输尿管镜下气压弹道碎石术与钬激光碎石术治疗输尿管结石的比较

目的比较输尿管镜下气压弹道碎石术与钬激光碎石术治疗输尿管结石的疗效和安全性。方法总结应用输尿管镜技术治疗326例输尿管结石患者的临床资料，其中气压弹道碎石术176例，钬激光碎石术150例。结杲钬激光碎石术碎石率为96．6％，高于气压弹道碎石术的89．8％（P〈0．01）；钬激光碎石术平均排净时间为10d，短于气压弹道碎石术的21d（P〈0．01）；钬激光碎石组有11例发生血尿，气压弹道碎石有54例发生血尿。结论钬激光碎石术的有效率和安全性优于气压弹道碎石术。钬激光碎石是治疗输尿管结石的一种安全、高效的方法。     

气压弹道碎石术与钬激光碎石术治疗输尿管结石的比较

目的：比较经输尿管镜气压弹道碎石术与钬激光石术治疗输尿结石的疗效和安全性。方法：总结应用输尿管镜技术治疗285例尿管结石患者的临床资料,其中气压弹道碎石术145例,钬激光碎石术140例。结果钬激光碎石术单次手术碎石率为95．75,高于气压弹道碎石术的69．7％,P＜0．01;钬激光碎石术平均结石排净时间为18d,短于气压弹道碎石术的31d,P＜0．01;钬激光碎石组无明显并发症发生,气压弹道碎石组有5例发生穿孔。结论钬激光碎石术的有效率和安全性优于气压弹碎石术,钬激光碎石术是治疗输尿管结石的一种安全、有高效的方法。     

输尿管镜钬激光碎石与气压弹道碎石的比较

目的：比较输尿管镜下钬激光碎石术与气压弹道碎石术治疗输尿管结石的疗效与安全性。方法：回顾性分析输尿管镜下治疗76例输尿管结石患者的临床资料，其中采用钬激光碎石治疗36例（钬激光组）．气压弹道碎石治疗40例（气压弹道组）。结果：钬激光组平均术中碎石时间为8min，明显短于气压弹道组15min（P〈0．01）。钬激光组碎石成功率为97．2％，明显高于气压弹道碎石组的87．5％（P〈0．01）。两组手术均较安全，无明显相关并发症出现。结论：钬激光碎石术的有效性优于气压弹道碎石术，是一种治疗输尿管结石安全、高效的方法。     

体外冲击波碎石术与输尿管镜气压弹道碎石术治疗输尿管下段结石的疗效比较

目的　比较体外冲击波碎石术 (ESWL)与输尿管镜气压弹道碎石术 (pneumaticlithotripsy ,PL)治疗输尿管下段结石的疗效和安全性。 方法　总结ESWL和PL治疗输尿管下段结石 3 75例的临床资料 ,其中ESWL组 190例 ,PL组 185例。结果　ESWL组单次碎石成功率为 60 .5 %(115 /190 ) ,PL组为 96.2 %(178/185 ) ;ESWL组术后 4周结石排净率为 66.3 %(12 6/190 ) ,PL组为 98.3 %(175 /178)。结论　PL治疗输尿管下段结石的疗效明显优于ESWL。     

上段输尿管结石3种微创治疗方法的比较

目的比较输尿管镜气压弹道碎石术、输尿管钬激光碎石术及后腹腔镜下输尿管上段切开取石术对输尿管上段结石的治疗效果,探讨治疗输尿管上段结石的最佳方法。方法回顾性分析130例输尿管上段结石患者临床资料,其中38例采用输尿管镜气压弹道碎石术（PL组）,45例采用输尿镜钬激光碎石术（LL组）,47例采用后腹腔镜下输尿管上段切开取石术（RLU组）治疗。对三组结石清除率行统计学分析,比较三种微创方法的治疗效果。结果术后1周,三组结石清除率分别为：PL组78.9%（30/38）,LL组95.6%（43/45）,RLU组100%（47/47）。LL组及RLU组结石清除率明显高于PL组,差异有统计学意义（P〈0.025）;LL组及RLU组结石清除率差异无统计学意义（P〉0.05）。结论输尿管镜钬激光碎石术及后腹腔镜下输尿管上段切开取石术创伤小,结石清除率高、并发症少,是治疗输尿管上段结石一种安全有效的微创治疗方法,但后腹腔镜下输尿管上段切开取石术需要全面的腹腔镜技术训练。     

钬激光碎石术与双频双脉冲激光碎石术治疗输尿管结石的比较

目的:比较经输尿管镜钬激光碎石术和双频双脉冲激光碎石术治疗输尿管结石的疗效与安全性。方法:对输尿管镜技术治疗101例输尿管结石患者,以钬激光碎石术治疗46例,双频双脉冲激光碎石术治疗55例,进行疗效比较。结果:钬激光碎石术结石一次粉碎率为91.3%,双频双脉冲激光碎石术结石一次粉碎率为87.3%;前者平均碎石时间(28.9min)短于后者(37.9min)(P<0.01);前者平均结石排净时间为16.5d,短于后者的26.3d(P<0.01);前者2例发生穿孔,后者无穿孔发生。结论:钬激光碎石术及双频双脉冲碎石术均为有效的碎石方法;在平均碎石时间、结石排净时间方面钬激光碎石术具有优势;双频双脉冲激光碎石术在安全性方面具有优势。     

Extracorporeal shock-wave versus pneumatic ureteroscopic lithotripsy in treatment of lower ureteral calculi

Aim: To compare the efficacy and complications of extracorporeal shock-wave lithotripsy (SWL) and pneumatic ureteroscopic lithotripsy (URS) in the treatment of lower ureteral calculi. Methods: From August 1997 to June 1999, 210 patients with calculi in the distal third of the ureter were treated with SWL and the other 180 with URS. The stones were fragmented with either HB-ESWL-V lithotripter or JML-93 pneumatic lithotripter through Wolf 7.5～9.0 Fr ureteroscope. The outcome was assessed in terms of stone clearance rate, re-treatment rate and complication incidence. Results: The stone clearance rate was 78.1% with SWL and 93.3 % with URS (P<0.05). SWL had a re-treatment rate of 11.9 %, vs 2.2 % in the URS group (P<.05). URS caused ureteral perforation in 3.3% of patients, while it was 0 with SWL (P<0.05). The differences in the incidence of other complications such as infection and stricture between the two groups were insignificant. Conclusion: Though the selection of these two options depends on equip     

Comparison of pneumatic and Holmium laser ureteroscopic lithotripsy for upper third ureteral stones

ObjectiveTo evaluate the outcomes of ureteroscopic lithotripsy with pneumatic lithotripter and Holium:Yttrium-Aluminum-Garnet (Ho:YAG) laser in the management of upper third ureteral stones.Materials and methodsPatients who underwent ureteroscopic lithotripsy with pneumatic lithotripter or Ho:YAG laser for upper third ureteral stones were retrospectively reviewed. Patients with urinary tract infection, radiolucent stones, loss of follow-up, concurrent middle or lower third ureteral stones or acute renal failure were excluded. Patient age, stone size and burden (based on KUB or computerized tomography), stone upward migration, double J stent insertion rate, stone free rate and secondary intervention rate for residual stones were compared in both groups.ResultsThere were 158 patients with 178 upper third ureteral stones (135 in pneumatic lithotripsy group and 43 in Ho:YAG laser lithotripsy group) meeting the study criteria. Patients' age, gender, stone laterality, stone size and burden were similar in both groups. The Ho:YAG laser lithotripsy group had better stone free rate, less double J stent insertion rate and less secondary intervention rate as compared with pneumatic lithotripsy (53.4% vs. 40.1%; 72.1% vs. 91.9%; 25% vs. 48.5% respectively, all p < 0.05). In patients with stones larger than 10 mm, Ho:YAG laser lithotripsy had significantly lower upward migration rate, lower double J stent insertion rate, higher stone free rate and less secondary intervention rate.ConclusionsHo:YAG laser lithotripsy is superior to pneumatic lithotripsy in the management of upper third ureteral stones in terms of double J stent insertion rate, stone free rate and secondary intervention rate for stones of all sizes. For stones larger than 10 mm, laser lithotripsy results in less stone upward migration.     

输尿管结石ESWL失败改腔内钬激光碎石术的疗效观察

目的 探讨输尿管结石ESWL失败后采用腔内钬激光碎石术的临床疗效。方法 自2001年10月至2002年8月，对28例输尿管结石(ESWL失败)行输尿管镜下钬激光碎石术。结果 26例经输尿管镜下钬激光碎石术治愈，治愈率92．8％(26／28)；1例结石上移，辅以ESWL治愈；1例因输尿管纤维性扭曲改开放手术。结论 输尿管镜下钬激光碎石术安全、有效、方便，可以作为输尿管结石的首选治疗。     

输尿管镜下钬激光碎石与气压弹道碎石术治疗输尿管结石的疗效比较

目的 比较输尿管镜下钬激光碎石与气压弹道碎石术治疗输尿管结石的临床效果.方法 回顾分析2009年1月至2011年2月输尿管镜下治疗输尿管结石459例临床资料,其中钬激光碎石术267例(312侧),气压弹道碎石术192例(220侧).结果 钬激光组260例(305侧)碎石成功,碎石总成功率97.76%;气压弹道组177例(205侧)碎石成功,碎石总成功率93.18%.术后4~6周随访,两组结石排净率分别为98.69%、94.15%,碎石成功率、结石排净率均有显著性差异.结论 输尿管镜下钬激光和气压弹道碎石术均是治疗输尿管结石的好方法,但在碎石成功率、结石排净率以及在处理输尿管结石合并息肉、狭窄时,钦激光具有更大的优势.     

The frequency-doubled double-pulse Neodym:YAG laser lithotripter (FREDDY) in lithotripsy of urinary stones. First clinical experience

Laser lithotripsy does not play an important role in urinary stone treatment, mostly due to ineffective fragmentation efficiency, and high purchase and maintenance costs. The aim of the following retrospective study was to show the clinical significance and efficiency of an innovative laser lithotripsy system for urinary stone treatment. Between November 1998 and October 1999, 48 patients were treated with the innovative frequency- doubled double-pulse Neodym: YAG laser lithotripter FREDDY. A total of 50 renal units were treated, 43 ureteroscopically, four ureterorenoscopically, three percutaneous-nephroscopically, and one bladder stone cystoscopically. With a median laser operation time of 5 min (range: 1-30 min) and a total procedure duration of 60 min (range: 15-180 min), a stone-free rate of upper ureteral stones of 62%, middle ureteral stones of 91% and distal ureteral stones of 100% were documented on the first day after treatment. In an observation period of 6 months, no complications were seen. In our experience Laser lithotripsy with FREDDY is an effective, simple and reliable method for the treatment of ureteral stones, with low purchase and maintenance costs. The extremely thin and highly flexible quartz fibre may extend the endoscopic spectrum to otherwise poorly accessible upper ureteral stones, the renal pelvis and renal calix stones. Therefore, a prospective validation study for comparison with ballistic lithotriptors is of great interest.     

输尿管肾镜联合钬激光碎石术治疗输尿管结石

目的探讨经输尿管肾镜联合钬激光碎石术治疗输尿管结石的有效性及安全性。方法分析2005年1月至2006年12月收治的经输尿管肾镜钬激光治疗输尿管结石206例的临床资料。其中181例伴有患侧轻至中度肾盂积水,IVP患肾不显影19例,28例同时合并结石远端输尿管狭窄,57例合并有息肉或肉芽组织包裹,26例为体外冲击波碎石术(ESWL)治疗失败。结果206例中195例单次手术碎石成功,单次手术结石粉碎率达94.7%(195/206)。平均手术时间25min,术中无输尿管穿孔等并发症发生,平均住院日5.5d。10例结石在钬激光碎石过程中移位于肾盏或结石残留,术后再行ESWL治愈;1例双侧输尿管结石,因输尿管狭窄无法入镜,中转开放手术。结论输尿管肾镜联合钬激光碎石术治疗输尿管结石有效、安全,可作为输尿管结石特别是中下段结石首选的治疗方法。     

Management of ureteral stones with pneumatic lithotripsy: report of 500 patients

PURPOSE: To evaluate the results of pneumatic lithotripsy (PL) with ureteroscopy in the treatment of ureteral stones. PATIENTS AND METHODS: We reviewed, retrospectively, the records of 500 patients (366 male, 134 female) with ureteral calculi treated by PL with the Swiss Lithoclast. Of these patients, 124 (24.8%) were treated primarily and 376 (75.2%) were treated secondarily after unsuccessful extracorporeal shockwave lithotripsy (SWL). The results were evaluated 3 months after treatment by excretory urography, ultrasonography, or both. RESULTS: The over-all stone-free and fragmentation rates were 94.6% and 96.8%, respectively. These values were 97.1% and 98.5% for stones 10 mm, respectively. The main complications were stone migration (2.0%), urosepsis (3.0%), and ureteral perforation (1.4%). CONCLUSIONS: While SWL is generally excepted as a first-line treatment option in ureteral stones because of its noninvasive nature, in situ lithotripsy, and especially PL, has higher success rates with minimal morbidity. Thus, PL seems to be a good alternative in patients in whom SWL was unsuccessful or not indicated and in patients who need early stone removal.     

钬激光与气压弹道碎石治疗输尿管上段结石的对比研究

目的：比较钬激光碎石术和气压弹道碎石术处理输尿管上段结石的疗效及安全性。方法：应用输尿管镜下钬激光及气压弹道碎石术治疗输尿管上段结石共135例,其中钬激光碎石治疗51例,气压弹道碎石治疗84例,进行疗效、安全性等方面的比较。结果：钬激光碎石组和气压弹道碎石组的结石一次粉碎率分别为90．2％和76．2％（P〈0．05）,平均手术时间前者（49．43min）较后者短（59．24min）（P〈0．05）。钬激光组出现输尿管穿孔1例。气压弹道组出现穿孔6例。结论：治疗输尿管上段结石钬激光较气压弹道碎石具有一定的优势,是一种安全有效的碎石方法。     

Treatment of urinary calculi with ureteroscopy and Swiss lithoclast pneumatic lithotripter: report of 150 cases

PURPOSE: To present our clinic experience with the Swiss Lithoclast pneumatic lithotripter in the endoscopic management of urinary calculi. PATIENTS AND METHODS: From August 1994 to December 1997, 145 patients with ureteral calculi and 5 patients with urethral calculi were treated with the Swiss Lithoclast. RESULTS: In the ureteral stone group, ureteroscopic addressing of the stones was successful in 133 patients. In 27 patients, the stones were partially fragmented and remained in situ or were pushed back to the calices. They were subsequently treated successfully with SWL. Stones were fragmented in a single session in 101 cases. Complications associated with the procedure included five perforations and four urinary tract infections. All of the five urethral stone patients were treated successfully with pneumatic lithotripsy. The overall successful fragmentation rate thus was 70.7% (106 of 150) and 88.7% (133 of 150) in combination with adjuvant SWL. CONCLUSIONS: We have found Swiss Lithoclast pneumatic lithotripsy to be a safe, effective, and economical treatment method for urinary calculi. If combined with other modalities such as SWL, this treatment will be even more effective.     

输尿管结石的现代治疗(附569例报告)

目的 :报告应用现代微创技术治疗输尿管结石的经验。方法 :2 0 0 1年 1月～ 2 0 0 2年 6月间 ,应用体外冲击波碎石 (ESWL)、输尿管镜腔内碎石 [包括气压弹道腔内碎石 (PL)和钬激光腔内碎石 (HLL) ]、腹腔镜输尿管切开取石 (LUL)和开放手术 (OS)治疗各种类型输尿管结石 5 6 9例 ,并随访其疗效及并发症的发生率。结果 :ESWL 36 8例 ,结石粉碎率为 96 .2 % ,3个月后结石清除率为 87.6 % ;HLL 110例 ,10 6例结石一次性粉碎(96 .4 % ) ;PL 4例结石均一次粉碎排出 ;2 1例行LUL患者 ,手术均获成功 ;6 6例行OS的患者均为结石体积较大(>1.8cm)或双侧结石伴有肾功能不全者。结论 :ESWL和HLL可作为输尿管结石的首选治疗方法。LUL和OS可作为首选疗法失败后的补救方法或用于少数结石体积较大的病例     

输尿管结石气压弹道碎石术与体外冲击波碎石术疗效比较

目的：比较输尿管结石气压弹道碎石术与体外冲击波碎石术的疗效。方法：回顾分析130例气压弹碎石术与1600例体外冲击波碎石术的的碎石率、结石排净率、平均结石排净时间及并发症发生率。结果：气压弹道碎石术碎石率、结石排净率均大于体外冲击波碎石术，平均结石排出时间小于体外冲击波碎石术，并发症发生率两组问无明显差异。结论：输尿管结石行气压弹道碎石术优于体外冲击波碎石术。     

输尿管镜气压弹道碎石治疗输尿管结石(附116例报告)

目的：总结输尿管镜气压弹道碎石治疗输尿管结石的疗效。方法：回顾性分析116例采用输尿管镜气压弹道碎石治疗的输尿管结石患者资料。男49例，女67例；平均年龄43岁。结石位于输尿管上段3例，中段24例，下段68例。肾结石ESWL后形成输尿管石街21例。结果：碎石成功率90％(104／116)，其中一次碎石成功者85％(99／116)。术中置镜失败3例，发生输尿管穿孔4例。94例随访1～18个月，术后1个月内结石排净91例。KUB加IVU检查未发现输尿管狭窄。结论：输尿管镜气压弹道碎石治疗输尿管结石创伤小、成功率高、并发症少。     

Extracorporeal shock wave lithotripsy. An update

Extracorporeal shock wave lithotripsy has revolutionized the treatment of urinary calculi. It should be considered the treatment of choice for renal stones smaller than 2 cm and for the majority of ureteral calculi, under which circumstances success rates approaching 80 to 90 per cent may be anticipated. Larger renal calculi or impacted ureteral stones probably should be managed by endoscopic techniques with or without adjunctive intracorporeal (ultrasonic or electrohydraulic) lithotripsy or laser fragmentation. Recent modifications in lithotripter design have been focused on the development of pain-free lithotripsy. Concomitant with a decrease in power, however, is an attendant decrease in the efficiency with which stones can be fragmented, resulting in an increase in the number of lithotripsy treatments required for adequate stone fragmentation. Additionally, sonography is assuming an increasing role in stone localization, and its use will require sonographic training on the part of the urologist. Biliary lithotripsy has been promising in preliminary European studies, with success rates approaching 90 per cent. It must be noted, however, that the U.S. experience has not been as impressive. Moreover, only 20 to 30 per cent of patients referred for biliary lithotripsy appear to be optimal candidates for this new technique. Adjunctive dissolution of gallstones with chronic oral medical therapy may be required after biliary lithotripsy, and long-term follow-up studies still need to be performed. Finally, the potential deleterious effects of extracorporeal shock wave lithotripsy must always be kept in mind. Although the majority of clinical and animal investigations have documented no significant long-term alterations in renal function, care must still be exercised when performing lithotripsy with the knowledge of the potential for long-term injurious effects on the functioning renal parenchyma.     

Laser lithotripsy of the difficult ureteral calculus: results in 122 patients.

We studied 122 patients with ureteral calculi who could not be treated by extracorporeal shock wave lithotripsy (ESWL) because the stones could not be localized or focused for treatment, the patient had failed prior ESWL, the stones were impacted and in situ ESWL was likely to fail or the stones were proximal to a ureteral stricture. These patients underwent laser lithotripsy using the Candela pulsed dye laser. In 107 patients (88%) the calculi were completely fragmented with the laser alone, while 10 (8%) needed another procedure (ESWL in 8 and stone fragment extraction by basket in 2), and 5 (4%) had failed laser therapy and needed some other form of treatment (ESWL in 4 and percutaneous antegrade extraction in 1). At 3 months 116 of 122 patients (95%) were stone-free. There were 2 immediate complications (ureteral perforations) and 1 late complication (ureteral stricture). Laser lithotripsy is a safe and effective method of intracorporeal fragmentation, even of the difficult ureteral calculus, and it is a useful adjunct to ESWL.