Percussion after extracorporeal shock wave lithotripsy.

ESWL does not remove the kidney stone, but pulverizes it into tiny particles so that it can be excreted with the urine. Drainage and percussion treatment after ESWL helps excrete particles from the kidney to the ureter much more rapidly and with less trauma, pain, and blood urine, and fewer medications for pain are needed as the particles pass through the urine. Teaching the principles behind this treatment will lead to greater patient compliance and success.     

鹿角形肾结石采用体外冲击波碎石术后的临床观察和护理

目的：探讨鹿角形肾结石采用体外冲击波碎石术后的临床观察及护理。方法：对68例鹿角形肾结石患者行体外冲击波碎石治疗,回顾性分析其并发症的发生情况及所采取的护理措施。结果：本组68例患者均出现不同程度的石街、疼痛、血尿及尿路感染等并发症,经合理的治疗和精心的护理,其中60例完全治愈,6例于肾盏中有少量残余结石,2例碎石不成功,改用其他方法治疗。结论：体外冲击波碎石治疗鹿角形肾结石是一种安全、经济、有效的方法,通过护理人员精心的护理能减少并发症带来的损害,促进患者早日康复。     

膀胱结石患者结石定位于膀胱体外侧壁碎石效果观察

目的探索一种能取得最佳体外冲击波碎石效果的膀胱结石定位的解剖部位。方法利用随机数字表将100例膀胱结石患者分为两组,每组50例,单数为观察组,双数为对照组。观察组采用定位于膀胱体外侧壁的侧-俯卧位进行体外冲击波碎石为改进定位组,对照组将结石定位于膀胱顶部的俯卧位进行体外冲击波碎石为常规定位组。观察碎石后两组结石破碎颗粒的大小、全部碎石排净时间及排尿顺畅和碎石嵌顿的情况。结果改进定位组排出的碎石颗粒全部<4mm,常规定位组有14例>4mm,碎石效果明显高于常规定位组(P<0.01)。两组碎石颗粒经t检验,P<0.001,有显著性差异,改进定位组碎石颗粒比常规定位组小。碎石排净时间:改进定位组50例2d内全部排净,常规定位组有10例在3～12d排净,两组碎石排净时间比较有显著性差异(P<0.01)。改进定位组碎石后排尿顺利,无1例出现碎石嵌顿,常规定位组有10例碎石嵌顿。结论膀胱结石患者采用结石定位于膀胱体外侧壁碎石效果优于定位于膀胱顶部。     

Management of the extracorporeal shock wave lithotripsy patient.

Over 2 million Americans experience kidney and urinary stone disease each year. Early treatments resulted in high mortality and morbidity rates. With the advent of extracorporeal shock wave lithotripsy less than 20 years ago, treatment for this disease has become far safer with more rapid recovery and fewer complications. The selection of patients eligible for extracorporeal shock wave lithotripsy is dependent on the location and size of the stones and the overall health of the patient. This article discusses the different treatment modalities used for stone disease and the different methods currently available for extracorporeal shock wave lithotripsy. Preprocedure preparation of the patient and postoperative care for this population is reviewed in detail.     

原位体外震波治疗输尿管结石临床分析

目的评估体外震波碎石（ESWL）治疗输尿管结石的疗效，探讨再治疗率商的原困及输尿管结石的治疗选择。方法回顾2000年1月-2004年12月间ESWL治疗输尿管结石的临床资料687例，男455例（66.2％），女232例（33．8％），平均年龄46．6岁（15～83岁）。有双侧输尿管结石6例，单侧多发性输尿管结石12例（4颗1例，3颗2例，2颗9例），共讣输尿管结石709颗（含透光结石13颗）。应用上海爱申公司生产的DESUNIT6030型碎石机，C臂X线球管做结石定位。上段输尿管结石（肾盂输尿管交界处至骶髂关节上缘）取仰卧位，下段输尿管结石（骶髂关节上缘下至输尿管口）取俯卧位。为减少ESWL引起的肾损伤和疼痛，应用较低的能量，震波发生器电压从9．8～13．2kV，震波频率1．5s。每次治疗设定为1500次震波。治疗后3天摄腹部平片或B超（透光结石），以后每隔7日重复检查。假如结石未碎或有残留结石最长径〉3mm以上，再次ESWL，两次治疗的间隔时间为两周。结石的大小用X线片上的表面积（mm^2）表示。结果709颗输尿管结石总的治愈率为97．3％（690颗），再治疗率34.1％（242颗）。其中一次治疗467颗，平均结石大小37．27mm^2，治愈464颗（65．4％），3颗改治疗；两次治疗138颗，平均结石大小62.48mm^2，治愈13l颗（18．5％），7颗改治疗；第1和第2次治疗治愈率（1个月治愈率）为83.8％。3次治疗52颗，平均结石大小79．60mm^2，治愈50颗（7．1％），2颗改治疗；4次治疗19颗，平均结石大小101．63mm^2，治愈17颗（2．4％），2颗改治疗；5次及5次以上治疗33颗，平均结石大小119．33mm^2，治愈28颗（3．9％），5颗改治疗。总计19颗（2．7％）结石改变治疗方式。上段输尿管结石335颗，治愈321颗（95．8％），再治疗129颗（38．5％）。下段输尿管结石374颗，治愈369颗（98．7％），再治疗113颗（30．2％）。经X^2检验，上、下段输尿管结石的再治疗率差异有显著性（X^2=5．40，P〈0．05），治愈率差异无显著性（X^2=0．15，P〉0．05）。不良反应：血压升高13例（1．9％），震波区域疼痛26例（3．8％），震波进入处皮肤点状淤血33例（4．8％），肉眼血尿128例（18．6％），均于第2、3天自行消失。结论ESWL目前仍是输尿管结石的第一线治疗，结石的大小是再治疗率高的主要因素。结石的位置有影响，上段输尿管结石可随呼吸移动，有效震波次数减少，再治疗率比下段输尿管结石高。ESWL前注重病例筛选可降低再治疗率。     

Sonographic evaluation of the kidney following extracorporeal shock wave lithotripsy

We investigated the value of real-time sonography for determination of pelvicaliceal dilatation 24-48 h after extracorporeal shock wave lithotripsy (ESWL) in 369 patients (419 treated kidneys). A varying degree of hydronephrosis was present in 121/419 (29%) kidneys. Fragmented stones post-ESWL were demonstrable in 346/419 kidneys (82%), but were missed by ultrasound in three kidneys (less than 1%). In four kidneys (1%), stone fragments which were shown to be present by ultrasound were not detectable on radiographs. In 25/419 kidneys (6%), evidence of renal trauma caused by ESWL was demonstrated by ultrasound. The most important incidental finding was a small renal cell carcinoma of the contralateral (untreated) kidney.     

体外电磁冲击波碎石治疗膀胱结石的体会

我院2003年1月-2005年12月使用科达ESWLNE-VB型电磁冲击波体外碎石机治疗膀胱结石61例，临床疗效满意，现报告如下。 1资料与方法 1．1一般资料本组病例61例，男54例，年龄30-87岁，平均67岁，女7例，年龄23-75岁，平均46岁。     

Ultrasound-guided piezoelectric extracorporeal shock wave lithotripsy of parotid gland calculi

PURPOSE: The introduction of piezoelectric extracorporeal shock wave lithotripsy (ESWL) has changed therapy for salivary calculi. This method seems especially suitable for treating calculi in the parotid gland. The purpose of this study was to evaluate ESWL in patients with such calculi. METHODS: From November 1990 to November 1999, all patients with sialolithiasis of the parotid gland were treated with piezoelectric ESWL. Three different lithotriptors were used over the 9-year study period. Results were analyzed according to both the patients' clinical status and follow-up sonograms. RESULTS: In total, 42 patients (21 women, 21 men; mean age, 59 years) were treated with ESWL. The mean follow-up period for all patients was 63 months (range, 7-96 months). After ESWL had been performed, 71% of the patients were completely free of symptoms, and 21% had marked improvement of their symptoms. Sixty-seven percent were completely free of calculi, and 27% had a marked reduction in the size of their calculi. Adverse effects of ESWL included temporary glandular swelling (4 patients), blood-tinged salivary secretions (9 patients), petechiae on the skin surface (3 patients), and parotid abscess (1 patient). CONCLUSIONS: ESWL is an outpatient procedure that can be performed without anesthesia and with scarcely any discomfort for patients. Conventional surgical procedures such as subtotal parotidectomy may be almost entirely replaced by ESWL because of the excellent treatment results and a very low rate of complications associated with ESWL. ESWL should be considered the treatment of choice for parotid calculi.     

体外冲击波碎石治疗婴幼儿泌尿系结石的护理

目的:总结体外冲击波碎石治疗婴幼儿泌尿系结石的护理经验。方法:采用德国多尼尔-DeltaⅡ型体外冲击波碎石机对100例婴幼儿泌尿系结石进行治疗,并加强对术前、术中及术后护理。结果:100例患儿碎石成功率100%,血尿95例,石街2例,无其他严重并发症。结论:选择体外碎石的适应症和准确定位非常关键。正确合理的护理,可减少并发症的发生。     

体外震波碎石配合总攻疗法治疗泌尿系结石的效果观察

目的观察体外震波碎石配合总攻疗法治疗泌尿系结石的临床效果。方法选择100例结石大小为0.8~2.0cm以内,无禁忌证的泌尿系结石病人,随机分成实验组(51例)及对照组(49例)。实验组行体外震波碎石后配合总攻排石治疗;对照组行体外震波碎石后嘱病人大量饮水、跳跃。2组病人碎石前均经B超或静脉肾盂造影,腹平片确诊结石大小、形状、部位、性质;检查血、尿常规及出凝血时间,必要时检查心电图、胸片及肾功能。2组病人碎石后均予消炎止血对症治疗2~3d。观察2组病人2周内结石排出情况、复震率,并进行统计处理。结果实验组51例2周内完全排出者49例(96.08%),部分排出者2例(3.92%),复震者4例(7.8%);对照组49例2周内完全排出者34例(69.39%),部分排出者15例(30.61%),复震者9例(18.36%)。短时间内实验组的结石排出率明显高于对照组,复震率低于对照组。结论体外震波碎石配合总攻疗法治疗泌尿系结石具有治疗时间短,结石排出完全,痛苦小,病人可不需住院治疗,总费用低等优点,深受病人欢迎,具有实用性。