杂性输尿管上段结石的临床经验.方法 62例复杂性输尿管上段结石患者随机分为2组：A组首先采用体外冲击波碎石1、2次,如无效改为输尿管镜气压弹道碎石;B组首先采用输尿管镜气压弹道碎石,术后根据情况采用体外冲击波碎石补充治疗.结果 经3个月治疗,A组有12例残留结石,仍需ESWL或药物进一步治疗,结石排净率61.3%.B组27例排净结石,4例残留结石,结石排净率87.1%.二组差异具有显著性（P＜0.05）.结论 对于复杂性输尿管上段结石,首先采用输尿管镜气压弹道碎石,术后根据情况,补做体外冲击波碎石,可明显提高结石排净率.     

体外冲击波碎石术治疗输尿管结石的治疗能量与疗效观察

目的 探讨体外冲击波碎石术（ESWL）治疗输尿管结石过程中治疗能量与疗效的关系,进一步提高ESWL治疗输尿管结石的排净率,尤其是初碎排净率.方法 分析对比2组采用体外冲击波碎石治疗的病例,一组为标准治疗能量（546例）;另一组为低治疗能量治疗（172例）.结果 在病例条件无明显差异的条件下,标准能量治疗组初碎排净率为90.5%（494/546）和总排净率为99.5%（543/546）,低能量治疗组初碎排净率79.1%（136/172）和总排净率94.8%（163/172）.结论 ESWL治疗输尿管结石时采用的治疗能量决定了治疗效果.     

准精确切割法在体外冲击波碎石治疗肾大结石中的应用

目的 探讨和总结体外冲击波碎石(ESWL)治疗肾内大结石提高排净率、减少石街发生的治疗方法.方法 利用现代冲击波碎石机有点状碎石的特点,根据结石位置及大小,计划每次结石粉碎的位置和量,使之得到充分粉碎.结果 437例碎石成功率97.9%(428/437),1个月排净率82.4%(360/437),3个月排净率90.6%(396/437),石街发生率5%(22/437).结论 准精确切割法是治疗肾内大结石的一种有效方法,值得进一步推广.     

ESWL治疗鹿角状结石的疗效观察

目的：总结体外冲击波碎石（ESWL）治疗鹿角状结石的经验，提高碎石技巧。方法：应用ESWL治疗鹿角状结石32例，针对不同类型的鹿角状结石，采用不同顺序的治疗方案，观察其疗效，并随访并发症。结果：32例鹿角状结石中，结石排净为29例。排净率90.6％，3例未排净或没有明显疗效，占9．4％，其中2例转由PCNL取石。1例转为开放式手术。所有病例均未发生严重并发症。结论：ESWL可以成为治疗鹿角状结石的首选方法，但应严格掌握适应症，采取措施预防并发症。提高碎石技巧是碎石成功与否的关键。碎石技巧主要体现在碎石顺序的不同，确定碎石顺序的原则是：（1）建立排石通道；（2）优先治疗积水处结石；（3）一次碎石量不宜过多。     

体外冲击波碎石治疗复杂性肾结石

目的 探讨体外冲击波碎石（ESWL）治疗复发性肾结石的方法、效果及不良反应。方法 采用低能量、多方位的体外冲击波碎石的治疗方法治疗复杂性肾结石。结果 86例复杂性肾结石患经ESWL后排石率100％，80例结石全部排净，排净率93．02％。结论 ESWL是治疗复杂性肾结石的较理想的方法之一。     

孤肾鹿角形结石的ESWL治疗（附13例报告）

目的 探讨应用HB-ESWL-V进行体外冲击波碎石(ESWL)治疗孤肾鹿角形结石的效果和安全性。方法 分析13例孤肾鹿角形结石患者的ESWL治疗过程、工作电压、冲击次数、冲击间歇时间、结石复打次数、排石情况和并发症情况。结果 ESWL治疗过程中工作电压为6～9KV，平均为7．5KV；每次治疗冲击次数为1803～3029次，平均为2618次；冲击间隔时间为10～18天，平均为15．7天；结石复震次数为2～4次，平均为2．3次；结石排净时间为3～7周，平均为4．6周；血尿发生率为70％(9／13)；石街发生率为1％(1／13)；无肾周血肿及术后高血压发生。结论 ESWL是治疗孤肾鹿角形结石的一种安全、可靠、有效的方法。     

肾结石体外冲击波碎石术后并发症45例分析

目的讨论分析体外冲击波碎石术(ESWL)治疗肾结石的并发症及发生原因。方法回顾性分析我院收治的45例肾结石行ESWL患者。结果 34例患者经一次或多次碎石后在3个月内排尽结石,11例残留结石中,结石<0.5cm者8例,结石>0.5cm者3例。术后患者均伴有不同程度的血尿,绞痛患者12例,石街3例,无肾周围血肿的发生。结论 ESWL治疗肾结石疗效确切,只要消除不良因素,行低能量碎石,就能减少并发症的发生,提高治疗效果。     

单纯性肾下盏结石的微创治疗方法选择

目的 探讨单纯性肾下盏结石有效而安全的治疗方法.方法 将106例直径1.0 cm以上肾下盏结石病例随机分成两组,58例行体外冲击波碎石治疗(ESWL),48例行微创经皮肾碎石取石术治疗(MPCNL),分析各组治疗结果、结石排净率及并发症.结果 所有病例术后随访1～3个月,ESWL组16例结石残留,残留结石最大为1.1 cm,不排石14例,28例完全排净,结石排净率为48.28%.MPCNL组术后3例仍有少量结石残留,残留结石最大为0.5 cm,结石总取净率为93.75%.两组结石排净率差异有显著性(P<0.05).ESWL组治疗后少数患者有轻微肉眼血尿,排石过程中出现肾绞痛8例,发热2例,无严重并发症发生.MPCNL组术中无大出血、肾实质撕裂、胸膜损伤等并发症发生,术后继发性出血2例,发热2例,经保守治疗治愈,术中和术后无输血和感染性休克病例发生.结论 直径1.0 cm以上单纯性肾下盏结石可首先选择MPCNL治疗,MPCNL治疗肾下盏结石是有效、安全的方法,能获得满意的治疗效果.     

补充性体外冲击碎石术治疗钬激光碎石术后残余结石

目的探讨补充性体外冲击碎石(ESWL)术治疗钬激光碎石术后残余结石的临床疗效和治疗价值。方法 2006年1月至2009年10月,上海市嘉定区中心医院对输尿管镜下钬激光碎石术中发生结石漂移或术后存在≥6 mm残余结石的86例患者进行了补充性ESWL术,取得了满意的疗效。结果 78例(90.6%)患者ESWL后B超下观察碎石成功,2个月后B超和腹部平片+静脉肾盂造影证实无残余结石;8例(9.4%)患者仍存在≤5 mm残余结石。结论补充性ESWL术是治疗输尿管镜下钬激光碎石术出现残余结石和结石漂移的主要选择之一,可明显提高结石排尽率。     

Efficacy of different chemotherapy programs, indications for surgery and radiotherapy in primary mediastinal B-cell lymphosarcoma

AIM: To evaluate efficacy of treatment of primary mediastinal B-cell lymphosarcoma (PMBLS). MATERIAL AND METHODS: Fifty nine patients with PMBLD were divided into three groups. Group 1 (n = 15) received 8 courses of CHOP, prevention of neuroleukemia and radiotherapy (RT). Group 2 (n = 8)--4 courses of ProMACE-CytaBOM or 1 course of MACOP-B, prevention of neuroleukemia and RT. Group 3 (n = 36)--2 courses of CHOP and 2-3 courses of ESHAP or 3 courses of DexaBEAM, surgical removal of residual mediastinal tumor (RMT), RT. RESULTS: The number of complete remissions in group 1 and 2 was the same (26 and 25%, respectively). Overall 5-year and event-free survivals in groups 1 and 2 were 52 +/- 5 and 13 +/- 5; 62 +/- 5 and 38 +/- 8%, respectively. In group 3 a complete remission was observed in 89% patients (p = 0.01), overall 5-year and event-free survival reached 88 +/- 8 and 85 +/- 7%, respectively. Removal of RMT in time of tumor size stabilization and partial remission (in 12 of 15 cases) led to a complete remission but in progression of the disease (in 3 cases) appeared ineffective. RT resulted in complete remission in 39 of 53 cases, stabilization of tumor growth was in 3 cases, progression--in 10, recurrence--in 1. RT was ineffective in all 4 cases of partial remission. RT use in stabilization of tumor size induced complete remission only in 1 of 7 cases. CONCLUSION: CHOP program is ineffective in PMBLS. Program ProMACE-CytaBOM or MACOP-B is insignificantly more effective than CHOP. Combined therapy is most effective. Surgery is justified in partial remission and tumor growth arrest. RT is indicated in complete remission to achieve its consolidation.     

The evaluation of gallbladder function by quantitative radionuclide cholescintigraphy before and after ESWL for gallstones: Preliminary report

We assessed changes of gallbladder function including concentration and contraction in patients with gallstones after extracorporeal shock-wave lithotripsy (ESWL). The abilities of concentration and contraction were expressed as filling fraction (FF) at 90 min and ejection fraction (EF) at 30 min after a fatty diet by Tc-99m DISIDA Cholescintigraphy. A total of 12 patients who had symptomatic gallstones without cholecystitis were included in our study. ESWL failed in three cases: FF decreased in two of three cases and increased in one of three cases, whereas EF decreased in two of three cases and increased in one of three cases. In another nine cases, ESWL was successful and the gallstones were fragmented. One month after ESWL, in three of these nine cases, the gallstones had completely disappeared. In the three cases at 1 month after ESWL, FF decreased in two of three cases and increased in one of three cases, whereas EF decreased in one of three cases and increased in two of three cases. In the remaining six cases after ESWL, there were still some residual stone fragments in the gallbladder. In these six cases after 6 months, no fragments were found in the gallbladders, the third Tc-99m DISIDA Cholescintigraphy was performed. In these six cases, the changes of FF and EF, before ESWL, 1 month after ESWL, and 6 months after ESWL, were irregular and fluctuant. However, no significant improvement of gallbladder function was demonstrated even when ESWL was successful. In our preliminary results, we found that not only the residual stone fragments but also the procedure of ESWL may impair gallbladder function by evidence of a noninvasive and quantitative Tc-99m DISIDA Cholescintigraphy.     

输尿管镜电子弹道碎石术治疗上段输尿管结石(附32例报告)

目的 探讨上段输尿管结石的最佳治疗方法。方法 对32例上段输尿管结石病人使用输尿管镜电子弹道碎石术。结果30例一次成功，2例进镜失败，1周后再次手术成功。27例1个月后复查X 光片结石排净，5例结石有残留，行ESWL后治愈。随诊9～15个月，平均11个月，未见结石复发。结论 输尿管镜电子弹道碎石术对上段输尿管结石效果良好，值得推广。     

部分脾栓塞治疗难治性原发性血小板减少性紫癜的疗效观察

【目的】探讨部分脾栓塞在治疗难治性原发性血小板减少性此癜（ITP）的临床疗效和应用。【方法】对9例难治性ITP患者进行部分脾栓塞治疗,其中3例短期有效而又复发者进行脾切除治疗,观察和随访其临床疗效。【结果】9例病人中有8例（包括脾切除术3例）完全缓解,缓解率达88．9％,1例无效。其中随访2年以上4例．1年以上2例,半年以上2例,均无复发。【结论】部分脾栓塞保留了脾脏的免疫功能,并发症少,临床疗效满意,是治疗难治性ITP安全可靠的方法,亦可作为脾切除治疗难治性ITP的一个手术指标。     

预激诱导治疗急性髓细胞性白血病临床分析

目的:探讨预激诱导治疗对急性髓细胞白血病(AML)的临床疗效及毒副作用。方法:将AML43例分为2组。常规化疗组17例,均为用经典方案诱导化疗2疗程以上未获完全缓解或首次完全缓解6个月内复发者;男7例,女10例,平均年龄43(17~65)岁。预激方案治疗组26例,其中14例为用经典方案诱导化疗2疗程以上未获完全缓解或首次完全缓解6个月内复发者,6例为MDS转化型,1例为继发性AML,5例为低增生性AML;男8例,女18例,平均年龄50.5(19~72)岁,60岁以上者有8例。主要方案:常规化疗方案(AA方案):阿克拉霉素(Acla)20 mg/d第1~5天,阿糖胞苷(Arac-C)150~200 mg/d第1~7天;预激方案(CAG方案):粒细胞集落刺激因子(G-CSF)150μg/d(与化疗同时进行,共10~14 d),Arac-C 30 mg/d,q12 h(共10~14 d),Acla 20 mg/d(第1、3、5、7、9天),WBC>30×109/L时停用G-CSF,治疗中出现骨髓Ⅳ度抑制时停止治疗。结果:常规化疗组,完全缓解(CR)4例,部分缓解(PR)3例,无效(NR)10例,有效率41.1%。预激方案治疗组,第1疗程后获CR 16例,PR 4例,NR 6例;PR中2例进行了第2疗程的预激治疗达CR,2例放弃治疗,有效率76.9%;8例老年白血病患者中CR 5例、PR 1例、NR 2例;5例低增生性白血病患者均获CR;CR后给予常规剂量强化治疗,除1例死于严重感染外其余均处于缓解状态。两组治疗有效率比较,预激方案治疗组明显高于常规化疗组。预激方案治疗组中有1例出现Ⅳ度骨髓抑制达1月,其余患者均能很好耐受。结论:G-CSF预激诱导治疗方案对难治及复发性AML患者具有良好的效果,且对老年AML及低增生AML同样具有较高的缓解率,是一种安全、有效的治疗方案。     

乌苯美司联合化疗治疗难治或复发性急性非淋巴细胞白血病临床观察

【目的】观察乌苯美司与化疗联合治疗难治或复发性急性非淋巴细胞白血病临床疗效及不良反应。【方法】将24例难治或复发性急性非淋巴细胞白血病患者分为两组,每组12例。治疗组接受含乌苯美司的联合治疗方案,有效者继续服药6～10个月;对照组单用普通联合化疗方案。【结果】治疗组7例达到完全缓解,1例为部分缓解,完全缓解率58．33％,总有效率66．67％。追踪观察1年,7例完全缓解者仅2例在6月个左右复发,且未见明显药物不良反应;对照组4例达到完全缓解,3例为部分缓解,完全缓解率33．33％,总有效率58．33％。追踪观察1年,4例完全缓解者均在1～6个月复发。【结论】乌苯美司能提高化疗药物对急性非淋巴细胞白血病的疗效,延长患者无疾病进展生存期,药物毒性低,值得推广与化疗药物联合应用。     

体外冲击波碎石术治疗尿路结石(附2 725例报告)

目的：探讨体外冲击波碎石术(ESWL)治疗尿路结石的有效性和安全性。方法：结合文献，回顾分析1993-2004年采用ESWL治疗尿路结石患者2725例，其中肾结石922例，输尿管结石1789例，膀胱结石14例。结果：随访3个月，结石排净率94．4％(2572／2725)，结石残留109例(4．0％)，16例无效(0．6％)，改用手术治疗。结论：ESWL具有治疗成功率高、副作用少、无严重并发症的优点，是治疗尿路结石安全、有效的方法。     

Treatment of advanced ovarian cancer as an interdisciplinary task: surgery, histopathology, radiotherapy, and chemotherapy

From February 1977 to February 1981 we treated 55 patients with ovarian cancer (45 stage III and 10 stage IV) with simultaneous radio-chemotherapy; 34 of these patients underwent a therapeutic second-look operation. The overall response rate was 94%, comprising 63% complete and 31% partial remissions. In the group with residual tumours exceeding 2 cm in diameter after primary operation 52% complete remissions were observed. In the stage III group there were 74% complete and 26% partial remissions. Cytoreductive surgery to less than 2 cm was achieved by means of an early second-look operation in 74% of these cases. These patients have as good a prognosis as those with an equivalent residual tumour after primary resection. Unlike the cases with tumour spread to the retroperitoneal area, macroscopic tumour spread to the surface of the liver or diaphragm indicated a worse prognosis. The survival time of patients who prove to be tumour-free at the time of the diagnostic operation is significantly longer than of those with residual tumours. Neither the age of the patients nor the histological findings after primary operation have any significant influence on survival time. Late intestinal complications made us change the therapeutic strategy employed since March 1981 to sequential radio-chemotherapy. Possible cure for stage III patients can be achieved only by way of interdisciplinary cooperation. In stage IV patients the prognosis is so bad that local therapy is possible only in selected cases.