尿石症住院患者1100例分析

目的了解近年来尿石症住院患者情况的变化。方法对1998年~2003年间的尿石症住院患者1100例进行分析。结果本组中,肾结石251例(22.8%)、输尿管结石742例(67.5%)、膀胱结石97例(8.8%)、尿道结石10例(0.9%)。上、下尿路结石的比例为9.28∶1。高钙尿患者27例(13.0%)、高钙血症91例(9.1%)、高尿酸血症167例(17.8%)。结石成分分析结果:草酸钙168例(62.7%);磷酸钙59例(22.0%);尿酸及尿酸盐25例(9.3%);磷酸镁铵10例(3.7%);碳酸盐5例(1.7%);胱氨酸1例(0.4%)。治疗:ESWL658例(59.8%)、肾切开取石术35例、肾切除术6例、输尿管切开取石术92例(占8.4%)、输尿管镜加气压弹道碎石52例(4.7%)、膀胱切开取石53例(其中前列腺摘除术加膀胱切开取石术26例);膀胱镜加气压弹道碎石20例;前列腺电切术加气压弹道碎石7例;膀胱镜加大力钳碎石术9例。尿道切开取石术1例;经尿道镜取石术2例;尿道镜加气压弹道碎石3例。结论本组尿石症患者以上尿路结石为主,含钙结石占绝大多数。尽管微创手术的普遍开展,ESWL仍不失为一种创伤小、效果好的治疗方法。     

Why laparoscopic cholecystectomy today?

Traditional open cholecystectomy became the gold standard of surgical treatment for symptomatic gallstone disease during the last century. In spite of its good results, clinicians have been trying to establish effective nonsurgical methods of eliminating gallstones. Although oral, percutaneous, or retrograde litholysis can be used effectively for cholesterol stones, these represent only 10% of all gallstones. Moreover, intracorporeal lithotripsy is an invasive method, and while extracorporeal shock wave lithotripsy is a promising procedure, even after careful selection, only 70%–80% of the patients become stone-free within 1 year. In fact, none of the methods which leave the gallbladder intact are free of complications, and they are followed by 50% stone recurrence within 5 years. Since 1987, laparoscopic cholecystectomy has become the procedure of choice as it is safe and only minimally invasive. We believe that the laparoscopic technique is a promising way to the surgery of the future.     

ESWL疗效相关因素分析

近年来，随着体外冲击波碎石术（ESWL）治疗泌尿系统结石的普及，如何提高结石的治愈率、初碎的有效率、碎石的排净率，降低复碎率，避免并发症的发生，已成为临床亟待解决的问题。笔者通过14000例ESWL的疗效观察，就其相关因素进行探讨。     

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。     

经皮肾穿刺微造瘘碎石取石术治疗复杂肾结石的临床应用

目的 通过观察经皮肾穿刺微造瘘碎石取石术(MPCNL)治疗复杂肾结石的临床疗效,总结其临床价值.方法 回顾性分析2010~2011年期间收治的复杂性肾结石患者200例,其中100例患者采用经皮肾穿刺微造瘘碎石术治疗,另外100例患者进行常规的体外碎石术(ESWL).观察两组的治疗效果,主要是对住院时间、并发症,碎石率、复发率进行比较.结果观察组中住院时间、并发症发生率、碎石率、复发率等均与对照组有明显差异具有统计学意义 (P<0.05).经皮肾穿刺微造瘘碎石取石术治疗复杂肾结石的临床疗效有着姣好的临床评价.结论 采用经皮肾穿刺微造瘘碎石取石术(MPCNL)治疗复杂肾结石的效果比常规治疗的效果好,碎石率高,复发率小.对肾结石的治疗效果明显,值得临床推广使用.     

Hepatic subcapsular hematoma after extracorporeal shock wave lithotripsy (ESWL) for pancreatic stones

We present a patient with complication of huge hepatic subcapsular hematoma after extracorporeal shock wave lithotripsy (ESWL) for pancreatic lithotripsy. The hematoma measured 78–110 mm. Angiography showed a subcapsular hematoma, rather than a hematoma in the liver. In the arterial phase, the distal end of the small vessel showed spotty opacification similar to microaneurysma, suggesting that it was an injury caused by separation of the liver and its capsule, caused by the shock waves. The portal vein and hepatic vein were normal. After 8 weeks of conservative therapy, the hematoma was gradually absorbed and the patient was discharged. Eight months after the accident, the hematoma had decreased to 40 mm in size. After 20 months, it was completely absorbed. The reported rate of renal subcapsular hematoma after ESWL for renal or ureter stones is 0.1%–0.7%. To date, however, only five cases of hepatic subcapsular hematoma after right renal stone disintegration have been reported. This is the first report of hepatic subcapsular hematoma after ESWL for pancreatic stones. Received: September 11, 1998 / Accepted: April 16, 1999     

Efficacy of Spyglass-Guided Electrohydraulic Lithotripsy in Difficult Bile Duct Stones

Background/Aims:

We aimed to evaluate the efficacy and safety of Spyglass-guided electrohydraulic lithotripsy (EHL) for difficult common bile duct stones (CBD) not amenable to conventional endoscopic therapy.

Design:

A retrospective study evaluating the efficacy of Spyglass-guided EHL in treating difficult CBD stones, in a single tertiary care center.

Patients and Methods:

All patients who underwent Spyglass-guided EHL from 2012 to 2013 were compared with a historical cohort who had ECSWL.

Results:

A total number of 13 patients underwent Spyglass-guided EHL, 8 (61.5%) of them were males. The mean age was 46.5 ± 5.6 years. Bile duct clearance was achieved in 13 (100%) of them. Seventy-six percent required only one Endoscopic Retrograde Cholangiopancreatography (ERCP) to clear the CBD, 7.7% required two ERCPs, and 15.4% required three ERCPs. Adverse effects (cholangitis) occurred in one patient (10%), whereas only 30 patients (64.4%) of the ESWL group had complete CBD stone clearance. Thirty-seven percent required one ERCP to clear the CBD, 35.6% required two ERCPs, and 20% required three ERCPs. Adverse effects happened in seven (15.5%) patients, where five (11%) had cholangitis and two (4.4%) had pancreatitis.

Conclusion:

Although a retrospective design with a small sample size, we concluded that Spyglass-guided EHL is an effective procedure in treating difficult CBD stones.     

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。