ESWL治疗泌尿系结石术后复发性结石

１９９３年８月至１９９５年３月，应用体外冲击波碎石术治疗泌尿系取石术后复发性结石１１２例，结石粉碎率１００％，复发性肾结石２周内排净率９２％，复发性输尿管结石４周内排净率７６％，复发性膀胱结石１周内排净率９６％。提示ＥＳＷＬ为治疗泌尿系取石术后复发性结石有效的方法。     

体外冲击波碎石后结石高复发原因的实验研究

目的　探讨上尿路结石体外冲击波碎石 (ESWL)术后结石高复发的原因。　方法　构建羊肾盂结石动物模型 ,对模型动物行ESWL ,分期观察羊肾并行组织形态学检查。　结果　碎石后1周肾盂粘膜均有不同程度的损伤 ,粘膜内有结石微小颗粒嵌入 ,肾小盏内有弥散的小结石颗粒嵌入 ;2周后肾盂粘膜开始修复 ,4周基本恢复正常 ,但粘膜内嵌入的微小结石仍然存在 ,且周围出现纤维化包裹。　结论　ESWL术后结石复发与碎石所产生的微小颗粒粘膜嵌入肾盏及粘膜损伤有关。     

上尿路结石的急诊ESWL治疗

报告８４例上尿路结石患者经急诊ＥＳＷＬ后效果满意，结石一次治疗粉碎率为１００％，结石一周内排净率为１００％。９例急性无尿患者经急诊ＥＳＷＬ后均在１～１２ｈ内迅速排尿，肾功能得已恢复。５６例急性肾绞痛患者经急诊ＥＳＷＬ后绞痛解除，结石排净。１９例输尿管结石在输尿管镜取石过程中将结石推入肾脏后即行ＥＳＷＬ均获一次治疗成功。急诊ＥＳＷＬ是治疗尿石症引起的急性无尿、急性肾绞痛等患者的简单、有效方法之一，能获得立竿见影之效果。     

上尿路结石CT值对结石成分和体外冲击波碎石（ESWL）疗效的预测和评价

目的 总结不同CT值对应的结石成分,对结石成分初步估计;评价不同CT值的上尿路结石行体外冲击波碎石（ESWL）的疗效。方法 建立筛选条件收集在我院行体外冲击波碎石治疗的患者169例,治疗前行结石CT平扫检查,治疗后收集碎石测定结石成分;并记录治疗方式、过程和结果。结果 一水草酸钙结石（716±191 Hu）、磷酸钙结石（1197±221 Hu）、尿酸结石（372±49 Hu）、磷酸钙＋一水草酸钙结石(981±283 Hu)、尿酸＋磷酸钙结石(556±299Hu)之间CT值的差异有统计学意义(P<0.05);结石获得1次碎石排空、2次碎石排空、和2次碎石不能排空对应的CT值范围分别为（537±71）Hu、（833±80）Hu和（989±96）Hu,三组间比较差异有统计学意义（F=44.679,P=0.000）。结论 治疗前CT平扫可以初步预测结石的成分,并对治疗方法的选择提供参考。     

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。     

ESWL治疗上尿路结石的远期效果

目的 了解体外冲击波碎石（ＥＳＷＬ）治疗上尿路结石的远期效果,方法 对我院应用ＪＤＰＮ－Ⅱ型碎石机治疗的时间超过５年的４０８例上尿路结石患进行随访。结果石被粉碎４０２例,占９８．５％其中完全排净者３７３例,仍有残留结石者２９例,结石复发２３例（复发率６．２％）碎石失败６例,ＥＳＷＬ后血压升高７例,肾萎缩４例,结论 只要严格掌握适应证,正确选择病例,控制冲击次数和治疗能量,ＥＳＷＬ治疗上尿路结石的远     

A study on the passage of the upper urinary tract stones after in situ ESWL]

Two hundred patients with upper urinary tract stones underwent in situ ESWL with Lithostar during the recent 20 months at Kanagawa Prefectural Atsugi Hospital. Actual residual stone rates were calculated based on the period from the initiation of the treatment to the stone free status, and discussed according to the location and size of the stone treated. Total 200 patients were submitted to 1.67 +/- 0.97 treatment sessions with 6742 +/- 5545 shock waves. After 3 months, 148 patients (78%) showed stone free status, and 32 patients (16%) had residual stones less than 4 mm. The actual residual stone rates were 90.5%, 66.5%, 39.1%, 26.9% and 17.9% after 1, 3, 6, 12 and 20 weeks, respectively. The residual stone rate were lower in the lower ureter, uretero-pelvic junction, upper ureter, renal parenchyma or diverticulum and renal pelvis or calyx in order. As for the size, the larger the stones the higher the residual stone rates; the therapeutic results were significantly worse in patient group of stones larger than 21 mm compared to the patient group of smaller stones (p less than 1%). The destructed stones were passed gradually up to 6th week after in situ ESWL, however, after that fragments seldom passed out. Therefore, it was concluded that decision on the additional or combination therapeutic intervention, if necessary, should be made after 6 weeks. Combination therapy with endoscopic surgery and/or others was seemingly needed for the patients with stones of more than 21 mm in size and of renal pelvis and renal calyx to improve the rates of stone free.     

国人肾盂的形态特点与上尿路结石的关系

目的 :探讨国人肾盂的形态特点与上尿路结石的关系。方法 :观察立位腹部平片和静脉肾盂造影片(KUB加IVP) ,记录双侧肾盂形态、上尿路结石的情况 ,并采用 χ2 检验分析两者间的关系。结果 :2 0 0 6个肾脏中 ,12 38个 (6 1.7% )为肾内型肾盂 ,75 1个 (37.4 % )为中间型肾盂 ,17个 (0 .8% )为肾外型肾盂。 2 18例(2 1.7% )病例双侧肾盂形态不一致。发生肾结石的 188个肾脏中 ,136个 (72 % )为肾内型肾盂 ;伴同侧输尿管结石的 2 32个肾脏中 15 8个 (6 8% )为肾内型肾盂。肾内型肾盂的肾和同侧输尿管结石发生率显著高于非肾内型肾盂 (P <0 .0 1,P <0 .0 5 ) ,肾内型肾盂发生多发肾结石率显著高于非肾内型肾盂 (P <0 .0 1)。结论 :肾内型肾盂最多见 ,中间型次之。少部分人双侧肾盂形态不一致。肾内型肾盂更易于发生上尿路结石 ,尤其是复杂性结石     

Clinical experience with extracorporeal shock wave lithotripsy (ESWL) in upper urinary tract stones

We treated 100 patients of upper urinary tract stone using extracorporeal shock wave lithotripsy (ESWL), from April to October 1986. Eighty-six of the patients were treated by ESWL monotherapy, and the other cases required further treatment, such as percutaneous nephrostomy (PCN), percutaneous nephrolithotomy (PNL), and transurethral ureterolithotripsy (TUL). On the X-ray film obtained from one to three months after ESWL, 73 patients had no stones, 8 patients had sandy stones, 7 patients had small fragments less than 5 mm, 2 patients had large stones equal to or greater than 5 mm and 10 patients could not be followed up. Therefore, 97.7% of all patients were successfully treated. In conclusion, ESWL is considered to be an ideal method to treat upper urinary tract stones, and soon will become the first choice of treatment of urolithiasis together with the progress in endourological techniques.     

孤立肾上尿路结石的ESWL治疗

目的:总结孤立肾并发上尿路结石ESWL治疗的经验。方法:电压比非孤立肾者略低,JT-Ⅲ型机8～12kV,HB-V型机4～8kV;放电次数比非孤立肾者略少,Ⅲ型机1500～2000次,V型机3000～3500次;同时减慢冲击频率;间隔时间二周以上比非孤立肾者稍长。直径大于2cm或多发结石且颗粒较大者,先行经皮肾镜取石后残石再行ESWL,多发或直径大于1.5cm的结石留置双J管后再ESWL,梗阻引起急性肾功能减退者急诊ESWL或先行肾造瘘或逆行插管引流积水,肾功能基本恢复后再ESWL。结果:22例独肾结石除7例多发外,15例一次成功,6例输尿管结石除1例再碎石外,5例一次成功。结论:ESWL治疗孤立肾上尿路结石损伤小且疗效好。     

复式脉冲体外碎石机治疗泌尿系结石1206例小结

目的:总结新碎石设备-复式脉冲体外碎石机治疗泌尿系结石的经验.方法:应用该机治疗泌尿系结石患者1206例,其中肾结石508例,输尿管结石603例,膀胱结石95例.结石大小0.4cm×0.5cm～2.5cm×2.5cm.碎石机工作电压4.0～8.5 kV,放电次数2 000～3 000.结果:肾结石治愈率达58.3%,输尿管结石为72.7%,膀胱结石82.4%.其中986例(81.8%)ESWL后有不同程度的肉眼血尿,164例(13.6%)出现肾绞痛,14例出现高热,2例出现肾被膜下血肿,经对症处理均消失.结论:体外复式脉冲碎石技术仍然是泌尿系结石的首选治疗方法.     

Late recurrence of upper urinary tract urothelial tumours

Two case reports of late recurrence of upper urinary tract urothelial tumours 13 years after ipsilateral local resection and 19 years after contralateral nephroureterectomy are used in the discussion on when to perform local resection. In accordance with existing literature we propose local resection in case of low-grade upper urinary tract urothelial tumours.     

Clinical study of cefotetan in complicated urinary tract infections

Clinical effectiveness and safety of Cefotetan were evaluated in 28 patients with complicated urinary tract infections. The results were excellent in 12 patients (42.9%), moderate in 10 patients (35.7%) and poor in 6 patients (21.6%), and the effectiveness rate was 78.6%. Bacteriologically, 24 (75%) out of 32 strains were eradicated. Subjective side effects, nausea and abdominal discomfort, were observed in one patient. Abnormal laboratory findings were observed in 6 patients, eosinophilia in 3 patients and slight elevation of transaminase in 3 patients.     

Clinical study of urinary tract infections in transurethral surgery

Effect of prophylactic administration of antimicrobials on postoperative urinary tract infection was studied in 40 patients who had undergone transurethral surgery. Two gm of cefoperazone (CPZ) per day was administered intravenously starting on the day of surgery for 5 days consecutively. In group I, 1 g of CPZ was administered 1 hour before surgery and another 1 g after surgery, while in group II 2 g of CPZ was administered after surgery only. Thereafter, in either group, 1 g of CPZ was administered intravenously 2 times a day. Urinary tract infection (UTI) was diagnosed when urine specimens yielded 1 X 10(4)/ml or more cells. In group I, 8 patients (40%) had UTI before surgery. Of 8 patients, 3 had bacteria resistant to CPZ. Of the remaining 5 patients with bacteria sensitive to CPZ 4 patients were cleared of bacteria after surgery. All these patients had bacteria sensitive to CPZ and therefore all were cleared of bacteria after surgery. In either group of patients all without bacteriuria at the time of preoperative evaluation were free from bacteriuria after surgery. All bacteria yielded after surgery were weak pathogens. All patients except 1 had no postoperative infectious complication such as septicemia, epididymitis and UTI. One patient showed UTI with fever after surgery. Urine culture yielded S. faecalis. This study showed that the prophylactic administration of antimicrobials for patients undergoing transurethral surgery was valuable, but the both methods of administration were similarly effective.     

Epidemiology of urinary lithiasis

An epidemiological study of urinary stone disease has been carried out in the districts of La Sierra and Hellín (Albacete, Spain). Between January 1992 and December 1999 a total of 887 patients with urinary lithiasis have been studied, analysing the number of patients discharged from hospital with the primary diagnosis of lithiasis, the distribution of lithiasis by area, age, gender, family history of lithiasis, diet, occupation and concurrent pathology. The geographical, geological, and climatic conditions, the composition of the water supply and the clinical characteristics are described. The incidence of urinary lithiasis in the whole area in 2.66 per thousand inhabitants/year, showing a male predominance with a male:female ratio of 1.26:1. The mean age was 51.34 years (bimodal distribution with peaks in the 4th and 7th decades). 20.41% of the patients had a family history, with the father being the most frequently affected relation. Those occupations associated with a sedentary life style or with a hot, dry workplace show a higher incidence of lithiasis. A hot, dry climate favours the formation of urinary lithiasis and the highest incidence of lithiasis is in the summer, during the months of July and August. No statistically significant influence was shown between at the hardness of the water and the incidence of urinary lithiasis in the study population.