低能量长间距ESWL治疗尿路结石1200例报告

目的探讨低能量长间距冲击波技术在体外冲击波碎石（ESWL）中的应用以及X线、B超双定位技术在ESWL中的优势。方法应用低能量长间距冲击波及X线、B超双定位技术进行ESWL1200例。结果总碎石成功率为99．5%，3个月结石排净率为83.%。结论低能量长间距冲击波技术碎石率高、组织损伤小、无严重并发症等优点。X线、B超双定位技术值得推广。     

体外冲击波碎石的护理

目的：观察护理干预在低能量体外冲击波(ESWL)碎石术治疗泌尿系结石中的效果。方法行ES-WL碎石术治疗泌尿系结石患者90例随机分为观察组和对照组各45例。术后对照组仅给予常规护理,观察组实施护理干预措施。观察两组排石时间,腹痛缓解、血尿消失和尿路感染控制时间及临床疗效。结果观察组排石时间,腹痛缓解、血尿消失和尿路感染控制时间均短于对照组,差异有统计学意义(<0.05)。观察组总有效率为91.1%,高于对照组的80.0%,差异有统计学意义(<0.05)。结论护理干预可提高ESWL碎石术后排石效果,并可有效缓解症状。     

体外冲击波碎石联合输尿管镜碎石术用于输尿管上段结石中的效果

目的：探讨体外冲击波碎石联合输尿管镜碎石术治疗输尿管上段结石的临床效果。方法我院2011年1月~2013年12月收治的输尿管上段结石患者72例,按照治疗方案分为对照组和观察组,对照组行单纯体外冲击波碎石治疗,观察组采用体外冲击波碎石联合输尿管镜碎石术,比较两组治疗效果。结果两组患者术后均未发生严重并发症,观察组患者结石清除率达到94.59%,对照组患者结石清除率为71.43%,观察组明显高于对照组(P<0.05)。结论输尿管上段结石治疗中行体外冲击波碎石联合输尿管镜碎石可有效提高结石清除率,提高治疗效果,值得临床推广应用。     

体外冲击波碎石术患者的护理

目的总结体外冲击波碎石术患者的围手术期的护理经验。方法通过对800例泌尿系结石患者的术前、术后的病情观察,分析和总结其护理要点。结果本组患者心情舒畅,愉快的接受并配合治疗,缩短了住院时间,排石率提高。结论针对性的护理及经验,能保障患者碎石成功,减少患者痛苦及医疗纠纷的发生。     

输尿管镜钬激光碎石术与体外冲击波碎石术治疗输尿管结石的疗效比较

目的 观察输尿管镜钬激光碎石术与体外冲击波碎石术治疗输尿管结石的临床疗效。方法 选取2015年1月~2018年10月在余江县人民医院治疗的输尿管结石患者72例,采用随机数字表法分为对照组和观察组,各36例。对照组采用体外冲击波碎石术治疗,观察组采用输尿管镜钬激光碎石术治疗,比较两组清石率、手术时间、住院时间以及并发症（血尿、输尿管水肿、结石移位）发生情况。结果 观察组结石直径≥1 cm清石率为92.30%,高于对照组的85.71%,差异有统计学意义（P＜0.05）;观察组结石直径＜1 cm清石率为91.30%,与对照组的90.90%比较,差异无统计学意义（P＞0.05）;观察组结石直径≥1 cm、＜1 cm手术时间均短于对照组,差异有统计学意义（P＜0.05）;观察组并发症发生率为5.56%,低于对照组的23.08%,差异有统计学意义（P＜0.05）。结论 输尿管镜钬激光碎石术治疗输尿管结石手术时间短,并发症少,且对于结石直径＞1 cm者效果更优。     

枸橼酸氢钾钠对上尿路结石患者ESWL术后CIRF、肾功能的影响

目的:探讨枸橼酸氢钾钠对上尿路结石患者ESWL术后CIRF、肾功能的影响.方法:按照随机数字表法将我院2018年9月至2020年2月期间收治的113例上尿路结石体外冲击波碎石术(Extracorporeal shock wave lithotripsy,ESWL)后患者分为两组,对照组56例患者予以常规宣教,嘱患者养成早睡早起的睡眠习惯,养成定时排尿的习惯,不憋尿,不食或少食草酸含量高的食物等措施;观察组57例患者口服枸橼酸氢钾钠治疗(早晨、中午各2.5 g,晚上5 g).治疗3 m后进行临床疗效评估,同时采用CT常规平扫检测临床无意义残留结石(Clinically meaningless residual stones,CIRF)发展状况,并统计术后残石相关肾绞痛发生率;以酶联免疫吸附法检测肾功能指标血肌酐(Serum creatinine,Scr)、半胱氨酸蛋白酶抑制剂C(Cysteine protease inhibitor c,Cys-C)、肾小球滤过率(Glomerular filtration rate,GFR)以及中性粒细胞明胶酶相关载脂蛋白(Neutrophil gelatinase-associated apolipoprotein,NGAL)水平;随访1 y后统计两组患者结石复发率.结果:治疗后,观察组总有效率明显高于对照组(P<0.05),CIRF发展状况优于对照组,术后残石相关肾绞痛发生率低于对照组(P<0.05);同时观察组Scr、Cys-C高于对照组,GFR以及NGAL水平低于对照组(P<0.05);观察组结石总复发率明显低于对照组(P<0.05).结论:对上尿路结石患者ESWL术后患者予以枸橼酸氢钾钠,可改善肾功能,调节CIRF指标,降低后残石相关肾绞痛发生率和复发率,提高治疗效果.     

体外冲击波碎石术联合结石通片治疗泌尿系结石临床疗效分析

目的 探讨体外冲击波碎石术联合结石通片治疗泌尿系结石临床疗效.方法 选取2006年12月～2008年12月在我院就诊的泌尿系结石患者132例,随机分为观察组和对照组,对照组采用单纯体外冲击渡碎石术,观察组在对照组基础上加用结石通片.观察两组疗效.结果 观察组总有效率(94.9%)和对照组总有效率(79.7%)比较,差异有统计学意义(P<0.01).结论 体外冲击波碎石术联合结石通片治疗泌尿系结石临床治疗效果优于单纯体外冲击波碎石术,值得临床推广.     

体外冲击波碎石实验研究

本文通过高速摄影机拍摄体外冲击波碎石机对模拟介质(水和明胶)中人体结石的破碎过程,分析了不同性质结石的破碎特点以及碎石过程中结石周围压力波的传播对周围介质的影响,并对临床治疗中所出现的并发症进行了一定的分析。这不仅是进行深入研究的实验基础,而且也为临床诊治提供参考依据。     

输尿管软镜碎石术治疗上尿路结石的临床疗效及安全性分析

目的 研究输尿管软镜碎石术治疗上尿路结石的临床疗效及安全性。方法 选取2022年1月-2023年10月我院诊治的46例上尿路结石患者为研究对象,采用随机数字表法分为对照组和观察组,各组23例。对照组采用经皮肾镜取石术治疗,观察组采用输尿管软镜碎石术治疗,比较两组结石清除率、并发症发生率、临床手术指标、疼痛（VAS）评分、肾功能指标。结果 观察组结石直径＜2 cm清除率高于对照组,结石直径≥2 cm清除率低于对照组（P＜0.05）;观察组并发症发生率为8.70%,低于对照组的21.74%（P＜0.05）;观察组手术时间长于对照组、术中出血量少于对照组、住院时间短于对照组（P＜0.05）;观察组术后24、72 h的VAS评分均低于对照组（P＜0.05）;观察组术后Scr、血红蛋白、尿素氮均优于对照组（P＜0.05）。结论 输尿管软镜碎石术可有效提升上尿路结石患者的结石清除率,降低术后并发症发生率,且具有对肾功能影响小、术中出血量少、疼痛程度轻的优势。     

泌尿系结石体外冲击波碎石的护理体会

目的：分析体外冲击波碎石治疗泌尿系结石的围手术期护理与影响因素。方法选取2012年~2013年在四川中医药高等专科学校第一附属医院(绵阳富临医院)泌尿外科明确诊断为泌尿系结石,同时行体外冲击波碎石的患者980例,给予患者严密而细致的围手术期护理。结果接受体外冲击波碎石的患者920例出现肉眼血尿,给予抗炎、止血治疗后血尿消失;215例出现腰痛,随结石排除后疼痛自然缓解,95例经二次碎石后得到好转。结论体外冲击波碎石对治疗泌尿系结石治疗效果好,治疗时间短,并发症少,并且操作简单。加之给予患者有效的围手术期护理,对于减轻患者的痛苦和减少并发症的出现,有着重要而实际的意义。     

泌尿系结石体外震波碎石治疗超声定位影响因素与对策

目的探讨泌尿系结石体外震波碎石术超声定位的方法、术中监视、定位的影响因素及采取的对策。方法按三分段区域扫查法，采用与常规B超检查正好相反的反常规体位，根据结石的不同部位，选择理想的碎石体位。结果该组资料显示，泌尿系结石体外震波碎石1次治疗完全粉碎排净率61．0％（742／1216），肾结石、输尿管结石、膀胱结石3个月无石率和效率商分别为94.3％、97．9％、100％和47．1％、50．2％、66．7％。结论超声定位技术的应用，扩大了体外震波碎石的治疗范围，超声的准确定位是提高碎石效果的关键。     

双J管在体外冲击波碎石治疗输尿管中上段结石中的合理应用

目的评估留置双J管在体外冲击波碎石治疗输尿管中上段结石中的有效性及安全性,探索双J管的合理应用。方法统计在我院治疗的输尿管中上段结石患者511例,留置双J管后再施行体外碎石患者161例,直接施行体外冲击波碎石患者350例,分为置管和未置管2组。分析2组间结石X光显示定位满意率、碎石效果及不良反应发生率。结果置管组X光结石显示定位满意率高于未置管组(P=0.025)。置管组、未置管组结石清除率比较有统计学意义(P=0.041)。置管组患者血尿、下尿路症状发生率明显高于未置管组(P0.05)。置管组患者肾绞痛发生率低于未置管组(P=0.001)。结论双J管置入对结石显示及定位有帮助,可提高结石清除率。对直径小于1 cm的输尿管阳性结石,是否置双J管对结石清除率影响不大,但可减少剧烈肾绞痛的发生率。     

体外震波碎石术治疗儿童泌尿系结石

目的:评价体外震波碎石术治疗儿童泌尿系结石的临床疗效。方法:回顾性分析57例经体外震波碎石术治疗的儿童泌尿结石的临床资料。结果:57例病人中肾盂肾盏结石23例,输尿管结石26例,膀胱结石5例,后尿道结石3例。52例病人结石清除,清除率为91.23%。3例结石残留(5.26%),2例无效(3.51%)。结论:体外震波碎石术是治疗儿童泌尿系结石的有效方法。     

从化地区尿石症患者结石成分及代谢异常的研究

目的分析从化地区尿石症患者的尿路结石成分及尿液代谢异常的关系。方法将200例尿路结石进行结石成分测定,并对其中的153例进行24 h尿液分析,对其结果进行综合评价。结果从化地区尿路结石以含草酸盐结石为主（90.5%）,其中单纯草酸钙结石占42.5%;其次为含尿酸结石（26.5%）,其中纯尿酸结石占5.5%;多数结石患者合并各种尿液代谢异常,其中高尿钙症36例（23.5%）、高尿磷症64例（41.8%）、高尿酸尿55例（35.9%）、低镁尿51例（33.3%）、高草酸尿39例（25.4%）、低枸橼酸尿症100例（65.3%）。结论尿路结石成分分析及尿液代谢分析对了解结石病因与预防有重要的指导意义。     

Removal of kidney stones by extracorporeal shock wave lithotripsy is associated with delayed progression of chronic kidney disease

Purpose

This study aimed to elucidate whether stone removal by extracorporeal shock wave lithotripsy (ESWL) is associated with delayed chronic kidney disease (CKD) progression.

Materials and Methods

We conducted a retrospective analysis of 131 nephrolithiasis patients with stage 3 and 4 CKD. We collected baseline clinical and laboratory data, kidney stone characteristics, and history of receiving ESWL. We classified study patients into two groups according to whether they underwent ESWL or not (Non-ESWL group vs. ESWL group). We initially compared annual estimated glomerular filtration rate (eGFR) changes of Non-ESWL group with those of ESWL group before undergoing ESWL. In the next step, we sought to compare annual eGFR changes in the same patients before and after ESWL. Finally, we compared annual eGFR changes between success and failure groups among patients undergoing ESWL.

Results

The mean age of the patients was 62 years and 72.5% were male. The mean observation period was 3.2 years. Non-ESWL group and ESWL group before undergoing ESWL showed similar annual eGFR changes (-1.75±6.5 vs. -1.63±7.2 mL/min/1.73 m²/year, p=0.425). However, eGFR declined slower after undergoing ESWL than before ESWL (annual eGFR changes, -0.29±6.1 vs. -1.63±7.2 mL/min/1.73 m²/year, p<0.05). In addition, among patients in ESWL group, eGFR declined faster in the failure group than in the success group (annual eGFR change, -1.01±4.7 vs. -0.05±5.2 mL/min/1.73 m²/year, p<0.05).

Conclusion

Our results suggest that stone removal by ESWL is associated with delayed deterioration of renal function in CKD patients with nephrolithiasis.     

上尿路结石致重度肾积水的临床治疗（附27例报道）

目的探讨上尿路结石致重度肾积水的临床治疗及最大可能保肾的可行性。方法 27例上尿路结石均致患侧重度肾积水,其中输尿管中下段结石12例,肾盂出口及输尿管上端结石8例,肾脏多发结石5例,肾脏多发结石伴输尿管结石2例;27例患者中,6例伴有对侧上尿路结石,采用经尿道输尿管镜,开放性肾切除、经皮肾穿刺造瘘及经皮肾输尿管镜等治疗手段。结果3例行肾切除,其余24例均成功处理结石并保肾成功。结论对于上尿路结石致重度肾积水患者,可结合尿动力学检查,在安全膀胱情况下尽可能保肾。     

Short-term effects of extracorporeal shock wave lithotripsy on the human gallbladder

Extracorporeal shock wave lithotripsy (ESWL), whereby shock wave energy is focused upon gallstones causing their disintegration into fragments sufficiently small to be passed via the biliary system, offers a promising non-invasive alternative to surgery for gallstone disease. The tissue effects in humans of ESWL are poorly characterized and no systematic study of the tissue effects of ESWL by piezoelectrically generated shock waves has been published. Sixteen patients for elective cholecystectomy were therefore subjected to ESWL before surgery and detailed histology of the gall-bladders (including scanning electron microscopy of the mucosa) was compared with that from 20 age/sex-matched control cases. The gall-bladders treated by ESWL, in addition to showing the histological changes associated with chronic cholecystitis, showed serosal vasodilatation, mural oedema, and serosal and mucosal petechial haemorrhages focally over the entire surface. Between 10 and 90 per cent epithelial denudation was observed, but all cases showed surviving columnar epithelial cells in the crypts. No case showed vascular thrombosis, tissue necrosis, or acute inflammation. These tissue effects are likely to be reversible and unlikely to present a risk of perforation, although the long-term clinicopathological effects await investigation.     

双侧上尿路梗阻致肾功能不全200例分析

目的探讨双侧上尿路梗阻引起肾功能不全的诊断和治疗。方法对我院收治的200例双侧上尿路梗阻引起肾功能不全患者的临床资料进行回顾性分析。结果农村患者发病比例为86%,明显高于城镇患者（P〈0.05）。最主要的梗阻原因是尿路结石。用输尿管插管、经皮肾穿刺造瘘和手术方法及早引流,解除梗阻,治愈88.5%,好转11.5%,平均住院26.55 d,血BUN、Cr恢复正常平均22.85 d,术后第7天总体血BUN、Cr分别下降73.35%和57.25%。结论双侧上尿路梗阻引起肾功能不全是泌尿外科的急重症,尽早解除梗阻有利于肾功能的恢复。     

Lesions produced by the extravasation of urine from the upper urinary tract

We present six cases which illustrate the spectrum of clinical features, macroscopic findings and light microscopic findings of urine extravasation from the upper urinary tract. The early lesions are characterized macroscopically by an oedematous, glistening or gelatinous appearance to the renal perihilar and peripelvic fat. Light microscopically there is lipolysis with associated foamy macrophages, multinucleate giant cells and lymphocytes. Immunohistochemical staining for Tamm–Horsfall protein is strongly positive in the extracellular space and in the foamy macrophages confirming urine extravazation. Later lesions are characterized by cicatrization of fibrous tissue around the renal pelvis and hydronephrosis. Microscopically there is relatively bland fibrosis with occasional lymphocytes and histiocytic cells. The late lesions are also characterized by extracellular deposits of weakly eosinophilic, granular or hyaline material, the so called 'urinary precipitates'. These deposits stain strongly with diastase PAS and weakly positive for Tamm–Horsfall protein. The staining of these urinary precipitates is analogous to renal tubular hyaline casts, thus supporting the theory that they are derived from uroproteins. We consider that these deposits are pathognomic of past urine extravasation.