ESWL联合坦索罗辛治疗输尿管下段结石的探讨

目的：探讨ESWL联合坦索罗辛治疗输尿管结石并促进结石排出的有效性与安全性。方法：对80例单发输尿管下段结石患者在应用ESWL治疗后分组进行为期2周的临床观察，40例采用保守治疗（对照组），即每天饮水2L，必要时采用非甾体类抗炎药物缓解症状；40例除采用保守治疗外，加用坦索罗辛0．4mg，每天1次（治疗组）。结果：ESWL后2周，两组均行影像学检查。对照组排石率为47．5％（19／40），治疗组为77．5％（31／40）。2周内，两组发生肾绞痛分别为15％（6／40）和7．5％（3／40）。治疗组有2例发生轻微头晕乏力。结论：坦索罗辛可以显著提高ESWL后的结石排出率，减少发生肾绞痛机率，不良反应轻微，是输尿管下段结石ESWL后辅助排石的治疗方法之一。     

ESWL联合坦索罗辛治疗输尿管结石的疗效分析

目的：评价α1受体阻滞剂坦索罗辛在ESWL治疗输尿管结石中的辅助排石效果。方法：将符合条件的160例输尿管结石患者彳FESWI。治疗后随机分成两组，一组给予常规治疗作为对照，另一组（观察组）除给予常规治疗外，增加坦索罗辛0．4mg／d。结果：在观察时问内，对照组排石率（53％）明显低于观察组（74％），两组之间的差异有统计学意义（P〈0．05）。结论：坦索罗辛能提高输尿管结石ESWL治疗后的排石率，可作为输尿管结石ESWL治疗后的辅助排石疗法．     

体外冲击波碎石治疗输尿管结石影响疗效的相关因素分析

目的探讨体外冲击波碎石（ESWL）治疗输尿管结石影响疗效的相关因素。方法收集2009年1月至2013年1月我院采用ESWL治疗单发输尿管结石的392例患者的临床资料,对11个可能导致排石失败的因素进行单因素和多因素logistic回归分析。结果ESWL治疗输尿管结石成功率80．1％（314／392）。单因素分析显示患者结石位置、结石直径、病程和术后服用坦索罗辛等因素在排石成功和排石失败的两组患者中差异有统计学意义（P〈0．05）。多因素logistic回归分析显示,结石直径≥10mm,结石位于输尿管中、下段和病程≥60d为排石失败的独立危险因素（OR分别为2．625、1．973、1．754、1．483,P均〈0．05）,术后服用坦索罗辛为保护性因素（OR=0．542,P〈O．05）。结论ESWL治疗输尿管结石的疗效与多种因素有关,结石位置、结石直径和病程是ESWL治疗输尿管结石失败的独立危险因素,术后服用坦索罗辛为保护性因素。     

逆行输尿管插管在体外冲击波治疗复杂输尿管结石中的应用

目的探讨逆行输尿管插管在体外冲击波碎石（ESWL）中治疗复杂输尿管结石的应用价值。方法对25例复杂性输尿管结石患者ESWL术前放置输尿管导管（治疗组15例）和未放置输尿管导管（对照组10例），观察比较ESWL疗效.结果对照组平均ESWL次数为4．2次，治疗组为2．8次（P〈0．05）。对照组结石一次粉碎率20．0％，治疗组40.1％（P〈0.05）。对照组平均排石时间为10．5周，治疗组为7．5周（P〈0．01），两组比较差异均有显著性。结论放置输尿管导管在复杂输尿管结石ESWL治疗中优于普通碎石。     

非同步俯卧位螺旋CT辅助定位行微创经皮肾镜取石的可行性研究

目的：探讨非同步俯卧位螺旋CT定位行微创经皮肾镜取石的可行性。方法：对5例肾结石和4例输尿管上段结石共9例拟行微创经皮肾镜取石患者,术前两次行俯卧位螺旋CT扫描,分别测量皮肤标记穿刺点到结石及肾下极的层面距离、标记穿刺点到达肾收集系统的深度以及穿刺径路与背部平面（人体冠状面）的角度并进行统计学分析。结果：两次扫描测得的穿刺点到结石及肾下极距离差值分别是（0．56±0．77）mm（P=0．49）和（1．11±1．54）mm（P=0．06）,穿刺深度及角度差值分别为（0．18±0．85）mill（P=0．84）和（-0．64°±0．55°）（P=0．27）。结论：非同步俯卧位螺旋CT定位行微创经皮肾镜取石切实可行。     

不同的定位系统用不同的卧位方式ESWL治疗输尿管下段结石

目的：不同的定位系统用不同的卧位方式ESWL治疗输尿管下段结石。方法：将385例输尿管下段结石分为近端、中间端、远端结石。对近端阳性结石选俯卧位X线定位,B超可见的阴性结石选同侧俯卧位B超定位治疗;对中间端和远端的阳性结石,选仰卧位X线定位配合B超监测治疗,B超可见的阴性结石选对侧俯卧位B超定位治疗。结果：碎石率与排石效率显著提高,可达99．7％。结论：分端治疗是取B超和X线二者的优点,能准确、有效定位,疗效提高。     

经尿道输尿管镜联合体外震波碎石治疗输尿管结石256报告

目的探讨输尿管镜联合体外震波碎石（extracorporeal shock wave lithotripsy，ESWL）治疗输尿管结石的价值。方法2005年10月-2007年6月采用输尿管镜联合ESWL治疗输尿管结石256例，中段（56例）及下段（170例）结石用输尿管镜取石，上段（30例）结石用ESWL碎石，输尿管镜取石失败或结石残留联合ESWL治疗。结果输尿管下段结石一期结石清除率98．2％（167／170），中段结石一期结石清除率89．2％（50／56），上段结石一期结石清除率73．3％（22／30）。输尿管穿孔3例，输尿管黏膜撕脱1例，结石远端输尿管扭曲进镜致使尿管穿孔改切开取石1例，输尿管镜取石失败或结石残留联合ESWL治疗二期结石清除率91．7％（11／12）。结论输尿管镜治疗输尿管下段及中段结石成功率高，输尿管镜取石失败或结石残留联合ESWL可提高二期结石清除率。     

输尿管镜气压弹道碎石术与体外冲击波碎石术治疗输尿管结石的疗效比较与选择

目的：比较输尿管镜气压弹道碎石术（URSL）和ESWL治疗输尿管结石的临床疗效。方法：回顾性分析输尿管结石患者490例的临床资料,其中ESWL治疗240例,URSL治疗250例。结果：URSL组总有效率为85．2％,明显高于ESWL治疗组的总有效率78．3％（P〈0．01）,URSL治疗上段结石有效率为75．4％,低于ESWL组的86．7％（P〈0．01）,URSI。治疗中下段结石有效率为93．9％,明显高于ESWL组的69．7％（P〈0．05）。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,对于复杂的输尿管结石,联合ESWL和URSL治疗可以取得更好的疗效。     

急诊输尿管镜钬激光碎石与体外冲击波碎石治疗输尿管结石并急性肾绞痛的疗效比较

目的比较急诊输尿管镜钬激光碎石（URL）与急诊体外冲击波碎石（ESWL）两种方法治疗输尿管结石引起的急性肾绞痛的疗效。方法2006年1月至2008年9月，采用Storz8／9F硬质输尿管镜、钬激光碎石机和DornierCompactS型低能量电磁式碎石机分别急诊治疗输尿管结石并肾绞痛175例和110例。所有病例均先行药物治疗症状无缓解后在急诊初诊12h之内接受急诊URL或急诊ESWL。结果对于输尿管上段结石，术后疼痛缓解率URL组虽优于ESWL组（93．94％和66．67％，P〈O．05），但碎石成功率（84．85％和83．33％，P〉0．05）及二周结石排净率（81．81％和77．78％，P〉0．05）均无显著差异。而对于输尿管中下段结石，术后疼痛缓解率（98．59％和92．39％）、碎石成功率（98．59％和91．30％）以及二周结石排净率（97．18％和94．78％）URL组均优于ESWL组fP〈0．05）。最大径10mm以内的结石URL组碎石成功率优于ESWL组（96．38和88．10％，P〈0．05）。最大径10mm以上的结石，术岳疼痛缓解率及2周排净率URL组均优于ESWL组（97．30％和69．23％，91．89％和61．23％，P〈0．05）。5RL及ESWL组并发症率分别为3．46％和2．73％（P〉0．05）。结论急诊URL和急诊ESWL均是输尿营结石并急性肾绞痛的安全、有效的治疗方法，对于输尿管上段结石或最大径不超过10mm的结石二首效果相当，而对于输尿管中下段结石或直径大于10rllm的结石来说，URL疗效优于ESWL。     

输尿管镜下阻挡网篮配合双频激光碎石术与ESWL治疗非复杂性输尿管上段结石疗效比较

目的：对体外震波碎石（ESWL）及输尿管镜下阻挡网篮配合双频激光碎石（URL）治疗非复杂性输尿管上段结石进行比较。探讨两种术式的疗效．方法：收治121例非复杂性输尿管上段结石病例。随机分两组．其中63例行ESWL-58例行URL,ESWL组采用多尼尔Cigma双定位体外冲击波碎石机,URL组采用Storz硬性输尿管镜,配用自制阻挡网篮,连接W．O．MU—100双频激光机后进行碎石,术后留置双J管。结果：两组在一次碎石成功率（ESWL93．7％、URI．93．1％）、术后1个月结石清除率（ESWI,90．4％．URI,93．1％）差异无统计学意义（P〈0．05）,治疗时间（ESWI．33．5±6．4、URL15．0±2．3）及术后1周结石清除率（ESWL69．8％、URL93．1％）URL组要优于ESWL组．差异有统计学意义（P〈0．05）。ESWI．组出现l例包膜下血肿。URL组出现1例输尿管穿孔．结论：对非复杂性输尿管上段结石的治疗,我们要根据患者具体情况及要求,科学地制定个体化治疗方案,以减少并发症。     

Is there significance of the choice of prone versus supine position in the treatment of proximal ureter stones with extracorporeal shock wave lithotripsy?

OBJECTIVE: To determine whether there is a significance of the choice of prone versus supine position in the treatment of proximal ureter stones with extracorporeal shock wave lithothripsy (ESWL). METHODS: Ninety-six patients with proximal ureter stones underwent ESWL. The procedure was performed in the supine position in 48 of them (group 1) and in the prone position in the other 48 patients (group 2). Stone-free rates, repeat ESWL rates, shocks per patient and shocks per session were compared in both groups. RESULTS: The mean session number per patients was 1.64+/-0.75 in group 1 and 1. 33+/-0.59 in group 2 (p = 0.224). The stone-free rates 3 months after ESWL were 88.3% in group 1 and 90.6% in group 2. The difference between the results was statistically insignificant (p<0.05). Therefore, these two parameters were similar in both groups. On the other hand, the number of shocks per session was 4,863.54+/-2, 114.85 in group 1 and 3,704.16+/-1,726.75 in group 2. This difference was statistically significant (p = 0.011). The patients tolerated the supine position better in general. Patients in the prone position experienced discomfort on inspiration and expiration and pain localized to the lumbar vertebrae. CONCLUSION: These results suggest that the supine position decreases the number of shocks per session in the treatment of proximal ureter stones with ESWL and this will be cost-effective.     

The 'modified prone position': a new approach for treating pre-vesical stones with extracorporeal shock wave lithotripsy

OBJECTIVE: To investigate the utility of a new 'modified-prone' position for treating pre-vesical stones with extracorporeal shock wave lithotripsy (ESWL), usually considered an acceptable and effective treatment for such stones, but for which many different body positions have been used in an attempt to increase its efficacy. PATIENTS AND METHODS: The study included 268 consecutive patients with a solitary pre-vesical stone who underwent ESWL either prone (69) or in the modified-prone position (199) between May 1999 and August 2001. Only those with one stone between the ureteric orifice and 1 cm proximal to the vesico-ureteric junction were included. In each case the stone diameter, days to stone clearance, number of shock waves applied per treatment, and number of sessions required to become stone-free were recorded. If the treatment failed this was also noted. Success rates in the prone and modified-prone groups were compared and analysed to assess which of the variables influenced success with ESWL. RESULTS: After ESWL, 95.5% of the 268 patients were stone-free; the rates in the prone and modified-prone groups were 89.9% and 97.5%, respectively (P = 0.015). The probability of success with ESWL therapy for pre-vesical calculi in modified-prone position was about five times (odds ratio 4.56, 95% confidence interval 1.2-17.7) greater than that expected with when prone. The modified-prone position was an independent factor most significantly influencing success with ESWL in these patients. CONCLUSION: The modified-prone position for ESWL is a new and very effective way to treat patients with pre-vesical stones.     

Extracorporeal shock wave lithotripsy in the prone position: treatment of stones in the distal ureter or anomalous kidney

A total of 15 patients underwent ESWL using the Dornier HM3 lithotriptor with the patient in the prone position. The stones were in the distal ureter over the sacroiliac joint in 10 patients, 8 of whom had undergone unsuccessful ureteroscopic manipulation. Two patients had horseshoe kidneys with stones that were too anterior to permit accurate targeting with the patient in the standard supine position. One patient had a solitary stone in a pelvic kidney and 1 had an obstructing ureteropelvic junction stone in a crossed ectopic kidney. The final patient had a reconstructed lower urinary tract with a stone at 1 of the ureterointestinal anastomoses. Excellent pulverization was achieved in all patients after only 1 prone ESWL treatment. One patient required temporary percutaneous nephrostomy after ESWL and 1 may require retrograde manipulation of fragments at the ureterovesical junction. No patient had melena, and other than temporary ileus in 1 patient who had concurrent supine ESWL of renal calculi, no gastrointestinal complications were seen. All but 1 patient were free of stones 1 month after prone ESWL. Prone ESWL prevents blockage of shock wave energy by the bony pelvis, because the shock waves enter anteriorly and exit posteriorly. ESWL with the patient in the prone position is a safe and effective treatment of calculi in the distal ureter or anomalous kidney.     

同步悬空俯卧位对健康人呼吸功能影响的探讨

目的：探讨同步悬空俯卧位对健康人呼吸功能情况的影响。方法：9例健康人志愿者,在“人工呼吸床”上随机四种不同体位：1、仰卧位2,悬空俯卧位3,托平俯卧位4、同步悬空俯卧位．每个体位观察10．9钟。通过NICO无创心肺功能监测系统连续测定志愿者的呼吸动力学指标,同时通过呼趿功能检测电极监测食道压和胃压：结果：四种体位对心率、呼吸频率、氧饱和度、呼气寒二氧化碳无明显的影响（P〉0．05）,其中同步悬空俯卧的呼吸频率是最慢的（15．1±4．3）／min,由慢至快呈现：同步悬空俯卧→仰卧→悬空俯卧→托平俯卧的趋势．同步悬空俯卧位的潮气量是最大的（584．6±151．3）ml．明显高于其余三种体位（P〈0．05）。同步悬空俯卧位较其它体位能显著降低死腔通气比率（Vd／Vt）0．43±0．8（P〈0．05）的情况下,能显著提高肺泡潮气量（VTalv）375．2±145．2ml和肺泡分钟通气置（MVatv）5．1±1．2L;同时经呼吸功能检测电极监测的跨膈压（Pdi）。托平俯卧位的Pdi平均为13．5cmH2O,较其它体位显著升高（P〈0.05）,平常的仰卧位Pdi平均10.1cmH2O。同步悬空俯卧位的Pdi平均为8．6cmH2O是四种体位中最低的;结论：同步悬空俯卧位经短时间观察是安全稳定的,能减少死腔通气、增加潮气量的前提下。不增加呼吸做功．志愿者的主观感觉最舒适。     

Morbidity associated with patient positioning in extracorporeal shock wave lithotripsy of distal ureteral calculi

In 115 patients with 123 distal ureteral stones located below the lower border of the sacroiliac joint, in situ extracorporeal shock wave lithotripsy (ESWL) was performed with a Siemens Lithostar Lithotriptor. Our initial experience with the prone position in 8 out of 49 cases did not reveal stone fragmentation and on the final treatment sessions shock waves were allowed to enter via the obturator or sciatic foramen whilst the patients were in the supine position, in order to compare the results of treatments performed in both positions. The mean number of treatment sessions per patient, mean number of shock waves per treatment sessions, mean shock voltage per session and mean fluoroscopy time per session were significantly lower in the supine group than in the prone group (p<0.05 for all variables). ESWL of the distal ureteral stones in the prone position seems to have an associated patient morbidity when we compare the results of treatments performed in both positions.     

坦索罗辛和山莨菪碱对输尿管下段结石体外冲击波碎石（ESWL）术后辅助排石的疗效比较

目的分析比较坦索罗辛和山莨菪碱在输尿管下段结石体外冲击波碎石术后辅助排石的疗效。方法90例输尿管下段结石患者随机分3组，每组30例，结石直径0．4—1．0cm。对照组未给予输尿管平滑肌松弛剂；山莨菪碱组给予山莨菪碱10mg，3次／d；坦索罗辛组给予坦索罗辛0．4mg，1次／d。每例患者治疗观察期不超过2周。结果2周内结石排出者对照组为27例（86．7％），山莨菪碱组为28例（93．3％），坦索罗辛组为28例（93．3％）。各组比较排石率无显著差异（P〉0．05）。各组平均排石时间分别为（5．6±4．0）d、（5．2±2．8）d、（4．6±2．7）d，山莨菪碱组、坦索罗辛组较对照组时间短，差异有统计学意义（P〈0．01），坦索罗辛组较山莨菪碱组短，差异有统计学意义（P〈0．01）。结论在输尿管下段结石体外冲击波碎石术后，坦索罗辛和山莨菪碱在辅助排石方面是安全、有效的，能缩短结石排石时间，坦索罗辛作用优于山莨菪碱。     

双肾结石俯卧与仰卧位经皮肾镜术的对比研究

目的：探讨俯卧位与仰卧位采取经皮肾镜取石术（percutaneous nephrolithotomy,PCNL）的安全性和疗效比较。方法：对9例双肾结石患者,分别分期行采用B超引导一侧俯卧和另一侧仰卧位PCNL。结果：9例患者18侧肾全部取石成功,其中3例5侧肾行二期取石。俯卧和仰卧位的手术时间、术后住院时间及一次清石率分别为（108．2土45．6）min,（116．5±31．2）min;（5．6±1．8）天,（5．8±1．5）天;66．7％（6／9）,77．8％（7／9）。术中血气均无显著变化,未出现严重手术并发症。俯卧位时恶心、呕吐者8例,呼吸困难4例,肩痛5例,术中因不适药物干预7例,其中2例因不能耐受终止手术2例;仰卧位肩痛2例,未出现药物干预和因不能耐受终止手术。结论：PCNL仰卧位较俯卧位患者耐受性好、痛苦小,而两者疗效无差异,是更好的PCNL治疗体位的选择。     

健侧俯卧位ESWL治疗输尿管末端结石的临床研究

目的：探讨健侧俯卧位ESWL治疗输尿管末端结石的效果。方法：让患者健侧俯卧于冲击波源一侧,使冲击波经健侧下腹壁聚焦于对侧输尿管末端的结石上,将结石粉碎。结果：结石排净率达100％,均1次碎石成功。结论：在碎石机性能许可的条件下,健侧俯卧位是ESWL治疗输尿管末端结石首选的碎石体位。     

Extracorporeal shock wave lithotripsy in the prone position for stones situated anteriorly

Stones situated anteriorly cannot be satisfactorily reached with extracorporeal shock wave lithotripsy (ESWL) in the supine position. By assuming the prone position, patients with stones in horseshoe or ectopic kidneys or in the iliac ureter can be treated by ESWL with the same success rate as patients with posterior stones. This new technique has been used in 30 patients with iliac ureteral stones, 5 patients with caliceal stones in horseshoe kidneys and 1 patient with a pyelic stone in a sacral kidney.     

复杂性上尿路结石微创综合治疗的临床应用研究

目的:探讨和总结上尿路结石微创综合治疗的有效方法和经验。方法:采用经皮肾微造瘘输尿管镜取石术(MPCNL)、逆行输尿管镜碎石术(URL)、体外冲击波碎石术(ESWL)等方法治疗复杂性上尿路结石患者52例,其中采用MPCNL治疗52例,俯卧位44例,侧卧位8例;采用URL治疗31例;采用ESWL治疗16例。最大结石直径1.7～4.0 cm,平均(2.40±0.07)cm。结果:52例患者住院天数9～22天,平均(15.27±0.46)天。Ⅰ期结石清除率71.1%(37/52),Ⅱ期结石清除率60.0%(9/15),总的结石清除率88.5%(46/52);Ⅰ期结石清除率与总的结石清除率比较,差异有统计学意义(P0.05)。其中15例肾功能不全患者术前肌酐平均值为(326.87±63.28)mmol/L,术后1～3个月拔管后血肌酐平均值为(142.60±28.53)mmol/L,二者比较差异有统计学意义(P0.05)。术中无气胸、腹腔脏器损伤等并发症发生。最后6例有残余结石,术中大出血3例(5.7%),肾对穿(孔)2例,输尿管穿孔2例(7.7%),尿外渗5例(9.6%),术后休克1例(1.9%),发热9例(17.3%)。结论:在治疗复杂性上尿路结石患者的过程中,制定个体化微创综合治疗方法非常重要,可以明显提高结石清除率,有效保护和改善肾功能,减少机体损伤以及其他并发症发生。