输尿管下段结石行体外冲击波碎石术后的超声表现及临床意义

目的 分析输尿管下段结石行体外冲击波碎石术后的超声表现，探讨超声检查对于后期治疗的临床意义。方法 回顾性分析笔者医院2014年6月~2016年6月313例行体外冲击波碎石术的输尿管下段结石患者，术中普通B超监测碎石情况，术后观察结石直径、位置变化及输尿管壁水肿情况，经辅助药物排石治疗后，观察术后不同直径结石的1周结石排净率。结果 本组313例输尿管下段结石患者，行体外冲击波碎石术后发现结石超声影像学表现有明显增大的有185例（59.1%）定义为A组；结石变小的有53例（16.9%）定义为B组，其中有21例可见膀胱内部分排出的结石；没有明显变化的有52例（16.6%）定义为C组；有23例（7.3%）患者可见结石当时完全排入膀胱。本组313例患者中有65例（20.7%）患者可见输尿管壁水肿，厚度为4.0±1.2mm。结论 普通B超运用在超声定位的体外冲击波碎石中，特别是对于输尿管下段结石，定位率高，能实时监测，可了解碎石情况，为后期药物治疗提供指导。

Ultrasonic Appearance and Clinical Significance of Lower Ureteral Calculi after Extracorporeal Shock Wave Lithotripsy

Objective To analyze the ultrasonic appearance of lower ureteral calculi after extracorporeal shock wave lithotripsy, and to explore the clinical significance of ultrasonography. Methods A retrospective analysis of 313 patients with lower ureteral calculi underwent ESWL in our hospital from June 2014 to June 2016 was performed.During the operation, the stones were monitored by ordinary B ultrasound. The changes of the size and position of the stones and the edema of the ureter wall were observed after operation. After treatment with adjuvant drugs, the stone free rate in one week after operation was observed. Results In this group of 313 patients with lower ureteral stones after extracorporeal shock wave lithotripsy, the sizes of stones in 185 cases(59.1%) were significantly bigger than before operation, which were defined as A group; in 53 cases (16.9%), the sizes of stones were smaller than before operation,which were defined as B group, of which there were 21 cases discharged into the bladder;there were no significantly changed in 52 cases (16.6%), they were defined as C group;in 23 cases (7.3%), the stones were completely discharged into the bladder. There were 65 cases(20.7%) in this group with ureteral wall edema, thickness of 4.0±1.2mm. Conclusion Ordinary B ultrasound applied in to ultrasonic positioning in the extracorporeal shock wave lithotripsy, especially for lower ureteral stones, has high positioning rate, real-time monitoring, and can observe the changes of stones, provide guidance for the latter drug treatment.