Extracorporeal shock wave lithotripsy in children: equivalent clearance rates to adults is achieved with fewer and lower energy shock waves

OBJECTIVE

To compare the outcome, safety and efficiency of extracorporeal shock wave lithotripsy (ESWL) using an electromagnetic lithotripter for upper urinary tract stones in children and adults.

PATIENTS AND METHODS

We retrospectively reviewed data over a 5‐year period for patients with solitary, renal and upper ureteric stones measuring <2 cm in whom ESWL was the treatment method. Group A consisted of 44 children (mean [sd ] age 5.9 [4.4] years) and group B of 562 adults (mean [sd ] age 40.9 [13.1] years). The number and energy of SWs used was not predetermined and was tailored until adequate fragmentation was achieved. Initial stone reassessment was performed at 48 h and monthly thereafter. The number of SWs, intensity of SWs, stone‐free rate, auxiliary procedure rate, re‐treatment rate, complication rate and effectiveness quotient (EQ) were assessed in each group.

RESULTS

The stone‐free rate with ESWL was 84% in children and 87% in adults (P = 0.78). The EQ was 77% and 75% in children and adults, respectively (P = 0.56). The mean (sd ) number of SWs and energy required per session was 950 (349) and 11.83 (0.48) kV in children and 1262 (454) and 12.36 (0.34) kV in adults (P < 0.001). The re‐treatment, auxiliary procedure and complication rates were similar in both groups.

CONCLUSION

ESWL is as safe and effective in children as in adults for solitary renal and upper ureteric stones that are <2 cm. Children required significantly fewer and lower energy SWs to achieve equivalent results.     

ESWL治疗肾输尿管结石200例体会

目的：总结肾输尿管结石ESWL治疗经验。方法：总结分析2008年3月至2009年2月期间我科为200例肾输尿管结石患者进行ESWL治疗的临床资料。结果：本组200例病例中肾结石33例,输尿管结石167例,经ES．WL治疗1～2次后均取得满意的效果。结论：ESWL治疗肾输尿管结石具有高效、安全、损伤小的特点。     

体外震波碎石配合排石汤治疗泌尿系结石80例疗效观察

体外震波碎石配合内服自拟排石汤治疗泌尿系结石80例,总有效率达87.5 %.     

ESWL治疗泌尿系结石临床体会

目的 探讨ESWL治疗泌尿系结石疗效评价.方法 对849例患者给予ESWL治疗.效果 拟定的标准应用849例患者中取得较好疗效.结论 ESWL具有创伤小、安全高效,不需麻醉可在门诊治疗等特点,已在临床广泛采用并作为治疗泌尿系结石的首选方法.     

ESWL联合中药治疗输尿管结石的术后护理

[目的]探讨ESWL联合中药治疗输尿管结石的护理方法。[方法]对223例输尿管结石病人的治疗进行护理，指导口服本院自制中药制剂进行治疗。[结果]223例病例中1次ESWL者182例，2次者36例，3次者2例，另3例3次碎石后不能排除，改开放手术治愈。[结论]ESWL联合中药治疗对患者创伤小，恢复快，治愈率高，配合完善的术前、术中、术后的护理尤为重要，能提高治愈率。     

泌尿系结石体外冲击波碎石术后辨证施护

目的:探讨ESWL术后给予辨证施护减轻自觉症状,提高排石效果。方法:100例泌尿系结石患者被随机分为实验组和对照组,实验组于术后在常规治疗基础上给中药及辨证施护,对照组仅给予常规治疗及护理。并于术前和术后1周时进行SCL-90自评及治疗效果的评估。结果:术前两组SCL-90的躯体化、焦虑、恐怖和抑郁四因子得分均明显升高,术后1周时实验组上述四个因子得分显著减低(分别P<0.01和P<0.05),而对照组则差异不明显(P>0.05)。实验组石街形成和复震人次均显著少于对照组(P<0.05),两组最终排石的总有效率相近。结论:ESWL术后配合中药及辨证施护对缓解负性情绪、减轻疼痛,减少石街的形成,降低复震率有明显作用。     

经尿道输尿管镜联合体外震波碎石治疗输尿管结石256报告

目的探讨输尿管镜联合体外震波碎石（extracorporeal shock wave lithotripsy，ESWL）治疗输尿管结石的价值。方法2005年10月-2007年6月采用输尿管镜联合ESWL治疗输尿管结石256例，中段（56例）及下段（170例）结石用输尿管镜取石，上段（30例）结石用ESWL碎石，输尿管镜取石失败或结石残留联合ESWL治疗。结果输尿管下段结石一期结石清除率98．2％（167／170），中段结石一期结石清除率89．2％（50／56），上段结石一期结石清除率73．3％（22／30）。输尿管穿孔3例，输尿管黏膜撕脱1例，结石远端输尿管扭曲进镜致使尿管穿孔改切开取石1例，输尿管镜取石失败或结石残留联合ESWL治疗二期结石清除率91．7％（11／12）。结论输尿管镜治疗输尿管下段及中段结石成功率高，输尿管镜取石失败或结石残留联合ESWL可提高二期结石清除率。     

急诊输尿管结石ESWL治疗及护理

目的：总结急诊输尿管结石ESWL治疗的临床经验和护理体会。方法：采取B超定位,对输尿管上段结石采取仰卧位,中下段结石采取俯卧位,配合精心治疗护理。结果：120例128枚结石,1.0cm以内的结石一次粉碎成功率98%,结石排空时间为7～10d;〉1.5cm的结石排空时间为15d。结论：对输尿管结石急诊就诊者通过ESWL治疗可以解除输尿管痉挛引起的疼痛,及时解除梗阻,治疗效果立竿见影。     

能量综合调节法在体外冲击波碎石术治疗尿路结石中的应用

目的：探讨能量综合词节法在体外冲击波碎石术（ESWL）治疗尿路结石中的作用。方法：585例泌尿系统结石患者分为2组：常规ESWL治疗组258例。碎石能量采用均匀递增的方法；能量综合调节ESWL治疗组327例．碎石能量采用分时段递增的方法。对2组总治愈率及并发症的发生率进行比较。站果：常规治疗组、综合治疗组肾结石总治愈率分别为89．94％、95．19％，输尿管结石总治愈率分别为82．42％、96．4l％。并发症发生率分别为10．47％、3．98％，综合治疗组肾结石、输尿管结石治愈率明显高于常规治疗组，并发症发生率明显低于常规治病组（P均〈0．05）。站论：能量综合调节法应用于ESWL中治疗泌尿系统结石，较常规ESWL既提高了疗效，又可以最大限度地减少并发症的发生。