体外冲击波碎石治疗肾下极结石的疗效观察

回顾性总结了３２６例直径为０．６￣２．３ｃｍ肾下极结石患者行体外冲击波碎石（ＥＳＷＬ）的资料。每位患者ＥＳＷＬ后均常规给予中药排石冲剂，ＥＳＷＬ后１个月及每隔６￣１２个月进行Ｘ线检查和临床随访。结果３２６例中，１６２例（４９．７％）在ＥＳＷＬ后１个月复查无结石，７５例（２３．０％）在１￣９６个月（平均２１个月）的随访中排净结石，总无石率为７２．７％。其余患者中，残余结石减少，保持稳定或增多者分别为     

ESWL与输尿管镜治疗输尿管下段结石的比较

目的：比较体外冲击波碎石术（ＥＳＷＬ）与输尿管治疗输尿管下段结石的结石排净率和并发症。方法：治疗输尿管下段结石患者３９０例,其中用ＥＳＷＬ治疗２１０例,输尿管镜治疗１８０例。结果：两组患者术后１个月的结石排净率分别为７８．１％和９３．３％（Ｐ〈０．０５）;ＥＳＷＬ组的主要并发症为再次治疗率高（１１．９％）,而输尿管镜组的主要并发症为输尿管穿孔（３．３％）。结论：输尿管镜治疗输尿管下段结石的疗效优于     

ESWL后影响肾下盏结石排空的解剖学因素

目的 探讨肾下盏解剖学因素对ＥＳＷＬ后结石排空的影响。方法 １９９５年４月～１９９９年１１月应用Ｓｔｏｒｚ Ｍｏｄｕｌｉｔｈ ＳＬ２０型碎石机治疗肾下盏结石１４５例,测量碎石前ＩＶＵ片肾下盏４项解剖指标,包括结石所在肾下盏肾孟夹角,肾下盏长度,盏颈宽度及肾下盏形状（简单或复杂）。随访３个月,碎石后第１天、２、４周及３个月时复查Ｂ超及ＫＵＢ,分析肾下盏解剖因素与结石排空的关系。结果 ３个月总结石排空     

腔镜下处理输尿管结石并息肉

目的　介绍输尿管镜下处理输尿管结石并息肉的经验。　方法　１９９１ 年７ 月至１９９８年１１ 月,对１ ８４７ 例输尿管结石行２ ０５９ 例次输尿管镜检查及治疗,其中１０７ 例检查前曾先后行１ ～５次体外冲击波碎石（ＥＳＷＬ） 未获成功。　结果　１ ８４７ 例输尿管结石中并发息肉５５３ 例（２９ ．９ ％ ） ,其中４５０ 例在输尿管镜下处理成功（８１ ．４ ％ ） 。　结论　输尿管结石并息肉为常见病;输尿管结石嵌顿时间超过３ 个月,肾积水程度与结石大小不相符的患者不宜行ＥＳＷＬ;输尿管镜下行输尿管息肉切除及气压弹道碎石治疗效果满意。     

ESWL治疗肾鹿角状结石引起肾无功能肾萎缩（附六例报告）

ＥＳＷＬ治疗肾鹿角状结石引起肾无功能肾萎缩（附六例报告）戴布民周志才刘起珠作者单位：５７０３１１海南省人民医院泌尿外科（戴布民），核医学科（周志才），Ｂ超室（刘起珠）我院从１９９０年１月～１９９５年１月采用ＥＳＷＬ治疗肾鹿角状结石２５例，治疗后１～３...     

连续变换体位排石法在ESWL治疗肾下盏结石中的应用

连续变换体位排石法在ＥＳＷＬ治疗肾下盏结石中的应用聂明季天佑何顺详赵芳１９８９年１２月～１９９５年１０月，我院应用国产ＫＤＥⅡ型碎石机结合连续变换体位排石法治疗肾下盏结石７６例。报告如下。临床资料本组肾下盏结石７６例，占同期尿石症患者的１４．０２％...     

急诊ESWL治疗输尿管结石疗效观察

为论证体外冲击波碎石术（ＥＳＷＬ）治疗输尿管结石绞痛的临床效果，对１０９例输尿管结石绞痛患者行急诊ＥＳＷＬ治疗，结果经１次ＥＳＷＬ治疗成功者９６例（８８．１％），余经第２次ＥＳＷＬ治疗全部碎石成功。经１次ＥＳＷＬ治疗后绞痛缓解者９５例（８７．１％）。认为出现输尿管结石绞痛时应及早施行ＥＳＷＬ，以求尽早解除患者痛苦；结石定位诊断应遵循简单、快捷的原则，综合分析，防止误诊；施行ＥＳＷＬ时应尽可能采用仰     

B超引导下肾上盏入路经皮肾镜取石术治疗肾铸型结石

目的：探讨B超引导下肾上盏入路经皮肾镜取石术（PCNL）治疗肾铸型结石的安全性及临床疗效。方法：我们于2005年1月～2011年8月对27例肾铸型结石采用B超引导下肾上盏入路PCNL。建立经皮肾通道F24,经皮肾镜下EMS碎石清系统碎石。回顾性分析27例患者的手术时间、结石清除率、并发症等临床资料。结果：本组27例均成功建立经肾上盏通道,其中经第11肋间25例,经第12肋下2例。手术时间50～140min,平均85min。一期结石清除率85．2％（23／27）。胸腔积液1例（3．7％）,输血1例（3．7％）,无重要脏器损伤及其他严重并发症。结论：B超引导下肾上盏入路PCNL治疗铸型肾结石安全、有效。     

自制倒置床治疗ESWL后肾下盏残留小结石(附184例报告)

自制倒置床治疗ＥＳＷＬ后肾下盏残留小结石（附１８４例报告）蒋展兴刘成倍吴桂强我院１９８９年１２月～１９９４年６月，应用自制倒置床治疗ＥＳＷＬ后肾下盏残留小结石１８４例，效果满意。报告如下。临床资料本组肾结石患者２６８４例，施行ＥＳＷＬ后，肾内残留小结...     

门诊ESWL治疗并发症的临床观察

门诊ＥＳＷＬ治疗并发症的临床观察［日］／间宫良美…／／临床泌尿器科－１９９５，４９（８）－５６７～５７１１９８９年３月～１９９４年７月日本东京医科大学泌尿科对１０６６例（１１２１侧肾及上段输尿管结石）进行ＥＳＷＬ治疗。其中门诊行ＥＳＷＬ治疗８６５例共...     

Calyceal stones: Fate of shock wave therapy with respect to stone localization

In a retrospective analysis the results of extracorporeal shock wave lithotripsy (ESWL) treatment were evaluated in patients with renal stones according to calyceal localization of treated stones. The 198 patients who underwent ESWL with the Dornier MPL 9000 were analyzed for success rate, complication rate, residual fragments, regrowth and recurrence rates. Totally 210 calyceal calculi located in different portions of the kidney have been comparatively evaluated. No major complications were noted during or after ESWL. Some minor complications such as flank pain, renal colic, haematuria were observed. Flank pain was observed during ESWL treatment especially in patients with upper calyceal stones. Although stone-free and residual fragment rates were similar in pelvic, upper and middle calyces, patients with lower calyceal and pelvicalyceal stones had high residual fragment rate and lower stone-free rate. Patients with stones in the lower calyces or pelvicalyces had high recurrence and regrowth rates (p<0.05). ESWL has been considered as the optimal treatment modality for most upper urinary tract calculi. It is especially effective in patients with pelvic, upper and middle calyceal stones. Patients with lower calyceal stones often failed to eliminate the fragments, hence had high recurrence and regrowth rates.     

体外冲击波碎石成功治疗肾结石的多因素分析

目的 确定病人和结石在非增强螺旋CT上的特点,预言2种体外冲击波碎石后的结果:结石分散状态(游离状态)或体外碎石成功.方法 回顾性分析200个相连续的用体外震波碎石治疗的肾结石患者.患者年龄、性别、结石侧别、体表面积、体重、结石最大容积、结石的平均CT值、结石密度、皮肤到结石距离,肾内结石的位置,研究这些潜在的预测因子.患者非肾脏、输尿管、膀胱手术后钙化,在第6周时拍腹部平片确定结石的分散状态,体外冲击波碎石成功者:结石残留碎片小于4mm.结果 发现肾内结石的位置是唯一一个预测体外碎石后结石分散状态的因子.肾盂、肾盂输尿管交界处结石清除率要高于肾盏结石;上盏或中盏结石清除率要高于下盏.结石大小、平均CT值和结石的位置能够预测体外震波碎石的成功率.小结石和低CT值结石更容易被击碎,在肾盏结石中更高的离散状态和体外碎石的成功率发现与更短的皮肤-结石距离有关,肾盂结石和肾盂输尿管交界处结石排除在分析之外.结论 结石的位置是体外震波碎石后获得结石离散状态最重要的因素,非增强螺旋结石特点:诸如结石大小、平均密度、结石肾内位置是体外震波碎石成功的重要预测因子.

Abstract：

Objectives To determine the patient and noncontrast computed tomography (NCCT) stone characteristics that predict either of 2 extracorporeal shock wave lithotripsy (ESWL) outcomes: stone - free (SF)status or ESWL success. Methods The records of 200 consecutive patients with nephrolithiasis treated with ESWL were reviewed. Patient age, sex, stone laterality, body surface area, body mass index, maximal stone dimension,mean stone Hounsfield units (HU), stone Hounsfield density, skin- to- stone distance (SSD), and intrarenal stone location were studied as potential predictors. Patients with no calcifications on postoperative kidneys, ureters,and bladder (KUB) at 6 weeks were defined as SF. ESWL success was defined as SF or remaining stone fragments less than 4 mm. Results lntrarenal stone location was found to be the only predictor of SF status. Renal pelvic/ureteropelvic junction (UPJ) stones cleared better than calyceal stones, and upper/middle calyceal stones cleared better than lower calyceal stones. Stone size, mean HU, and location predicted ESWL fragmentation success. Smaller stones and stones with lower mean HU levels were more successfully fragmented. Higher SF and ESWL success rates were found with a shorter SSD among calyceal stones when renal pelvic/UPJ stones were excluded from analysis. Conclusions Stone location is the most important factor in achieving SF status after ESWL. NCCT stone characteristics such as stone size, mean HU, and intrarenal location are important predictors of ESWL success.     

经皮肾镜取石术联合套石网篮治疗 ESWL 排空障碍的输尿管上段结石合并肾盏结石

目的：探讨经皮肾镜取石术（ percutaneous nephrolithotomy , PCNL ）联合套石网篮治疗体外震波碎石（ extracorporeal shock wave lithotripsy ,ESWL）排空障碍的肾盏及输尿管上段结石的临床疗效。方法2009年4月～2012年8月采用PCNL联合套石网篮治疗ESWL排空障碍的输尿管上段结石合并肾盏结石78例。 B超定位,58例肾盏结石长径＜1 cm或分布于单组肾盏,采用微通道经皮肾镜下气压弹道碎石;20例肾盏结石长径＞1 cm或分布于多组肾盏采用新型经皮肾镜标准通道下气压弹道或超声联合气压弹道碎石。结果78例手术均获成功,手术时间52～98 min,平均61 min。71例一期取净结石,结石取净率91．0％（71/78）;2例二期碎石后取净;3例辅助行ESWL治疗;2例因残留结石较小药物排石排出。住院5～12 d,平均7．2 d。无胸膜及其他重要脏器损伤,无大出血等严重并发症。78例随访3个月,未见结石残留。结论PCNL术中联合套石网篮可减少皮肾穿刺通道数,避免大出血及集合系统狭窄风险,是处理ESWL排空障碍的肾盏及输尿管上段结石恰当的选择。     

Retrograde ureteropyeloscopic holmium laser lithotripsy for large renal calculi

OBJECTIVE: To assess the efficacy and safety of the retrograde ureteropyeloscopic holmium laser for treating renal stones that are too large to treat with extracorporeal shock wave lithotripsy (ESWL). PATIENTS AND METHODS: Thirty patients (22 men and eight women, mean age 43 years, range 18-62) with a renal stone burden of > 2 cm were selected for laser treatment. The stones were in the renal pelvis in 16 patients, lower calyx in five, middle calyx in two, upper calyx in one and multiple pelvic and calyceal in six. Lithotripsy was undertaken using a holmium laser through 550 microm and 200 microm laser fibres passed through a semi-rigid fibre-optic long ureteroscope or the actively deflectable flexible ureteropyeloscope, respectively. Success was defined as total fragmentation of the stone to < 2 mm in diameter and/or clear imaging on renal ultrasonography and plain films within the 3-month follow-up. Patients in whom the treatment failed received either alternative therapy or complementary ESWL. RESULTS: Endoscopic access and complete stone fragmentation was achieved in 23 of the 30 patients (77%). The treatment failed in seven patients because of poor visualization, the initial presence of stones in, or migration of their large fragments to, an inaccessible calyx. There were no major intraoperative complications. Minor complications after treatment included haematuria that persisted for 2 days in one patient and high-grade fever in two patients; all were treated conservatively. CONCLUSION: Large renal calculi that are not amenable to ESWL monotherapy can be safely and effectively treated with a retrograde endoscopic technique that seems to compete well with the more invasive percutaneous or open surgical manoeuvres.     

Preliminary results of a randomized controlled trial of prophylactic shock wave lithotripsy for small asymptomatic renal calyceal stones

OBJECTIVE: To report a prospective, randomized study to determine whether prophylactic extracorporeal shockwave lithotripsy (ESWL) is justified as a treatment for small, asymptomatic calyceal stones. PATIENTS AND METHODS: The study included 228 patients with small (< 15 mm total diameter) asymptomatic calyceal stones; 113 patients were randomized to undergo ESWL and 115 to the control group who were kept under observation. Outcome measurements included the stone-free rate, requirement for additional treatment, symptoms, quality of life and renal function. RESULTS: In all, 200 patients had at least one annual follow-up; all outcome measurements reported were those at the most recent follow-up (mean 2.2 years, range 1-5). In the ESWL group 28 patients (28%) were stone-free, compared with 16 (17%) in the observation group (odds ratio 1.95, 95% confidence interval, CI, 0.97-3.89, P = 0.06). Additional treatment in the form of analgesics, antibiotics, ESWL, stent insertion and ureteroscopy, was required in 21 (21%) patients in the observation group and 15 (15%) in the ESWL group (odds ratio 0.66, 95% CI 0.32-1.37, P = 0.27). Ten patients in the observation group required invasive procedures, vs none in the ESWL group. There was no evidence of differences in the symptoms, quality of life or renal function tests between the arms of the trial at the final follow-up. CONCLUSIONS: Prophylactic ESWL for small asymptomatic renal calyceal stones does not appear to offer any advantage to patients in terms of stone-free rate, quality of life, renal function, symptoms or hospital admissions. However, a policy of observation is associated with a greater risk of requiring more invasive procedures. A longer follow-up is required to assess the validity of these preliminary findings.     

输尿管软镜钬激光碎石联合排石颗粒治疗肾结石的临床研究

目的 观察输尿管软镜钬激光碎石联合应用排石颗粒治疗肾结石的疗效.方法 将本科室2013年8月至2015年8月收治的192例行输尿管软镜钬激光碎石的肾结石患者随机分为观察组(101例)和对照组(91例).结石最大直径约<25 mm,术前均行泌尿系平片(KUB)+静脉尿路造影(IVU).对照组60例结石位于上盏、中盏或肾盂内,41例位于下盏或多个肾盏,采用输尿管软镜钬激光碎石.观察组60例结石位于上盏、中盏或肾盂内,31例位于下盏或者多个肾盏.采用输尿管软镜钬激光碎石术,术后联合排石颗粒治疗.术后4周KUB平片或者双肾CT平扫,评估结石清除率.结果 全部患者进镜顺利并成功碎石.观察组4周后总排石成功率为97.0% (98/101) ,下盏及多盏结石排净率为97.6%(40/41),肾中上盏及肾盂内结石的排石率为96.7%(58/60);对照组4周后总排石成功率为90.1% (82/91),下盏及多盏结石排净率为80.6%(25/31),肾中上盏及肾盂内结石的排石率为95.0%(57/60) .两组相比总排石率差异具有显著统计学意义(P<0.05),下盏及多盏结石排净率差异具有显著统计学意义(P<0.05),肾中上盏及肾盂内结石的排石率无明显差异(P>0.05).结论 输尿管软镜激光碎石治疗肾结石尤其是肾下盏结石术后联用排石颗粒可明显提高排石率.     

输尿管镜气压弹道碎石治疗肾结石23例

目的探讨输尿管镜气压弹道碎石治疗肾结石的可行性。方法回顾分析2001年1月～2004年3月23例肾上盏结石和肾盂结石采用输尿管镜经下尿路气压弹道碎石的临床资料。结果23例均获成功,无并发症。手术时间25～60min,平均45min。6例肾盂结石术后2周残留长径>0.5cm结石,行ESWL1～2次,术后3个月结石全部排净。23例术后3个月复查腹部平片和静脉肾盂造影,结石排净,12例轻度肾积水消失,11例中、重度积水改善。结论选择合适病例采用输尿管镜经下尿路实施气压弹道碎石可以治疗肾上盏结石和肾盂结石。     

Efficacy of extracorporeal shock wave lithotripsy for solitary lower calyceal stone: a statistical model

OBJECTIVE: To evaluate the effect of inferior calyceal radiographic anatomy, number of extracorporeal shock wave lithotripsy (ESWL) sessions and stone size on the successful clearance of solitary inferior calyceal calculi after ESWL. PATIENTS AND METHODS: In a prospective study between January 2001 and November 2002, 66 renal units with a solitary inferior calyceal calculus of < or = 2 cm were treated with electrohydraulic ESWL. The infundibulopelvic angle (two definitions), infundibulovertebral angle, inferior calyceal infundibular diameter, infundibular length, cortical thickness over the lower pole, number of minor calyces and stone size were determined from intravenous urography before treatment. The number of ESWL sessions was also included in the analysis. Treatments which produced residual fragments not clearing within 3 months of satisfactory fragmentation were considered as failures. All patients in whom the treatment failed were treated successfully by percutaneous nephrolithotomy. The data were then analysed using two different statistical methods; first by intravariable differences using the test of proportion (Fisher's test) and then all the variables together using logistic regression. RESULTS: At 3 months 78.8% of the renal units were clear of stone. All intravariable differences were statistically significant except stone size (<1 cm, 1-2 cm). In a multivariate analysis of all variables, only stone size was the most important predictor for successful stone clearance (P = 0.03). CONCLUSIONS: ESWL is the initial treatment of choice in selected patients with inferior calyceal stones. The stone size appears to be the most important predictor for stone clearance.     

Experience in 3,500 patients with urinary stones treated with the Dornier HM-4 bath-free lithotriptor

During a 3-year period, hundreds of patients underwent ESWL treatment with the Dornier HM-3 and HM-4 lithotriptors operating at our institution. Our experience in 3,500 patients treated with the HM-4 bath-free lithotriptor is reported. Patients with radiolucent or cystine stones, stones larger than 3 cm or staghorn calculi, multiple stones with a total burden of more than 3 cm and those not amenable to follow-up were excluded from the study. The overall stone-free rate was 70.7% and 81% at 1 and 3 months, respectively. The stone-free rates at 1 and 3 months were further determined by the exact location of each stone within the urinary tract. Stone-free rates at 3 months ranged from 90.84% for renal pelvic stones to 71.08% for lower calyceal stones, while the stone-free rates for ureteral calculi ranged from 80.85% for upper third unstented ureteral stones to 92.92% for lower ureteral stones. The overall complication rate was 6.02% with a 1.2% post-ESWL intervention rate (ureteroscopy or placement of percutaneous nephrostomy or stent).     

Extracorporeal shock wave lithotripsy produces a lower stone-free rate in patients with stones and renal cysts

BACKGROUND: Renal cysts have a space-occupying effect and therefore can distort the pelvicalyceal anatomy. This distortion often produces abnormalities in normal urinary drainage. In the same way, it may effect the ability of the kidneys to become stone free after extracorporeal shock wave lithotripsy (ESWL). The purpose of the current study is to evaluate the effect of renal cysts on the outcome of ESWL. METHODS: We studied 15 patients who had renal stones and coexistent renal cysts. Four patients had polycystic disease, five patients had multiple cysts and six patients has solitary ones. All cysts produced a distortion to the calyceal system of the kidneys, a fact confirmed by intravenous urography (IVU) and computed tomography (CT). All patients underwent ESWL and their stone-free status was evaluated 1 month later by ultrasound and plain kidney ureter bladder (KUB) X-ray. RESULTS: We had a total 60% (9/15) stone-free patients in our study group and a stone fragmentation rate of 100%. Patients with more cysts had lower stone-free rates. Patients with polycystic kidneys had a 25% (1/4) stone-free rate, while patients with multiple cysts and solitary cysts had, 60% (3/5) and 83.3% (5/6), respectively. These results are lower than the rates reported in patients without renal cysts. CONCLUSIONS: We believe that renal cysts may interfere with the passage of stone fragments, due to the impediment of drainage and urinary stasis from the stretching and distortion of the calyceal system by the renal cysts.