体外冲击波碎石术治疗尿路结石(附2 725例报告)

目的：探讨体外冲击波碎石术(ESWL)治疗尿路结石的有效性和安全性。方法：结合文献，回顾分析1993-2004年采用ESWL治疗尿路结石患者2725例，其中肾结石922例，输尿管结石1789例，膀胱结石14例。结果：随访3个月，结石排净率94．4％(2572／2725)，结石残留109例(4．0％)，16例无效(0．6％)，改用手术治疗。结论：ESWL具有治疗成功率高、副作用少、无严重并发症的优点，是治疗尿路结石安全、有效的方法。     

超声技术在体外冲击波碎石中的应用

本文介绍了作者在近５年时间里，采用西德Ｗｏｌｆ体外冲击波碎石机（该机使用超声影像定位系统）共治疗３００６例尿路结石病人和４１０例胆结石病人的经验。本文将超声定位系统与Ｘ线定位系统做了比较。结果显示超声定位不仅可替代Ｘ线定位，而且还可以显示透Ｘ线的阴性结石。同时还可以定位的治疗胆囊结石。超声不仅可清楚定位不同部位的尿路结石。而且还可以鉴别一些不适宜碎石治疗的泌尿系统疾病。如肾髓质海绵肾和肾盏憩室合并     

Sialendoscopy-assisted transfacial surgical removal of parotid stones

Minimally invasive surgical approaches to parotid stones (such as extra-corporeal shockwave lithotripsy and sialendoscopy) have proved to be effective in a high percentage of cases, although success depends on factors such as the localisation of the stone, its size and its mobility. The failure rate of 10% is largely due to large and impacted stones and, in such cases, a combined external and sialendoscopic approach can be used to avoid morbidity and the risks of more invasive superficial parotidectomy. We treated eight patients with large parotid stones (>7 mm) using a sialendoscopy-assisted transfacial surgical approach that was effective in all but one case, which was successfully solved by combining this procedure with extra-corporeal lithotripsy and operative sialendoscopy. Our results confirm that the combined approach is a valid alternative to parotidectomy for large parotid stones and should be added to other minimally invasive techniques aimed at restoring the function of the affected parotid gland.     

经皮肾微造瘘取石术结合ESWL治疗复杂性肾结石

目的:探讨经皮肾微造瘘取石术(PCNL)结合ESWL治疗复杂性肾结石的临床效果.方法:对34例复杂性肾结石患者采用经皮肾微造瘘取石术,结合一次或多次ESWL治疗.结果:经皮肾微造瘘取石术结合一次ESWL治疗后结石清除率为76.5%,二次ESWL治疗后结石清除率88.2%,三次ESWL治疗后结石清除率为94.1%.结论:经皮肾微造瘘取石术结合一次或多次ESWL治疗复杂性肾结石是安全,有效的方法.     

Extracorporeal shock-wave lithotripsy for retained common bile duct stones

Retained common bile duct stones (CBDS) become a challenging problem when percutaneous and endoscopic methods fail. Extracorporeal shock-wave lithotripsy (ESWL) is a noninvasive and effective treatment modality, and can be used as an alternative treatment of retained CBDS. We report our experience with 20 patients who had retained CBDS, using a second-generation electromagnetic lithotriptor. Thirteen patients who had cholecystectomy and common bile duct exploration, with stone extraction and T-tube drainage, were in the early postoperative period. Seven patients had undergone previous endoscopic sphincterotomy and nasobiliary drainage. Fourteen patients had only one ESWL session. Stone fragmentation rates were 100% and 57% in patients with T-tube and nasobiliary catheter, respectively. The overall stone fragmentation rate was 85% and complete stone clearance was achieved in all these patients (85%). Complications were mild and relatively infrequent (20%). There was no mortality. We conclude that ESWL for retained CBDS is a safe, effective and minimally-invasive treatment modality. ESWL should be considered as a significant alternative to surgery when endoscopic and percutaneous treatment modalities are not successful.     

梯形式升降电压法在体外冲击波碎石中的应用效果评价

目的：探讨梯形式升降电压法在体外冲击波碎石中的碎石效果。方法对47例泌尿系结石患者在行体外冲击波碎石治疗时运用梯形式升降电压三步法进行碎石治疗。结果本组患者体外冲击波碎石治疗显效率为72．3％,总有效率为87．2％。结论在体外冲击波碎石术中应用梯形式升降电压法碎石效果显著,可促进结石排出。     

Utility of the Guy’s Stone Score in predicting different aspects of percutaneous nephrolithotomy

Objective

To evaluate Guy’s scoring system (GSS) as a grading system for complexity of kidney stone before percutaneous nephrolithotomy (PCNL) as a predictor for different items of outcome.

B 超定位下行体外电磁冲击波碎石术治疗男性尿道结石60例临床体会

目的：总结男性尿道结石在B超定位下行体外电磁冲击波碎石术（ ESWL）治疗的临床体会。方法选取60例男性尿道结石患者在B超定位下采取多种体位行ESWL治疗。结果59例尿道结石ESWL治疗后结石成功排净,1例碎石失败（因患者在碎石过程中情绪过于紧张,放弃碎石治疗）,成功率为98.3％。结论男性尿道结石在B超定位下行ESWL治疗效果好,值得在临床上推广应用。     

输尿管软镜下钬激光碎石治疗体外震波碎石失败后复杂性输尿管结石的临床探讨

目的：探讨输尿管软镜下钬激光碎石治疗体外震波碎石失败后复杂性输尿管结石的临床效果。方法选取2014年2月-2014年12月期间该院收治的复杂性输尿管结石患者80例,其中40例体外震波碎石失败后使用微创经皮肾穿刺取石+术(MPCNL)的患者作为对照组,另外40例体外震波碎石失败后使用输尿管软镜下钬激光碎石治疗的患者作为研究组,分析研究两组的治疗效果。结果对照组患者碎石成功率为95.0%(38/40),研究组患者中碎石成功率为92.50%(37/40),上段结石成功率80.00%(8/10),中段结石成功率90.00%(9/10),下段结石成功率95.00%(19/20),失败3例,占7.50%(3/40),研究组与对照组碎石成功率之间差异无统计学意义(P>0.05)。其中有2例冲入肾盂后再次经输尿管软镜下钬激光碎石治疗,1例通过后腹腔镜下输尿管结石切开取石的方式取石,手术中输尿管穿孔1例,手术平均时间(65±15.50)min,住院时间(7.50±1.50)d。结论输尿管软镜下钬激光碎石是一种治疗体外震波碎石失败后复杂性输尿管结石的可靠手段,临床应用前景广阔。     

经皮肾镜治疗体外震波碎石失败的上尿路结石的临床研究（附视频）

目的探讨经皮肾镜技术应用于体外震波碎石（EswL）治疗失败的上尿路结石的疗效和安全性。方法本组共26例,男19例,女7例,年龄25～67岁,结石直径1～2．5cm,既往均有不同次数ESWL史,行肾镜下超声或气压弹道碎石,对于较低位置输尿管结石者则更换输尿管镜下碎石。结果全部病例均一次性成功建立单通道,通道建立时间6～17min,结石处理时间20～105min,出血量10～30ml。术中发现游离型结石7侧,其余25侧结石周围均有不同程度炎性息肉包裹,结石与周围管壁粘连,6例结石中心有大量基质成分堆积。术后复查清石率75％（24／32）,无临床意义残石率25％（8／32）。结论肾镜可有效治疗ESWL治疗失败的上尿路结石。