输尿管支架管在腔内泌尿外科的应用(附230例报告)

目的 探讨输尿管支架管在腔内泌尿外科手术中的适应证及并发症。方法 对230例复杂肾结石、输尿管结石、输尿管狭窄、肾盂输尿管连接部梗阻患者在腔内泌尿外科手术中应用输尿管支架管作内支架和内引流，置管时间1-12个月（一般小于5周）。结果 体外冲击波震波碎石术后肾结石排出顺利，未形成石街；输尿管结石、输尿管狭窄、肾盂输尿管连接部梗阻经输尿管镜腔内手术后梗阻均被解除，肾积水改善或消失；腔内插管延长了盆腔肿瘤晚期致输尿管梗阻患者的生存时间。结论 留置输尿管内支架管治疗效果肯定，操作简便，并发症少，在腔内泌尿外科手术中有良好的应用价值。     

18F通道经皮肾镜碎石取石术联合尿石通治疗肾结石

目的观察18 F通道经皮肾镜钬激光碎石联合尿石通治疗肾结石的疗效。方法回顾性分析采用18 F通道PCNL钬激光碎石治疗196例肾结石患者临床资料,根据术后是否辅以尿石通治疗分为两组,观察两组的手术时间、手术碎石率、结石排净率及并发症发生率等。结果手术均取得成功,平均手术时间(76±20)min。一次手术结石取净结石159例(81.12%)。两组在年龄、性别、手术时间、手术清石率、并发症发生率等方面差异无统计学意义(P0.05);加用尿石通组最终排石率明显高于未加尿石通组(99.1%vs 93.1%,P0.05)。196例患者均有效解除梗阻,无一例出现大出血、全身性感染及中转开放手术。结论 18 F通道PCNL钬激光碎石治疗肾结石具有手术创伤小、严重不良并发症少、手术时间短、术后恢复较快等优点,术后加用尿石通辅助排石治疗,利于碎石排出,提高最终排石率,临床疗效满意。     

经皮肾镜钬激光碎石治疗海绵肾肾结石(附30例报告)

目的:探讨海绵肾肾结石经皮肾镜钬激光碎石取石的疗效及安全性。方法:回顾性分析我院2009年1月~2016年1月住院治疗的30例海绵肾合并肾结石并行经皮肾镜钬激光碎石取石治疗的患者,术后观察患者临床疗效。结果:30例均成功去大部分游离结石,解除上尿路梗阻,术后复查KUB平片结石均较术前明显减少。结论:引起肾盂输尿管上段梗阻的海绵肾肾结石可行经皮肾镜取石术,只需要清除引起梗阻的游离结石,部分黏膜下较大结石也可碎石清除。不主张进行较大面积的干扰髓质内结石。     

小切口辅助经皮肾镜气压弹道碎石术治疗复杂性肾结石

目的评价小切口辅助经皮肾镜气压弹道碎石术治疗复杂性肾结石的疗效。方法回顾性分析2005年3月至2009年7月采用小切口辅助经皮肾镜气压弹道碎石术治疗复杂性肾结石患者57例的资料。结果手术时间2.0~3.0h,平均2.5h。术中出血50~300ml,平均170ml,术后结石总取净率91.2%,一期结石完全清除率56.1%,肾盂梗阻解除率100%。术中、术后无严重并发症。结论小切口辅助经皮肾镜气压弹道碎石术治疗复杂性肾结石具有安全、有效、微创的优点。     

复杂性肾结石并慢性肾功能不全的外科治疗

目的:总结2 6例复杂性肾结石并慢性肾功能不全病例的手术经验,提高复杂性肾结石并慢性肾功能不全的治疗水平。方法:采用切开肾盂,肾内肾盂患者可暴露肾窦,甚至分离至肾盏颈,根据结石的特点,必要时可切开部分薄弱区域肾实质及盏颈。结果:手术不损伤肾内主要血管,术中出血少。术后4周复查肾功能,2 6例患者中16例恢复正常,10例明显好转。术后7例有部分小结石残留。结论:复杂性肾结石并慢性肾功能不全的处理原则是早期诊断和处理,及时解除梗阻,最大限度保护肾功能。消极等待不如积极治疗。     

小儿多发性上尿路结石梗阻致急性肾功能衰竭的诊断及早期处理

目的：提高小儿上尿路多发性结石的诊断及早期治疗水平。方法：回顾性分析32例小儿上尿路多发性结石致急性肾功能衰竭的诊断及早期治疗过程，总结出较好的早期诊断与治疗的方法。结果：32例患者经腹部平片(KUB)及B超检查确诊27例，5例另行CT检查而确诊，32例患者均急诊处理，其中5例行输尿管镜碎石、4例经小儿膀胱镜置人小儿双J管而解除梗阻，23例经小儿膀胱镜置小儿双J管失败后，经常规手术解除梗阻，术后肾功能恢复良好。结论：小儿上尿路多发性结石致急性肾功能衰竭须早期诊断及治疗，KUB及B超检色是较好的诊断方法，应以简单、有效、创伤小的方法解除梗阻，可光用内镜方法治疗，如失败，则应急行常规手术解除梗阻。结石可留作Ⅱ期处理。     

体外冲击波碎石治疗尿路结石术后复发性结石

目的探讨尿路结石术后复发结石的原因及治疗。方法1988年～1999年应用ESWL治疗尿路结石取石术后复发性结石88例。结果结石粉碎率为100％,三个月结石排净率为93．1％。结石残留、梗阻因素、尿路感染和代谢紊乱是尿路结石术后复发的主要因素。结论ESWL是治疗尿路结石术后复发性结石的有效方法,提出首次治疗结石应以消除结石,解除梗阻,防治感染,纠正代谢紊乱为原则。     

输尿管镜治疗急性输尿管梗阻

目的探讨输尿管镜在急性输尿管梗阻的诊断及处理中的优势。方法回顾分析54例急性输尿管梗阻经过输尿管镜技术治疗的临床资料。结果52例经过输尿管镜技术成功解除梗阻。结石性梗阻50例,其中双侧输尿管结石3例,孤肾1例;息肉及狭窄各1例。2例因置镜失败经过手术解除梗阻,术后证实为结石。结论输尿管镜技术对急性输尿管梗阻性疾病具有诊断及治疗双重作用,对于持续性肾绞痛及急性肾后性肾功能不全等需急诊处理者更为适宜。     

胆道梗阻解除前后肾血管通透性的变化及其意义

目的 探讨胆道梗阻解除前后肾血管通透性的变化。方法 用放射免疫分析法检测３０例胆道梗阻病人前后的蛋白和免疫球蛋白Ｇ的含量，其中１９例胆道梗阻得到完全解除。另选２４例慢性结石胆囊炎病人对照。结果 胆道梗阻病人尿Ａｌｂ及ＩｇＧ均较对照组升高，术后不论胆道梗阻有无解除均进一步升高。结论胆道梗阻病人肾血管通透性增加，术后更为明显，解除胆道梗阻并不能改善病人近期肾血管通透性。     

复发性肝内胆管结石再手术的疗效分析

目的：探讨不同术式治疗复发性肝内胆管结石的近远期效果。方法：回顾性分析76例复发性肝内胆管结石再手术患者的既往病史及手术方式、结石再发部位、治疗效果及随访结果等临床资料。以术后情况作为近期疗效分析的依据,以随访结果作为远期疗效分析的依据。结果：患者平均住院时间为10.4d,术后并发症发生率为14.5%。院外随访8个月～8年,平均复发率为38.2%,联合式手术较单一式手术的复发率低（P〈0.05）。结论：肝内胆管结石复发率高,应强调严格遵循＂解除梗阻、去除病灶、通畅引流＂的基本原则,重视首次手术。选择合适的手术方式是减少术后胆管结石复发、提高近远期疗效的关键。     

Prevalence of calcified upper urinary tract stone disease in a random population survey. Report of a combined study of general practitioners and hospital staff

There are few randomised studies specifically designed to establish the prevalence of upper urinary tract stone disease. The present random study sampled a population of 7000 in the central belt of Scotland. Three thousand three hundred and ninety-eight subjects were X-rayed and possible calcified upper tract stones were further investigated, revealing a prevalence rate of 3.5% of the total surveyed population. Socio-economic characteristics of the population were determined, such as occupation, history of previous infection, stone disease and backache. Simple urine and blood analyses were undertaken. There was no difference in stone prevalence between males and females (1.03:1) as distinct from treated stone patients. There were no differences between the sexes with respect to family history of stone disease but females have a greater chance of having had previous urinary tract infection.     

The fate of residual fragments after extracorporeal shock wave lithotripsy monotherapy of infection stones

We reviewed 53 patients with infection stones treated by extracorporeal shock wave lithotripsy (ESWL*) monotherapy to determine the long-term rate free of stones and the stone recurrence rate as correlated with the pre-treatment stone burden and the radiological presence of sand or fragments after the procedure. Long-term followup (mean 26.6 months) was available on 33 patients representing 38 kidneys. Although only 3 kidneys were free of stones immediately after ESWL, 20 were without stones at 3 months and 18 (47%) were stone-free at followup. Of 9 kidneys with fragments of more than 5 mm. after the final treatment 7 (78%) had residual fragments at 3 months and experienced stone progression. Of 9 kidneys with sand remaining 6 (66%) and all 3 kidneys that appeared to be free of stones after ESWL were without stones at followup. The 3-month plain film of the kidneys, ureters and bladder was a reliable indicator of eventual outcome. Of 20 kidneys that were free of stones at 3 months 16 remained without stones. Of 18 kidneys with residual stone particles at 3 months 14 showed disease progression, 2 had stable disease and 2 passed residual sand. Only 1 of 17 patients who were free of stones or had stable stone disease had a positive urine culture at followup. Patients with infection stone fragments 3 months after ESWL monotherapy have a high rate of stone progression (78%) and should undergo further treatment. ESWL monotherapy of infection stones requires close patient followup to assure that all residual fragments have passed and urine remains sterile.     

Effect of stone motion on in vitro comminution efficiency of Storz Modulith SLX

BACKGROUND AND PURPOSE: During SWL, stone motion secondary to ventilatory motion can be as much as 50 mm. This is much larger than the 4- to 15-mm diameter of the focal regions on most clinical machines. The goal of this study was to determine the effect of stone motion on the fragmentation efficiency of a clinical lithotripter with a small (4-mm) focal spot. MATERIALS AND METHODS: A model stone (6.5 x 7.5 mm) made of gypsum cement was used as an in vitro target for a Storz Modulith SLX lithotripter with a custom-designed waterbath. A motorized positioner was used to translate the stone in order to simulate ventilatory motion. The excursion was variable up to 48 mm (+/- 24 mm about the focus). After treatment by 400 shockwaves, the remnants (> 2 mm) were dried and weighed. RESULTS: Fragmentation efficiency was reduced (P < 0.05) for motion of > or = 10 mm. Similar results were found with different energy levels and firing rates. The reduction in fragmentation efficiency was consistent with calculations of the time the stone was outside the focal region. CONCLUSIONS: Clinically relevant stone motion has a dramatic effect on in vitro comminution. Motion of 10 mm led to a significant reduction in comminution, and for motion > 20 mm, it appeared that three-quarters of the shockwaves missed the stone. These data imply that ventilatory gating or stone tracking may result in fewer shockwaves being required for successful treatment with this lithotripter.     

Formation of the staghorn calculi

To study the process of formation of staghorn calculi, 58 patients with staghorn calculi were evaluated clinically and the removed stones were studied architecturally. Of 35 patients with infection stones composed of struvite and/or apatite in the nuclei as well as peripheral layers, 18 had identified predisposing factors related to infection. Of 13 patients with infection stones containing calcium oxalate in the nuclei, 7 had predisposing factors of infection but only 2 had metabolic disorders. The patients with infection stones who had no predisposing factors may have transient or subclinical abnormalities. Initial stone formation of oxalate may also be one of the predisposing factors of infection. Most of the patients with staghorn calculi composed of uric acid, oxalate and cystine, had metabolic disorders related to these substances. Large numbers of bacteria and large amounts of organic matrix were found extensively within infection stones and were thought to be important components as well as crystals. Metabolic stones contained little matrix. In this case crystal aggregation is thought to play the most important role in stone formation.     

A comparison of stone damage caused by different modes of shock wave generation.

A standard stone phantom was used to compare stone damage after extracorporeal shock wave administration from electrohydraulic, electromagnetic and piezoelectric lithotripters. For each machine, a low and high shock wave intensity setting was chosen: 18 & 24 kV for electrohydraulic; 16 & 19 kV for electromagnetic; power levels 1 and 4 for piezoelectric. The shock wave was focused either at the front (surface facing the wave source) or back surface of the stone and 50, 100, 200 or 400 shocks were delivered to different stone groups. Effects of varying physical properties in the stone phantom were also investigated. Stone damage was described in terms of volume loss and both depth and width of the resulting damage crater. At the lower intensity settings, all three machines produced stone volume loss which was linearly related to the number of shock delivered. At higher intensity settings, volume loss increased rapidly as the number of shocks increased. With the same number of shocks, stone volume loss was greatest with the electrohydraulic machine, followed by electromagnetic and piezoelectric lithotripters for both low and high intensity settings. Damage craters from the piezoelectric device were narrow and deep; those from the electromagnetic machine were of the shape of a right angle circular cone; whereas those from the electrohydraulic lithotripter were shallow and wide. At the high intensity settings, damage from the piezoelectric and electrohydraulic lithotripters appeared to depend upon the position of the focal point with a higher volume loss when the shock waves were targeted at the front surface of the stone. For the electromagnetic device, a higher volume loss was found when we positioned the focal point at the back surface of the stone phantom. Stone phantoms with lower mechanical strength and acoustic impedance were more easily damaged than those with higher values. Finally, a computer regression model was developed to express volume loss in terms of the intensity setting, focal position and number of shocks for each lithotripter.     

The relation between urinary tract infections and stone composition in renal stone formers

During a seven-year period (1975-1981) a total of 1325 patients hospitalized for stone disease were studied as to the occurrence of positive urine cultures. Urinary stones from 535 surgically treated patients were analyzed with infrared spectrophotometry and the relationships between stone composition, level of surgery and bacteriological strains were studied. Positive urinary cultures were found in 34% of the surgically treated patients and in 21% of those not operated upon. Among the surgically treated patients with urinary tract infection (UTI) E. coli was the most frequent microorganism (35%), followed by Proteus (28%). Patients with Proteus infection had the highest frequency of UTI episodes, most of which occurred before hospitalization. There was a higher frequency of magnesium ammonium phosphate (MAP) calculi among patients with Proteus infection than among those with non-Proteus infection, in whom no difference in stone composition was found. Patients infected with E. coli had more phosphate-containing stones (CaP+MAP) than non-infected patients. The highest frequency of oxalate calculi (CaOx+CaOx/CaP) was found among patients without infection. No E. coli infections were seen in male patients with CaP and MAP calculi. MAP stones were most often found in the kidney and oxalate stones in the ureter.     

Clinical patterns of paediatric urolithiasis

A series of 270 paediatric stone patients was studied retrospectively according to the clinical pattern of urolithiasis (age and sex, stone location, stone analysis, recurrence rate) and aetiology of stone disease (infection, anatomical, metabolic or idiopathic). Infection stones occurred earliest and more commonly in males and were usually upper tract struvite calculi related to Proteus infection. Anatomical stones were most commonly associated with pelviureteric junction (PUJ) obstruction and had a high recurrence rate, despite surgical correction of obstruction. Idiopathic stones most resembled those found in adult urolithiasis by virtue of occurring latest, being sited in the ureter more often and being more frequently composed of calcium oxalate. Metabolic stones were most frequently calcium phosphate or cystine and virtually all were renal. They comprised the smallest group but had the highest recurrence rate.     

Effect of potassium citrate therapy on stone recurrence and residual fragments after shockwave lithotripsy in lower caliceal calcium oxalate urolithiasis: a randomized controlled trial

BACKGROUND AND PURPOSE: To evaluate the efficacy of potassium citrate treatment in preventing stone recurrences and residual fragments after shockwave lithotripsy (SWL) for lower pole calcium oxalate urolithiasis. PATIENTS AND METHODS: One hundred ten patients who underwent SWL because of lower caliceal stones and who were stone free or who had residual stone 4 weeks later were enrolled in the study. The average patient age was 41.7 years. All patients had documented simple calcium oxalate lithiasis without urinary tract infection and with normal renal morphology and function. Four weeks after SWL, patients who were stone free (N = 56) and patients who had residual stones (N = 34) were independently randomized into two subgroups that were matched for sex, age, and urinary values of citrate, calcium, and uric acid. One group was given oral potassium citrate 60 mEq per day, and the other group served as controls. RESULTS: In patients who were stone free after SWL and receiving medical treatment, the stone recurrence rate at 12 months was 0 whereas untreated patients showed a 28.5% stone recurrence rate (P < 0.05). Similarly, in the residual fragment group, the medically treated patients had a significantly greater remission rate than the untreated patients (44.5 v 12.5%; P < 0.05). CONCLUSION: Potassium citrate therapy significantly alleviated calcium oxalate stone activity after SWL for lower pole stones in patients who were stone free. An important observation was the beneficial effect of medical treatment on stone activity after SWL among patients with residual calculi.     

移植肾输尿管梗阻的诊断与治疗：（附13例报告）

为了提高对移植肾输尿管梗阻患者的诊断与治疗水平，对在５３６例次肾移患者中发现的１３你输尿管梗阻患者进行临床总结分析，其中输尿管狭窄性梗阻１０例，输尿管结石性梗阻３例。分析认为，肾移植术后早期排斥反应、伤口深部感染及漏尿可能与发生移植肾输尿管狭窄性梗阻有关，而肾移植术后高尿酸血站与输尿管结石形成有关。提出Ｂ超、肾图、经皮顺行造影和肾盂内压测定为诊断移植肾输尿管梗阻的手段；对于输尿管狭窄性梗阻患者，早     

输尿管支架结痂的原因分析以及石痂与原发结石成分的比较

目的探讨输尿管支架结痂的原因，比较石痂和原结石成分的异同，了解成因及预防。 方法回顾性分析我院2020年3月至2021年8月80例输尿管支架结痂泌尿系结石患者，及同期接受治疗的80例输尿管支架未结痂泌尿系结石患者的资料。采用结石红外光谱自动分析系统分析结石及石痂，对比其成分的差异。 结果结痂组与非结痂组患者的性别比例、年龄、肌酐、肾小球滤过率、肾积水情况、术前感染控制情况、尿培养情况、手术方式、结石部分、术后口服抗生素时间等差异均无统计学意义（P>0.05）。结痂组和非结痂组患者相比更容易出现腰痛（P<0.05）。结痂组和非结痂组患者相比患代谢综合征的比例高，结石清除率较低，尿pH值较高，饮食偏荤和喜饮茶者较多（P<0.05）。71.25%（57/80）患者的支架管石痂成分与原结石成分一致，28.75%（23/80）患者的支架管石痂与原发结石成分不一致，可能与感染控制不佳和代谢性疾病有关。 结论输尿管支架结痂这一并发症需要引起足够的重视，大部分的石痂与原发结石成分相同。可通过改变生活习惯，控制带管时间，积极控制尿路感染及治疗代谢性疾病预防。