Extracorporeal shock-wave lithotripsy and endoscopy: combined therapy for problematic bile duct stones

Summary Endoscopic treatment of bile duct stones is currently successful in 86% of patients. We prospectively studied the efficacy and complication rate of extracorporeal shock-wave lithotripsy (ESWL) of problematic bile duct stones combined with endoscopy. When stone removal was not possible, patients were subjected to ESWL, Fragmented stones were removed endoscopically. During 1 year, 220 patients presenting with choledocholithiasis were diagnosed and 188 were successfully treated endoscopically. In all, 3 subjects received alternative treatmenl and the remaining 29 (13%) constituted our study group: 19 (65%) were women and the mean age was 76.7 years. Overall, 22 (76%) were high-risk patients; 23 (79%) were jaundiced and 9 (31%) had cholangitis at admission. The most frequent indication for ESWL was stone size. Stone fragmentation was achieved in 80% of cases. Complications were mild and were managed conservatively. No patient died. Complete stone clearance was possible in 23 (80%) cases. The association of ESWL and endoscopy enhanced the success rate of endoscopic stone clearance from 86% to 96%. During the same period, open surgery was performed in 4 cases for residual common bile duct (CBD) stones and in 32 cases in association with simultaneous cholecystectomy.     

EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR URINARY CALCULI： 18 YEARS EXPERIENCE

Objective To report our experience of extracorporeal shock wave lithotripsy （ESWL） for patients with urinary calculi. Methods From Jun. 1987 to Dec. 2005, a total of 10100 patients with urinary calculi in the kidney or ureter accepted ESWL. The kidney stones were sorted by FDA standard. The ureteric stone was sorted by its site and retrograde pyelography. At the same time, we summarized the recurrence of kidney stone and its relationship between extracorporeal shock wave lithotripsy （ ESWL ） and hypertension. Results The efficacy for class I kidney stone was 91.2% that for class II 86. 5% and class III 72.3% , the healing rate for ureteric stone was 84. 5%. Combined retrograde pyelography and ESWL couM improve the efficacy. If ESWL failed, the ureteric stone could still be removed by operation or ureterscopy （ 1.1% ）. The rate of recurrence of kidney stone was 6. 1% and the incidence of hypertension post-treatment reached 7. 9%. Conclusion ESWL is a preferred approach to treat urinary calculi.     

ESWL治疗输尿管石街的研究

目的：总结分析输尿管石街ESWL的技巧与方法，旨在提高其单纯ESWL的成功率。方法：将117例输尿管石街分为粉末型（26例），蛇头型（72例），石块型（19例）。不同类型的石街按不同治疗方法处理。结果：①粉末型石街长度≤5cm 21例，仅药物对症排石治疗2周排净13例，4周排净8例；长度〉5cm5例，ESWL一次2周排净3例，4周排净2例。②蛇头型石街72例，其中ESWL一次2周排净38例，4周排净22例，3个月排净5例，有7例2周复查时行第二次ESWL，2～4周复查均排净。③石块型石街19例，ESWL一次2周排净3例，4周排净4例，3个月排净5例；其中有7例2周复查时行第二次ESWL，4周复查排净3例，4例行第三次ESWL，2例2个月排净，1例3个月复查排净，1例历时半年排净。上述117病例中有9例出现患侧肾绞痛或（和）发热、明显肉眼血尿，予抗炎解痉等对症治疗或感染控制后即予ESWL，症状均缓解或消失，余病例均无严重并发症。结论：ESWL治疗输尿管石街具有清除率高、损伤少、安全性高、并发症少、可重复治疗等优点，对于碎石机性能较好、ESWL技术成熟的医疗单位，尤其对于无腔内微创治疗条件的医院，目前仍可作为首选的治疗方法。     

预先留置双“J”管再行ESWL处理孤立肾肾结石35例分析

目的探讨预先留置双“J”管再行ESWL术处理孤立肾肾结石的治疗效果。方法回顾性分析我院2000年12月～2008年11月行预先留置双“J”管再行ESWL术处理孤立肾肾结石共35例,所有患者均为孤立肾肾结石,先在膀胱镜下留置该侧输尿管之双“J”管,再行ESWL术。结果21例1次ESWL成功,8例行2次ESWL成功,6例行3次ESWL成功,无并发症发生。结论预先留置双“J”管再行ESWL术处理孤立肾肾结石具有安全、高效、结石清除率高、并发症少的特点,可作为孤立肾肾结石的常规治疗方法。     

The evaluation of gallbladder function by quantitative radionuclide cholescintigraphy before and after ESWL for gallstones: Preliminary report

We assessed changes of gallbladder function including concentration and contraction in patients with gallstones after extracorporeal shock-wave lithotripsy (ESWL). The abilities of concentration and contraction were expressed as filling fraction (FF) at 90 min and ejection fraction (EF) at 30 min after a fatty diet by Tc-99m DISIDA Cholescintigraphy. A total of 12 patients who had symptomatic gallstones without cholecystitis were included in our study. ESWL failed in three cases: FF decreased in two of three cases and increased in one of three cases, whereas EF decreased in two of three cases and increased in one of three cases. In another nine cases, ESWL was successful and the gallstones were fragmented. One month after ESWL, in three of these nine cases, the gallstones had completely disappeared. In the three cases at 1 month after ESWL, FF decreased in two of three cases and increased in one of three cases, whereas EF decreased in one of three cases and increased in two of three cases. In the remaining six cases after ESWL, there were still some residual stone fragments in the gallbladder. In these six cases after 6 months, no fragments were found in the gallbladders, the third Tc-99m DISIDA Cholescintigraphy was performed. In these six cases, the changes of FF and EF, before ESWL, 1 month after ESWL, and 6 months after ESWL, were irregular and fluctuant. However, no significant improvement of gallbladder function was demonstrated even when ESWL was successful. In our preliminary results, we found that not only the residual stone fragments but also the procedure of ESWL may impair gallbladder function by evidence of a noninvasive and quantitative Tc-99m DISIDA Cholescintigraphy.     

ESWL治疗胆总管结石88例临床分析

目的:探讨应用体外冲击波碎石技术(ES WL)治疗胆道系统结石的效果。方法:经B超检查确诊为单纯胆总管结石88例患者,胆囊造影证实胆囊功能良好,采用国产威达牌B超定位ES WL机(冲击波总量≤50 J/次)碎石并辅以中西药综合治疗。结果:85例均经ES WL碎石和中医结合治疗而治愈,治愈率达96.6%(85/88)。其中,碎石后在1月内结石完全排净者52例,治愈率为59.1%;2月内净排者17例,治愈率为19.3%;3月内净排者13例,治愈率为14.8%;4~6个月内排净者2例,治愈率为2.3%。结论:ES WL术作为非手术治疗胆道系统结石是有效的,辅以中西医结合治疗手段能提高治愈率,胆总管结石更易排出。     

体外冲击波碎石术治疗108例男性尿道结石患者的护理

我院用PIEZOLITH2300和PIEZOLITH2501型体外冲击波碎石机治疗原位尿道结石108例，改变了将结石推回膀胱内碎石，用膀胱镜钳夹取石或经会阴部开放式手术切开取石等传统治疗方法。这种治疗方法简单、患者痛苦小、治疗成功率100％，是治疗尿道结石的首选方法。该文总结了术前、术中、术后及并发症的护理，并介绍了治疗后常见并发症产生机理及预防措施。     

Treatment of ureteric lithiasis with retrograde ureteroscopy and holmium:YAG laser lithotripsy vs extracorporeal lithotripsy

OBJECTIVE

To analyse the efficiency of extracorporeal shockwave lithotripsy (ESWL) vs retrograde ureteroscopy and holmium:YAG laser lithotripsy, as ESWL is successful in 67–90% of cases but endoscopic lithotripsy with pneumatic lithotrites or lasers is successful in 90–96% of distal ureteric calculi, and holmium:YAG lithotripsy is effective in proximal ureteric calculi.

PATIENTS AND METHODS

From April 2006 to April 2008 we assessed 164 patients undergoing ureteric lithiasis in two homogeneous groups: group A included 83 treated with retrograde ureteroscopy and holmium:YAG endoscopic lithotripsy, and group B, 81 treated by ESWL. For laser lithotripsy we used 2071 mJ pulses at 3–6 Hz, with a mean of 1105 pulses and 2.5 kJ of total energy. ESWL was carried out using 37.5–87.5 mJ shock waves, a mean of 3650 shock waves and 187.6 J, with a radioscopy time of 1–4 min. The results were assessed after 3 weeks with plain films and ultrasonography, or urography. The efficiency of each procedure was assessed by calculating the relative risk, and results compared using the chi‐square or Student’s t‐test. The efficiency quotient (EQ) was determined for both procedures, and the focal applied energy quotient (FAEQ) used to assess ESWL.

RESULTS

The overall success rate for retrograde ureteroscopy and laser lithotripsy was 96.4% (80/83 patients), with an EQ of 0.52; a JJ catheter was placed in 67 patients. The success rate for the first ESWL session was 48%, and after repeat ESWL was 64% (52/81 patients), giving an EQ of 0.39. For successful treatments the FAEQ was 9.22, vs 6.47 for the failures (P < 0.005). There was a significant difference (P < 0.001) favouring laser lithotripsy, with an absolute benefit of 46% (95% confidence interval 33.8–57.9%), and number needed to treat of 2 (2–3), but no significant differences for lumbar ureteric calculi.

CONCLUSIONS

Endoscopic lithotripsy with the holmium laser is more effective than ESWL, but for lumbar ureteric calculi ESWL is therapeutically recommended as it is less invasive.     

输尿管中下段结石ESWL急诊治疗137例疗效分析

我院2004年10月-2007年12月应用体外冲击波碎石术（ESWL）及中西药协同治疗急性输尿管中下段结石嵌顿伴绞痛137例,取得良好效果,现报告如下。 1临床资料1.1临床资料本组137例,男101例,女36例,年龄16～80岁,平均36岁。     

泌尿系结石体外震波碎石术600例临床护理体会

目的探讨体外震波碎石术的护理方法。方法对600例泌尿系结石行体外震波碎石术治疗的患者,给予术前、术中、术后细致的心理护理及健康指导。结果全部患者无碎石恐惧感,顺利接受碎石治疗,并逐渐排出结石。结论对泌尿系结石体外震波碎石术患者进行细致的护理及健康指导,可使患者积极主动配合治疗及调整饮食结构,促进排石及预防再次发生结石。