中段输尿管结石的原位体外冲击波碎石

目的 报告电磁式体外冲击波原位治疗中段输尿管结石疗效。方法 患者５４例,结石直径为５－２０ｍｍ,平均１１ｍｍ。ＥＳＷＬ治疗时经侧腹部入路并采用工能量冲击技术。工作电压２－７档,发射次数每序列３０００－５０００次,治疗结果代入效率商公式测算。结果 碎石治疗３个月内无石率为９６％,复震率３０％,效率商７４％。     

输尿管插管注水配合体外冲击波碎石治疗输尿管结石

目的　探讨输尿管内注水体外冲击波碎石术治疗难治性输尿管结石的临床疗效。　方法　对 5 98例难治性输尿管结石采取逆行输尿管插管 ,输尿管内高压 (10 0ml/ 5min)注入生理盐水 ,同时进行体外冲击波碎石。　结果　患者一周内排石率 10 0 %。一周内结石排净率 77% (4 60 / 5 98) ,两周内结石排净率 98% (5 85 / 5 98) ,两个月结石排净率 10 0 %。　结果　输尿管插管注水配合体外冲击波碎石是治疗难治性输尿管结石的良好方法。     

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。     

体外冲击波碎石术治疗输尿管结石151例疗效分析

1995年12月～1996年7月，我们采用DernierCompectS碎石机行体外冲击波碎石术（ESWL）治疗原位输尿管结石151例，现将结果报告如下。1资料与方法1.1临床资料全组151例，年龄18～71岁，平均41．8岁。病程1d～21个月，平均43个月。有12例系肾绞痛期间急诊碎石。碎石前行KUB及IVU以了解结石大小、数目、部位、肾积水及是否有尿路畸形等情况，并检查血、尿常规，肝、肾功能等。1.2治疗方法除输尿管中段结石采取俯卧位外，上、下段结石取仰卧位，如定位有困难者可改用俯卧位。治疗电压为12～17kV，冲击次数为1800～3600次，平均2700次。暴露…     

反复体外冲击波碎石致输尿管狭窄1例

男 ,40岁。 2 0 0 2年 2月发生右肾绞痛 ,6月在外院行Ｂ超检查示 :右输尿管下段结石 ,右输尿管无扩张。当月在该医院行Ｂ超定位 ,俯卧位体外液电冲击波碎石术 ,术后有部分碎石排除 ,1周后复查Ｂ超见右输尿管下段残余结石。在该结石部位反复进行体外液电冲击波碎石术治疗 ,4个月内共行体外冲击波碎石术 1 5次。随访 4个月 ,有少量碎石排除。Ｂ超示 :右肾积水进行性加重。收住我科。入院后行ＫＵＢ加ＩＶＵ检查提示 :右肾排泄延迟 ,右肾中度积水 ,右输尿管中上段扩张 ,右输尿管下段梗阻。膀胱镜检查见右输尿管开口清晰 ,未见喷尿 ,逆行插管在 …     

输尿管结石急诊行体外冲击波碎石疗效分析

目的观察输尿管结石急诊行体外冲击波碎石疗效结果。方法将98例输尿管结石患者进行体外冲击波碎石治疗，配合中药及支持对症处理。结果1次碎石治疗成功87例（占88．8％）。再次碎石治疗成功11例（占11．2％）。结论输尿管结石急诊行体外冲击波碎石配合中药及支持对症治疗是理想的治疗方法。     

体外冲击波碎石术后输尿管石街74例临床分析

体外冲击波碎石术（extracorporeal shock wave lithotripsy，ESWL）能及时解除结石引起的肾绞痛，减少肾功能损害，具有创伤小、恢复快、费用低、疗效可靠等优点，是目前治疗上尿路结石的首选方法。输尿管石街是ESWL治疗复杂上尿路结石常见的并发症，严重者可引起输尿管梗阻、肾功能受损。现总结分析青州市人民医院2001年10月～2007年10月1800例肾结石、输尿管结石患者行ESWL后发生的74例（4．1％）输尿管石街患者资料，旨在探讨ESWL术后输尿管石街的防治措施。     

体外冲击波碎石治疗输尿管结石疗效分析

目的总结体外冲击波碎石（ESWL）治疗输尿管结石的疗效。方法回顾性分析2009年1月至2011年4月期间ESWL治疗的272例输尿管结石碎石效果与结石的病程、大小及结石成分的关系。结果 272例结石碎石排净率为76.84%。其中病程小于60d与大于60d的病例碎石排净率分别为80.51%和56.09%（P〈0.01）。结石直径小于1cm与大于1cm的病例碎石排净率分别为86.03%和59.14%（P〈0.01）。一水草酸钙和二水草酸钙结石碎石排净率为77.78%和95.06%（P〈0.01）。15例带双J管的病例碎石排净率20%。结论 ESWL仍然是一种治疗输尿管结石简单、实用的方法。ESWL治疗输尿管结石的疗效与结石的病程、大小、化学成分以及预先置入双J管等因素都有着密切的关系。     

体外冲击波对兔输尿管形态及组织学影响的研究

目的 :探讨冲击波 (SW )对输尿管形态的影响。方法 :将 4 2只成年兔随机分为 7组 ,每组 6只。第 1组为正常对照组 ;第 2～ 6组为液电式SW组 ;第 7组为电磁式SW组。各组接受冲击并在冲击后不同时间取材。全部标本行常规病理检查并予评分。结果 :第 2～ 5组和第 7组 ,肉眼可见焦点周围组织有出血、水肿等改变 ,输尿管直径较冲击前显著增加 (P <0 .0 1 )。光镜下可见平滑肌细胞变性及管腔狭窄 ,病理量化评分显著高于正常组 (P <0 .0 5 ) ;电镜下则有肌细胞线粒体破坏等改变。第 6组形态改变不明显 ,病理评分和正常组的区别无显著性意义。结论 :临床剂量的冲击波能导致输尿管多种病理变化。冲击后第 5天 ,输尿管形态已基本恢复正常。由液电式和电磁式冲击波所致的输尿管急性损伤程度无明显的区别     

输尿管结石伴肾绞痛患者应用体外冲击波的急诊治疗体会

目的:探讨体外冲击波对急诊输尿管结石伴肾绞痛患者的治疗效果及体会.方法:我院在2008年2月至2012年2月期间共接诊120例急诊输尿管结石伴肾绞痛患者,所有患者均采取体外冲击波进行治疗,回顾其临床资料,总结分析其临床治疗效果.结果:所有患者肾绞痛明显减轻或者消失,输尿管双侧结石20例、单侧100例,共140例结石其中1次碎石成功113例,成功率为80.8％,2次碎石27例成功15例,成功率为55.6％,3次碎石12例成功8例,成功率为75.0％,总成功率为97.1％.其中一周结石排净率为97.1％,碎石成功患者结石的平均直径为(0.67±0.31)厘米,失败结石直径为(1.37±0.11)厘米差异具有统计学意义(P＜0.05).而输尿管的不同部位结石碎石成功率及排除率均无明显差异,无统计学意义(P＞0.05).结论:体外冲击波法可安全有效的治疗急诊输尿管结石伴肾绞痛,可在临床中大力推广应用.     

Prediction of success of extracorporeal shock wave lithotripsy in the treatment of ureteric stones

Objectives To define the factors that affect the success rate of extracorporeal shock wave lithotripsy (ESWL) for the treatment of ureteric stones. Patients and methods Between January 2000 and December 2003, 468 patients with ureteric stones underwent in situ ESWL using Storz SL 20 lithotriptor. The results of treatment were evaluated after 3 months of follow-up. Treatment success was defined as complete clearance of the stones. Characteristics of the patients, condition of the urinary tract and stone features were correlated to the success rate to define the significant predictors of success. Results At 3-month follow-up, the overall success rate was 394/468 (84.2%). Repeat treatment was required in 239 patients (51.1%). Post-ESWL auxiliary procedures were necessary in 58 patients (12.4%). Post-ESWL complications were observed in 11 patients (2.4%). Only three factors had a significant impact on the stone-free rate, namely stone site, stone width and the presence of a ureteral stent. The stone-free rate was highest for stones located in the lumbar ureter (159/183; 86.9%) and lowest for those in iliac ureter (28/40; 70%) (P < 0.05). Stones with a transverse diameter <8 mm were associated with a stone-free rate of 89.9% (248/276), compared to 66.7% (128/192) for those with a transverse diameter of >8 mm (P < 0.01). Non-stented patients had a stone-free rate of 89.2% (313/348), compared to 75.2% (85/113) for stented patients (P < 0.01). Conclusions The site and transverse diameter of the stone and the presence of a ureteral stent are the only significant predictors of success of ESWL therapy for ureteric stones.     

Effect of high-energy extracorporeal shock waves on the immature epiphysis in a rabbit model

Introduction We investigated the effect of high-energy extracorporeal shock wave (ESW) on immature tibial epiphysis in a rabbit model. Materials and methods Twenty New Zealand white immature rabbit were used in this study. Animals were divided into two groups and they received 14 kW, 0.6 mJ/mm², 1,500 or 3,000 shots for three times with an interval of 7 days. After 6 weeks all rabbits were killed. The all tibia epiphysis were assessed by histology. The epiphyseal plaque thickness of right tibiae of the 3,000-shot ESW group was significantly higher than those of the 1,500-shot ESW group and the left tibia epiphyses of the 1,500- and 3,000-shot ESW groups as controls (P < 0.05). Results The epiphyseal plaque thickness of right tibiae of the 1,500-shot ESW group was significantly higher than that of the left tibia epiphyses of the 1,500- and 3,000-shot ESW groups as controls (P < 0.05). Discussion We demonstrated that high-energy ESW stimulated the growth of immature rabbit epiphysis. The long-term effect of shock wave on the immature rabbit epiphysis deserves further study.     

In vitro analysis of the effect of hyperbilirubinemia on rabbit ureter and bladder

Spontaneous resolution of intrauterine pelvic dilatations after birth is an expected outcome. In nonobstructive pelvic dilatations, changes in ureteral and bladder physiology may also play a part. We aimed to demonstrate the effect of increased concentrations of bilirubin on ureteral and bladder muscles in vitro. Normal and pathologic concentrations of bilirubin (3.5×10^-7–10^-5M and 10^-4–4×10^-4M, respectively) caused no change in the basal ureter tension (343.9±29.4 mg). Normal concentrations of bilirubin caused no difference in basal bladder tension (430.2±70.2 mg), but pathologic concentrations caused a decrease of 303.8±52.9 mg. Normal and pathologic amounts of bilirubin were cumulatively applied to rabbit ureteral and bladder tissues both after reaching basal tension and when contracted with KCl (80 mM and 120 mM KCl for ureter and bladder, respectively). The cumulative addition of normal bilirubin concentrations to the ureteral tissues precontracted with KCl produced 86.4±7.2% relaxation, while the addition of pathologic bilirubin concentrations produced a relaxation of 133.9±17.4%, which was significantly higher (p=0.04). Similarly, the addition of normal concentrations of bilirubin to the bladder tissues precontracted with KCl produced a maximal relaxation of 35.3±2.2%, while pathologic concentrations produced a maximal relaxation of 53.5±3.5%, which was significantly higher (0.001). Consequently, high concentrations of bilirubin caused a mild relaxation in basal ureteral and bladder tensions, while pathologically increased concentrations led to significant relaxation in both types of precontracted tissues. We suggest that high bilirubin levels may partly but not directly contribute to the spontaneous recovery of hydronephrosis because of the relaxation effect on bladder while probably causing susceptibility to urinary tract infections because of relaxation of both ureteral and bladder tissues.     

Perforation of the upper ureter: a rare complication of extracorporeal shock wave lithotripsy

Perforation of the upper ureter is a rare but serious complication of extracorporeal shock wave lithotripsy (SWL). Ureteral perforation can cause a series of problems including the retroperitoneal urinoma, urosepsis, abscess formation, infection, and subsequent renal function impairment. We reported here a rare case of SWL-induced upper ureteral rupture resulting in an expanding retroperitoneal urinoma that required percutaneous drainage. Ureteral perforation was treated successfully without major surgical intervention by employing temporary percutaneous drainage and antibiotics. The present case indicates that potential ureter rupture may form in rare cases; especially in patients having infected stones and exposed to a high number of shock waves. This complication further emphasizes the importance of adequate pre-and post-operative evaluation and the precise identification of the cause of the persistent pain after SWL.     

Effect of magnesium on the function of the rabbit corpus cavernosum

Contraction and relaxation of the smooth muscle, including the corpus cavernosum, are mediated by changes in the intracellular concentration of calcium. Since magnesium modulates the movement of calcium it can modify the function of the erectile tissue. We designed this study to investigate the effects of magnesium in doses ranging from 5 to 30 mM on the function of the rabbit corpus cavernosum in vitro. The resting tension of tissue strips was significantly reduced by exposure to a solution high in magnesium (5–30 mM). The contractile response to field stimulation under resting conditions, and the contraction to phenylephrine, were significantly decreased by magnesium (5–30 mM). There were no differences in the contractile strength of the corpus cavernosum to KCl. Although the relaxation induced by field stimulation under preincubation with 200 M phenylephrine was abolished in the presence of 30 mM magnesium, there were no differences at a concentration of 5 mM or of 10 mM magnesium. The relaxation induced by sodium nitroprusside under precontraction with 200 M phenylephrine was further increased by magnesium dose dependently. A high concentration of magnesium (30 mM) enhanced both bethanechol-induced and ATP-induced relaxations under precontraction with phenylephrine. Our study demonstrated that magnesium reduced the receptor-mediated contraction of the rabbit corpus cavernosum and enhanced the relaxation of this tissue induced by sodium nitroprusside, bethanechol, and ATP.     

不同能流密度体外冲击波对骨质疏松兔股骨髁部松质骨影响的实验研究

目的 观察不同能流密度体外冲击波对骨质疏松兔股骨髁部松质骨成骨作用的差异.方法 采用卵巢切除法(OVX)对30只5月龄雌性新西兰兔去势,5个月后建立骨质疏松模型.将所有骨质疏松兔随机分为3组,每组10只,其中一组为空白对照组(A组),一组为体外冲击波(ESW)能流密度0.28 mJ/mm~2处理组(B组),另一组为体外冲击波能流密度0.47 mJ/mm~2处理组(C组),脉冲次数均为2000次,在实验组兔右侧股骨髁部进行体外冲击波(ESW)处理.于处理后4、8周时分二批每组处死5只动物,分离右侧股骨远端,进行显微CT(micro-CT)测量分析.结果 micro-CT三维重建分析表明,不同能流密度冲击波处理后4周时B组和C组在骨组织体积比(BV/TV)、骨小梁数目(Tb.N)等指标之间的差异有统计学意义;8周时B组和C组分别在骨密度(BMD)、骨矿含量(BMC)和BV/TV、骨表面积体积比(BS/BV)、骨小梁连接密度(Connectivity Density)等指标之间的差别有统计学意义,其中C组的BMD和BMC分别较B组增高16.8%和10.6%,尽管C组在其他骨小梁立体测量学等指标方面均较B组优,但两组测量结果 的差别无统计学意义.结论 不同能流密度体外冲击波对骨质疏松局部治疗后,不同时间,其成骨作用不同,较高能流密度的体外冲击波在治疗后8周时,促进骨质疏松被处理局部骨小梁的改建、改善骨小梁的三维结构、增加骨密度作用较优.     

The effect of urine on ureteral motility

Summary Ureteral rings were used to study in vitro spontaneous phasic contractions, similar to the peristaltic waves in vivo. Addition of small amounts of sheep or human urine inhibited or totally blocked rhythmic contractions, and induced tonic contracture. Changes in osmolality induced by the addition of urine were analysed and electrolyte and protein catabolites determined. Similar changes in osmolality which were induced by the addition of urine were elecited by adding sucrose to the organ bath. This had the opposite effect, it increased both the frequency and the amplitude of rhythmic contractions. Therefore, an increase in osmolality per se cannot be responsible for the observed changes of motility. A reduction of pH, resulted in similar changes of motility. In an in-vivo situation with a damaged urothelial barrier there is reason to believe that entrance of urine to the lamina propria and smooth muscle cells will induce profound changes of motility.Supported by: Grant No. MR 049, Kuwait University     

逐步提高冲击波能量预处理对体外冲击波碎石术肾损伤的保护作用

目的探讨逐步提高冲击波能量（GESW）预处理对体外冲击波碎石术（ESWL）肾损伤的保护作用及机制。方法制成单肾的40只雌性家兔随机等分为对照组、GESW组、ESWL组、ESWL＋GESW预处理组。GESW组肾接受300次GESW;ESWL组肾接收标准的1500次ESWL：ESWL＋GESW预处理组先按GESW组处理,然后同ESWL组处理。24h时观察肾组织超氧化物歧化酶（SOD）活性、丙二醛（MDA）含量和尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG）变化,原位缺口末端标记法（TUNEL）检测凋亡细胞。结果与ESWL组比较,GESW预处理组肾组织SOD活性增高（P〈0．05）,MDA含量和细胞凋亡指数降低（P〈0．01）、尿NAG降低（P〈0．01）。与对照组比较,GESW组各项指标差异无统计学意义（P〉0．05）。结论GESW预处理可减轻ESWL所致的肾损害,与其抗氧化应激损伤、抗细胞凋亡有关。     

The effect of extracorporeal electromagnetic shock waves on renal proximal tubular function

In order to investigate the effect of electromagnetic shock waves on proximal tubular renal function, we measured the urine levels of the lysosomal enzyme N-acetyl-beta-glucosaminidase (NAG) prior to, 1 hour, 1 day, and 1 week after extracorporeal electromagnetic lithotripsy (ESWL) in 50 patients with urinary stone disease. Mean NAG level which was 5.18+0.09 U/l prior to ESWL increased to 5.29+0.09 U/l in the first hour and to 10.7+0.19 U/l on the first day after ESWL (p<0.001). The level returned to pre-ESWL values one week after ESWL (5.27+0.09 U/l). These findings show that extracorporeal electromagnetic shock waves cause significant damage to the proximal tubular epithelium of the kidney; however, these changes return to normal in the first week.