经输尿管镜钬激光碎石术治疗泌尿系结石（附417例报告）

目的 探讨输尿管镜下钬激光碎石术治疗泌尿系结石的疗效。方法 采用输尿管镜下钬激光碎石术治疗泌尿系结石417例，其中肾结石43例，输尿管上段结石219例，输尿管下段结石198例，双侧输尿管结石27例，肾结石合并输尿管结石19例，膀胱结石8例，尿路结石1例。结果 钬激光碎石术的一次性碎石治疗后结石排净率为91％（378／417）。手术时间20～105min，平均51min；术后住院1～10天，平均5．3天；结石排净时间2～7周，平均3周。术中结石移位20例、输尿管穿孔6例、13例肾结石术中出血较多中途终止碎石术。结论 输尿管镜下钬激光碎石术治疗泌尿系结石具有安全、有效、并发症少的特点，是治疗泌尿系结石的一种可靠方法。     

腔镜下钬激光碎石术治疗泌尿系结石136例体会

目的探讨钬激光碎石术治疗泌尿系结石的疗效。方法总结应用腔镜下钬激光碎石治疗136例泌尿系结石患者的临床资料（其中肾结石68例,输尿管结石57例,膀胱结石11例）。结果肾结石碎石成功率为95．6％,其中一期取石56例,二期取石9例;输尿管结石碎石成功率为96．5％;膀胱结石碎石成功率为100％。结论腔内钬激光碎石术是治疗泌尿系结石安全、有效的方法。     

一期输尿管软镜钬激光碎石术治疗双侧肾结石2O例报告

目的：探讨一期组合式输尿管软镜钬激光碎石术治疗双侧’肾结石的临床疗效及安全性。方法：2010年1月~2012年1月采用德国铂立组合式输尿管软镜联合钬激光一期治疗双肾结石患者20例,结石大小0．7～2．0cm,平均1．3cm。含有大于1cm肾结石12例。20例均为双肾结石,含结石68枚,位于肾上盏13枚,中盏17枚,下盏18枚,肾盂20枚。结果：本组20例双肾结石均顺利完成一期双侧手术。一次手术结石清除率为80．0％（32／40）。本组总结石寻及率95．6％（65／68）。其中上、中盏及肾盂结石寻及率100％,单次碎石成功率92．0％（46／50）;下盏结石寻及率83．3％（15／18）,单次碎石成功率72．2％（13／18）。一期双侧手术总时间70～120min,平均90min。术中无输尿管穿孔等严重并发症发生。住院时间3～7d,平均4．2d。术后随访3～6个月,KUB或CT未见结石复发。结论：双肾结石采用输尿管软镜钬激光碎石术治疗安全、有效。尤其对于肾结石体积较小患者,可实施一期治疗双肾结石,以缩短治疗周期,减少费用。     

ESWL与输尿管镜碎石联合处理上尿路结石

目的：探讨对部分上尿路结石采用ESWI．与输尿管镜碎石联合处理的方法。方法：对70例上尿路结石患者采用ESWI。与输尿管镜下钬激光碎石（URS）联合交替治疗。其中输尿管结石48例,。肾结石22例。结果：结石总排净率为91．4％00（64／70）,其中输尿管结石排净率为95．8％（46／48）,肾结石排净率为81．8％（18／22）。3例治疗失败,其中1例输尿管结石因输尿管狭窄无法入镜;另2例肾结石,1例因交替治疗次数过多中途停止治疗,1例因结石硬度过大ESWI,不佳,均改为PCNL术。结论：ESW[。与URS联合交替进行的疗法处理上尿路结石,避免了创伤性治疗,扩大了ESWI,治疗范围,降低了URS手术难度,缩短了URS操作时间,提高了结石排净率,患者创伤微小、恢复快、并发症少,是治疗上尿路结石,特别是部分复杂性上尿路结石较理想的方法之一。     

输尿管软镜结合多波长激光治疗输尿管上段及肾结石46例体会

目的总结输尿管软镜结合多波长激光治疗输尿管上段及肾结石的体会。方法2012年1月至2013年2月对46例输尿管上段及肾结石行输尿管软镜结合钬激光与U-100双频双脉冲激光碎石治疗,评价输尿管软镜结合多波长激光的碎石疗效。结果46例结石寻及率100％,一次碎石成功率97．82％（45／46）,1例肾下盏结石带光纤软镜无法弯曲到位而中止手术。平均手术时间46min。6例因合并息肉行钬激光电灼术,3例合并下段输尿管狭窄行钬激光内切开。术后2周拔出双J管,残石排尽率84．4％（38／45）。结论输尿管软镜下碎石技术可明显提高输尿管上段结石及2cm以下肾结石寻及率和碎石成功率,钬激光与U-100激光联合使用可提高结石的粉碎率,还可处理合并息肉及轻度输尿管狭窄。     

经皮肾微造瘘输尿管镜钬激光碎石结合ESWL治疗复杂性肾结石

目的：探讨经皮肾微造瘘输尿管镜钬激光碎石结合ESWL治疗复杂性肾结石的效果。方法：对26例复杂性肾结石患者采用经皮肾微造瘘输尿管镜钬激光碎石结合一次或多次ESWL碎石治疗。结果：经皮肾微造瘘输尿管镜钬激光碎石结合一次ESWL治疗后结石清除率为73．1％,二次ESWL治疗后结石清除率为84．6％,三次ESWL治疗后结石清除率为88．5％。结论：经皮。肾微造瘘输尿管镜钬激光碎石结合一次或多次ESWL治疗复杂性肾结石是安全、有效的方法。     

输尿管软镜钬激光碎石术治疗肾结石98例临床观察

目的 探讨输尿管软镜钬激光碎石术治疗肾结石的疗效、安全性.方法 回顾性分析2010年5月至2012年4月应用输尿管软镜钬激光碎石术治疗肾结石98例,结石位于肾中上盏54例,下盏31例,肾盂7例,多肾盏结石6例.结石直径8mm ～ 19mm,平均13.2mm.输尿管软镜寻及结石后,使用200μm钬激光光纤碎石.留置DJ管2周.术后4周复查KUB或双肾CT,评估结石排净率.结果 96例寻及结石(96/98,98.0％);一次碎石成功率90.8％(89/98),总的碎石成功率为95.9％ (94/98);术后4周复查总结石排净率为88.8％(87/98).平均手术时间33.7min(15min～58min).术中未出现严重并发症.结论 输尿管软镜钬激光碎石术是处理肾盂肾盏内结石的一种安全有效的微创手段,结石寻及率高,碎石成功率高,结石排净率高,手术并发症少.     

ESWL与腔内技术联合处理复杂性上尿路结石(附编者按)

目的　探讨复杂性上尿路结石的治疗方法。　方法　对近期 138例复杂性上尿路结石患者 ,采用体外冲击波碎石 (ESWL)与输尿管镜下气压弹道碎石 ,经皮肾微穿刺造瘘碎石、取石等腔内技术联合治疗。其中复杂性输尿管结石 110例 ,复杂性肾结石 2 8例 ,均有不同程度肾积水。对输尿管结石先行ESWL ,2 4h内再行输尿管镜下气压弹道碎石 ;对肾结石及输尿管镜碎石困难的输尿管上段结石 ,先一期行经皮肾微穿刺造瘘术 ,5～ 7d后行ESWL ,2 4h内再经肾造瘘通道行输尿管镜下气压弹道碎石、取石。　结果　结石总排净率为 97.1% (134/138) ,其中输尿管结石排净率为10 0 .0 % (110 /110 ) ,肾结石排净率为 85 .7% (2 4 /2 8)。无治疗失败病例。　结论　ESWL与腔内技术联合处理复杂性上尿路结石 ,降低了腔内手术难度 ,缩短了腔内操作时间 ,提高了结石排净率 ,患者创伤小 ,恢复快 ,并发症少 ,是治疗复杂性上尿路结石较理想的方法。     

B超定位体外冲击波碎石术治疗尿路结石20625例临床报告

目的 总结B超定位ESWL治疗尿路结石的临床经验. 方法 回顾性分析1995年8月至201 1年7月采用B超定位电磁冲击波体外碎石一体机治疗的20 625例尿路结石患者的临床资料.肾结石8659例,输尿管结石11 712例,膀胱结石 254例.阴性结石 1965例. 结果 结石总粉碎率97.04％( 20 014/20 625),其中肾结石粉碎率96.27％( 8336/8659),输尿管结石粉碎率97.56％(11 426/1l 712),膀胱结石粉碎率99.21％ (252/254).术后3个月结石总排净率91.69％(18 912/20 625),其中肾结石排净率86.63％(7501/8659),输尿管结石排净率95.32％ (11 164/11 712),膀胱结石排净率97.24％(247/254).阴性结石总粉碎率为97.91％(1924/1965),术后3个月排净率为94.40％(1855/1965).结论 B超定位ESWL治疗尿路结石安全有效,但需要严格掌握其适应证,以提高治疗效果.     

大功率钬激光经皮肾微造瘘输尿管镜治疗复杂性肾结石（附65例报告）

目的：探讨大功率钬激光经皮肾输尿管镜治疗复杂性肾结石的方法与效果。方法：应用大功率（60w,3．0J,20Hz）钬激光经皮肾输尿管镜治疗复杂性肾结石65例,其中多发性肾盂肾盏结石48例（平均直径3．1cm）,鹿角状结石17例（平均直径5．3cm）,统计大功率钬激光碎石术碎石时间、结石取净率以及手术并发症等。结果：平均每次手术碎石取石时间为65（36～128）min,一次治疗结石取净率为69％（45／65）,总的取净率为91％（59／65）,术后5例出现发热,6例结合ESWL排净,3例有少量残留结石,1例术后出血较多行超选择性动脉栓塞后治愈,无其他并发症。结论：大功率钬激光经皮肾输尿管镜治疗复杂性肾结石能快速粉碎结石,缩短手术时间,出血量少,效率高,是治疗结石的安全、有效方法。     

ESWL治疗复杂上尿路结石的体会

目的探讨ESWL治疗复杂上尿路结石的效果。方法总结自1993年以来行ESWL治疗的所有上尿路结石,对其中较大的肾、输尿管结石、肾鹿角形结石及多发性结石的碎石效果进行分析。结合文献对石街的防治和双“J”管的应用进行讨论。结果ESWL治疗上尿路结石总有效率96．4％。治愈率92．1％。较大肾结石有效率93．9％,治愈率84．8％,石街形成率63．6％。鹿角形结石治愈率40％。较大输尿管结石有效率96．6％,治愈率91．5％,石街形成率23．7％。单侧多发结石治愈率95．7％。双侧多发结石治愈率100％。结论ESEL治疗较大的上尿路结石及多发性结石均有很好的效果。对鹿角形结石应与其它治疗方法联合应用。应及时发现并治疗碎石后形成的石街,双“J”管的应用并非必要。     

上尿路结石的手术方式选择(附2 528例临床报告)

目的分析上尿路结石的各种手术方式，探讨临床治疗中合理的术式选择。方法回顾性分析1997年2004年收治的2528例上尿路结行患者的临床分类、手术方式及并发症。结果单纯性肾结石和输尿管上段结石以ESWL治疗为主，3个月内结石排净率为86％。5％形成石街，9％经2—3次ESWL治疗无排石现象，转手术率14％；中、下段结石采用输尿管镜下气压弹道碎石治疗为主，结石排净率为92％。经皮肾穿肾镜取石，肾盂和输尿管上段结石的取净率为100％；鹿角形结石的取净率为95％；复杂性肾结右选择升放性手术取石或联合方式治疗为主，因肾脏无功能而行一侧肾切除7例（1．6％），下术后输尿管漏7例，切口经久不愈3例，肾脏大出血5例，无死亡病例。结论上尿路结石的微创手术可以避免开放于术对患者造成的痛苦，减少术后并发症，但也不能盲目采用，对于复杂性结石，开放手术仍有实际应用价值。     

In situ extracorporeal shock wave lithotripsy for obstructing ureteral stones with acute renal colic.

In situ (no instrumentation) extracorporeal shock wave lithotripsy (ESWL*) was used to treat 49 patients with obstructing ureteral stones causing acute renal colic. Ureteral obstruction was diagnosed on the delayed films of an excretory urogram and was classified as severe (dilatation above and no contrast medium seen below the stone) in 17 patients and partial (dilatation above and contrast medium seen below the stone) in 32. Upper third ureteral stones were present in 41 patients (obstruction severe in 15 and partial in 26) and lower third ureteral stones were present in 8 (obstruction severe in 2 and partial in 6). ESWL was performed within 14 days of the onset of the acute renal colic because of persistent pain with an unmodified Dornier HM3 lithotriptor in 17 patients and a Medstone STS device in 32. With single stones the stone-free rate at 3 months, the repeat ESWL rate and the secondary procedure (stone basketing) rate were 92%, 6% and 8%, respectively, with severe obstruction, and 78%, 6% and 6%, respectively, with partial obstruction. No urinary drainage procedures for sepsis were required after ESWL. Obstructing ureteral stones, which presented mainly in the upper third of the ureter, were successfully treated with in situ ESWL without the need for either bypassing the stone with a ureteral stent or for pushing the stone back into the kidney before treatment with ESWL.     

上尿路结石的现代治疗方法的探讨(附5178例报告）

目的：探讨上尿路结石的现代治疗方法。方法：回顾性分析2001年2月8日～2002年12月31日收治的5178例上尿路结石患者的临床资料。结果：5178例中，采用体外冲击波碎石术(ESWL)治疗1826例，输尿管镜取石术(URL)2157例，微创经皮肾镜取石术(mini-PCNL)1131例，腹腔镜输尿管切开取石术8例和开放手术56例，分别占总数的35．3％、41．7％、21．8％、0．2％和1．0％。ESWL治疗中，1个月后结石排净率为83．0％，2个月后结石排净率为86．0％，3个月后为86．5％。术后有13例发生输尿管石街，采用URL或PCNL取净。URL对输尿管中、下段结石取净率为100％，上段为76％，术中无输尿管穿孔和撕脱并发症发生。mini—PCNL对肾盂和输尿管上段结石的取净率为100％，鹿角形结石为93％。术中未见肾盂大穿孔和。肾皮质撕裂。术后79例输血，输血率为1．5％。腹腔镜治疗8例全部成功，无并发症发生。结论：上尿路结石可用腔内技术和ESWL治疗，开放手术几乎可避免。     

Clinical experiences of renal and ureteral stones by extracorporeal shock-wave lithotripsy (ESWL). IV: 3-year clinical experience of cases treated with ESWL

We report our 3-year experience with extracorporeal shock wave lithotripsy (ESWL) since we first used it for upper urinary tract stones on September 1st, 1984. A total of 1,225 patients (1,320 cases) underwent 1,647 sessions with ESWL; They consisted of 855 males (70%) and 370 females (30%). Treated stone locations were 593 renal stones, which contained 112 complete staghorn calculi, 504 ureteral stones, 110 renoureteral stones, and 1 bladder stone. ESWL monotherapy was performed on 90% of cases with renal and ureteral stones, and 46% of cases with complete staghorn calculi. In all the cases so far observed for more than 12 weeks after ESWL, 84.9% of the former showed complete discharge of the stones, and 0.7% showed no change. Only 48.9% of the later showed the complete discharge of the stones, 43.3% of which had residual stones, and 7.8% had fragments of the size of small beans. Complications, which were fever and pain, were noticed in 33.6% of the cases with renal and ureteral stones, and 64.3% of the cases with complete staghorn calculi. After ESWL, hematuria was noticed in almost cases, but the average volume of hemorrhage was 28 +/- 33 ml/day. The only contraindication of ESWL was severe obesity, and in the cases in which spontaneous stone discharge can be expected.     

患肾不显影输尿管结石的ESWL治疗

目的　总结由输尿管结石梗阻引起患侧肾脏不显影者行ESWL治疗的临床经验。　方法　输尿管结石致急性绞痛患者 16 8例 ,ESWL术前行KUB和IVU检查明确诊断输尿管结石而患侧肾脏不显影。结石位于髂骨缘以上者采用仰卧位 ,髂骨缘以下者采用俯卧位治疗。对 10 4例病史 <1个月、年龄 <6 0岁者于结石排空后行IVU ,观察其肾功能恢复情况。　结果　 16 8例患者全部于 2周内排空结石 ,其中 10 4例在结石排空后 1周～ 1年复查IVU ,患侧肾均已显影 ,2例仍有肾盂轻度积水。　结论　输尿管结石急性发病时 ,可因肾内压力骤增而引起肾功能受损 ,表现为患侧肾不显影。这种损害是可逆的 ,及时解除梗阻可使患肾功能得到恢复 ,ESWL是有效措施之一     

开放手术治疗上尿路结石667例回顾分析

目的 总结开放手术治疗上尿路结石的有效性,探讨在微创时代开放手术治疗上尿路结石的手术适应证.方法 回顾分析1995年1月至2004年12月在四川大学华西医院泌尿外科行开放手术治疗的上尿路结石病例.结果 共667例上尿路结石行开放手术治疗,同期约有9000例上尿路结石病例在我科治疗,开放手术比例约7.4%.开放手术原因包括:复杂结石及巨大结石297例,结石致患肾无功能137例,结石合并上尿路解剖畸形134例,微创治疗失败57例,结石合并各种内科疾病30例,结石合并肾肿瘤5例,结石合并黄色肉芽肿性肾盂肾炎3例,结石合并肾外伤2例,结石合并同侧其他手术2例.145例肾切除病例中共16例出现术中并发症,6例出现术后并发症;522例肾输尿管切开取石病例中,7例出现术中并发症,34例出现术后并发症;术后57例结石残留,总结石清除率为89.1%;围手术期无一例死亡.结论 开放手术在上尿路结石的治疗中仍然有重要作用,结石性无功能肾切除、复杂及巨大肾结石、结石合并解剖畸形、微创治疗失败及合并内科疾病的部分选择性病例适合选择开放手术治疗,治疗效果确切,并发症低.     

Clinical value of minimally invasive percutaneous nephrolithotomy in the supine position under the guidance of real-time ultrasound: report of 92 cases

To determine the clinical value of the real-time-ultrasound-guided minimally invasive percutaneous nephrolithotomy (m-PCNL) technique in the supine position, 92 patients suffering from renal or upper ureteral stones were treated by m-PCNL with a nephroscope/ureteroscope in the supine position. The ipsilateral flanks of the patients with different body sizes were elevated with a 1,000 or 3,000-ml water bag. Under cystoscopy, a ureteral catheter was inserted into the kidney. Normal saline was infused into the kidney via the ureteral catheter to dilate the entire urinary system. Under the guidance of real-time ultrasound, the needle was inserted into the urinary system to dilate the tract and establish the 16F mini-tract for percutaneous nephrolithotomy. All 92 (100%) m-PCNL procedures were successfully performed in the supine position. Primary stone clearance was achieved in 64 cases (69.6%). Residual stones occurred in 28 cases (30.4%). M-PCNL was performed for a second time in 16 cases to clear the residual stones. In 4 cases, stones remained after the second m-PCNL. Two of them were treated further by extracorporeal shockwave lithotripsy (ESWL). The total stone clearance rate of m-PCNL was 82.6%. Only one case required blood transfusion. No other serious complications occurred. The supine position is a favorable position for the patients, the surgeons and the anesthesiologists during the m-PCNL procedure. Real-time ultrasound is a valuable technique for guiding of the m-PCNL.     

Clinical experience of extracorporeal shock wave lithotripsy for cystine calculi

Thirty patients (16 men and 14 women) with cystine urinary stones were treated by extracorporeal shock wave lithotripsy (Dormer HM-3) from December 1984 through October 1989. The average patient age was 35.2 years with a range of 14 to 59 years. Seventy per cent of these subjects had had previous open surgical operations for stones. The cases consisted of 7 ureteral stones and 37 renal stones, including 15 staghorn calculi. An average of 1.3 session of ESWL was carried out to treat ureteral stones. Thirty-seven renal units with renal stone required 96 sessions of lithotripsy (average 2.6 sessions per unit). Seven patients with ureteral stones required auxiliary procedures, i.e., one transurethral lithotripsy (TUL), two percutaneous nephrostomies (PNS) and one open surgery. Thirty-seven renal stones, including staghorn calculi was treated by ESWL and auxiliary treatment of 21 TUL procedures, one PNS, 16 PNL procedures and one chemical chemolysis. Successful fragmentation (residual debris less than or equal to 4 mm) was achieved in 85.7% of ureteral stones, 90.9% of renal stones and 73.3% of staghorn calculi. The stone free rates of patients with ureteral stones, renal stones and staghorn calculi were 71.4%, 50.0% and 53.5%, respectively, at 3 months after ESWL. No serious complications were seen in this series. Fever above 38.5 degrees C was the most common complications (13.5%). Ureteral perforation was encountered once in TUL procedures. Transfusion and selective arterial embolization were needed for one case treated by PNL procedures. Although cystine stone is harder to be fragmented by ESWL than other stone composition, ESWL and endourology may be effective and safe procedures for cystine stone patients.(ABSTRACT TRUNCATED AT 250 WORDS)