电子动能碎石机在泌尿系腔内碎石中的应用

介绍了一种新型电子动能碎石机在泌尿系腔内碎石中的应用。５１例泌尿系结石，其中肾结石２例、输尿管结石４４例、膀胱结石４例、后尿道结石１例，术后碎石率达９８％。该碎石机碎石效果好，损伤小，操作简便，为泌尿系结石碎石提供了新途径     

Biliary lithotripsy

At Baylor University Medical Center in Dallas, we began performing lithotripsy with the Medstone STS lithotripter for gallstones in January 1988 and in the first year treated 81 patients. Fifty-five of these patients were available for 4-month follow-up. We randomized half of the patients to receive ursodeoxycholic acid for 7 days prior to lithotripsy and gave all of the patients ursodeoxycholic acid after lithotripsy. Only 10.4 percent of the patients who contacted us ultimately proved to be candidates for lithotripsy. Gallstone fragmentation occurred in 95 percent of all patients and in 97 percent of those patients with solitary stones under 20 mm in size. The rate of clearance for solitary stones less than 20 mm in size was 50 percent. Unfavorable effects ascribable to lithotripsy were infrequent. All of the patients had pain before treatment, and one-third complained of biliary colic after treatment. Minor skin bruising which resolved in 1 to 5 days was found in 20 percent of the patients. This study lends credence to the findings of previous studies and demonstrates that lithotripsy combined with bile acid therapy is a useful therapy for cholelithiasis.     

Percutaneous lithotripsy

We have performed percutaneous extractions of renal pelvic stones in 194 patients via the Wolf percutaneous universal nephroscope. At 1 session, with the patient under general anesthesia, a percutaneous tract is dilated to 24F and the stone is removed immediately. We have removed 185 stones successfully by ultrasonic lithotripsy, basket retrieval and/or use of forceps. Average operating time was 54 minutes and mean hospitalization was 5 days. The advantages of this technique are that a skin incision of only 1 cm. is required to remove the stone, hospital days are fewer than with open procedures and postoperative morbidity is minimal. In selected situations this method represents a significant advance over standard open surgical procedures for removal of renal pelvic stones.     

Extracorporeal shock-wave lithotripsy

Analysis of our data clearly demonstrates that morbidity, secondary treatment, post-treatment manipulations, and failure of treatment increase as the stone size increases because of the increased stone fragment burden. Patients whose stone burden was less than 2 cm clearly had less morbidity. Composition of the stone may also alter the success of treatment (with cystine, calcium oxalate monohydrate, and brushite stones being resistant to treatment). However, post-treatment morbidity and complications were observed in all categories. Perirenal hematomas are unpredictable by current preoperative testing. Obstruction with pain can occur any time after treatment but usually occurs within the first 48 hours in the majority of patients. Only 1 per cent of our patients required hospitalization in another institution after discharge. Ambulatory ESWL requires that staff at the facility or a urologist be able to observe and appropriately follow the patient for 24 to 48 hours after treatment.     

Extracorporeal shockwave lithotripsy of the ureteral calculus--clinical results with local shockwave lithotripsy

Second generation local shockwave lithotripsy appliances (Lithostar) were used for the treatment of upper and lower ureteral stones in 199 patients, 145 of whom had upper ureteral stones. In 78 patients the calculi were pushed back and all but one disintegrated. In 33 patients a catheter was inserted past the stone, which resulted of primary disintegration in 66%. In 19 of 34 patients (56%) in whom the stones could not be moved, primary disintegration was achieved. Distal ureteral stones were present in 54 patients and these were treated successfully by ESWL alone in 83.3%. Auxiliary measures (total 10%) included ureteroscopy, percutaneous extraction and ureterolithotomy. The results are discussed under the aspects of 'in situ' versus 'push-and-smash' procedures.     

Pneumatic lithotripsy versus laser lithotripsy in the endoscopic treatment of ureteral calculi

PURPOSE: To compare the efficacy, safety, and features of pneumatic lithotripsy (PL) with those of laser lithotripsy (LL) and present our clinical experience in the endoscopic management of ureteral calculi. PATIENTS AND METHODS: From August 1994 to February 2000, 285 consecutive patients underwent endoscopic lithotripsy with either the Swiss Lithoclast pneumatic lithotripter (145 patients) or the Ho:YAG laser lithotripter (140 patients) for the treatment of ureteral calculi. RESULTS: In one single session, the overall successful stone fragmentation rate of LL was higher than that of PL (95.7% v 69.7%; P < 0.01). The average time to stone-free status was shorter for LL than for PL (18 days v 31 days; P < 0.01). No major complications were observed in LL, while five ureteral perforations were encountered in PL. CONCLUSIONS: Laser lithotripsy has advantages over PL in high efficiency of stone fragmentation and a low complication rate. Laser lithotripsy is a powerful, effective, and safe treatment modality for ureteral calculi.     

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。     

气压弹道碎石术与钬激光碎石术治疗输尿管结石的比较

目的：比较经输尿管镜气压弹道碎石术与钬激光石术治疗输尿结石的疗效和安全性。方法：总结应用输尿管镜技术治疗285例尿管结石患者的临床资料,其中气压弹道碎石术145例,钬激光碎石术140例。结果钬激光碎石术单次手术碎石率为95．75,高于气压弹道碎石术的69．7％,P＜0．01;钬激光碎石术平均结石排净时间为18d,短于气压弹道碎石术的31d,P＜0．01;钬激光碎石组无明显并发症发生,气压弹道碎石组有5例发生穿孔。结论钬激光碎石术的有效率和安全性优于气压弹碎石术,钬激光碎石术是治疗输尿管结石的一种安全、有高效的方法。     

经皮肾镜钬激光碎石术与双导管超声碎石术治疗鹿角型肾结石的比较

目的比较钬激光碎石与双导管超声碎石在经皮肾镜手术中的临床疗效和安全性。方法回顾性分析我院2010年1月至2012年6月131例鹿角型肾结石患者的临床资料,其中双导管超声碎石组51例,钬激光碎石组80例,比较两种碎石方法在手术时间、术中估计出血量、结石清除率、术后并发症发生率及术后住院时间等方面的差异。结果两组患者在性别、年龄、身体质量指数（BMI）、结石大小及位置上无差别（P〉0．05）。双导管超声碎石组术中手术时间及平均估计出血量显著低于钬激光组（52．1±25．1min掘78．4±33．9min,P〈0．001;101．7±25．8mlvs124．2±18．4ml,P〈0．001）。双导管超声碎石组平均术后住院日为7．1d,钬激光碎石组为6．4d,组间差异无统计学意义。双导管超声碎石组结石清除率为90．2％,钬激光碎石组结石清除率为81．3％,二者差异无统计学意义（P〉0．05）。两组患者总的并发症发生率相当（13．7％vs．26．3％,P=0．09）,但双导管碎石组感染性并发症发生率显著低于钬激光碎石组（7．8％ vs.21．3％,P=0．04）。结论与钬激光碎石术相比,双导管超声碎石术具有手术时间短、出血少、术后感染性并发症少等优点,值得临床推广应用。     

Extracorporeal shockwave lithotripsy or extracorporeal piezoelectric lithotripsy? Comparison of costs and results

One thousand patients with renal stones up to 3 cm in diameter were divided equally into 2 groups matched for age, sex and stone size. One group was treated on the Dornier HM3 lithotriptor and the other on the EDAP LT01. The results showed that for stones less than 1 cm both lithotriptors were equally effective, with a stone-free rate of 87.5% for the Dornier and 90.4% for the EDAP at 3 months. The success rate fell more steeply for the EDAP machine, however, to become 77.2 and 42.5% respectively as the stone size increased to 3 cm. Treatment time was longer on the EDAP lithotriptor and more sessions were required but patients preferred it to the Dornier. Running costs per patient were higher on the EDAP.     

经皮肾取石术中钬激光与气压弹道的疗效比较

目的 比较钬激光碎石术（LL）与气压弹道碎石术（PL）在经皮肾穿刺取石术（PCNL）中的疗效和安全性.方法 128例肾结石患者,其中采用PL治疗49例,采用LL治疗79例.结果 LL组在手术时间、术中出血量、术后住院时间和并发症发生率方面均低于PL组（P〈0.05）,分别为（72.4±2.3）min与（100.5±1.9）min,（75.8±5.3）ml与（91.4±4.3）ml,（5.1±1.2）d与vs（8.2±1.1）d,1.3% 与10.2%;LL组一次碎石成功率则高于PL组,LL为92.1%,PL为71.2%（P〈0.05）.结论 LL的疗效和安全性优于PL,在PCNL中更适合,更安全和高效.     

输尿管镜下气压弹道碎石术与钬激光碎石术治疗输尿管结石的比较

目的比较输尿管镜下气压弹道碎石术与钬激光碎石术治疗输尿管结石的疗效和安全性。方法总结应用输尿管镜技术治疗326例输尿管结石患者的临床资料，其中气压弹道碎石术176例，钬激光碎石术150例。结杲钬激光碎石术碎石率为96．6％，高于气压弹道碎石术的89．8％（P〈0．01）；钬激光碎石术平均排净时间为10d，短于气压弹道碎石术的21d（P〈0．01）；钬激光碎石组有11例发生血尿，气压弹道碎石有54例发生血尿。结论钬激光碎石术的有效率和安全性优于气压弹道碎石术。钬激光碎石是治疗输尿管结石的一种安全、高效的方法。