Objective To investigate the clinical applications of plasma shock wave lithotripsy （PSWL） in the treatment of calculi via choledochoscope. Methods Between 2004 and 2009, 56 huge residual calculi (54 cases) were underwent PSWL via choledochoscope treatment in our hospital. Calculi size: diameter ≤10 mm in 9 calculi, 10 mm lt;diameter ≤15 mm in 24 calculi, 15 mm lt;diameter ≤20 mm in 17 calculi, and diameter gt; 20 mm in 6 calculi. Twenty four cases of these 54 patients had bile duct stricture. Procedure: Firstly found the calculus, and then the lithotriptor wire was introduced to the place 0.5-1.0 mm far away from the calculus surface through choledochoscope channel, and powered on, fired, destructed. Results Forty-eight cases of 54 patients were cured by PSWL with 1 times, 2 cases with 2 times, 2 cases with 3 times, and 2 cases with 4 times. Shock 4-300 times were exported per PSWL, with an average of 65 times. Crushing each stone needed shock for 4-680 times, with an average of 77 times. The calculi were ruptured in different degrees by PSWL, of which 20 cases were completely ruptured. All calculi were completely extracted. Except one case with bile duct stricture was found a small amount of bile duct bleeding during operation, all other patients had no operation complications. Conclusion PSWL technique plays an important role in lithotripsy. It is easy to deal with intrahepatic impacted calculi by PSWL, especially the pigment stones with rough surface.
目的 探讨经胆道镜联合钬激光碎石治疗肝内外胆管难取性结石的价值。方法 纤维胆道镜窥视下用钬激光碎石治疗肝内外胆管难取性结石29例，观察临床效果。结果 经1～3次胆道镜下钬激光碎石治疗，28例患者结石全部取尽，1例未完全取净，成功率为96.55%（28/29）； 近期无胆道出血、漏胆、黄疸等并发症发生。26例获得随访，随访时间6～20个月，平均13个月，未发现结石复发及胆管狭窄。结论 经胆道镜钬激光碎石是一种治疗肝内外胆管难取性结石简便、安全及有效的方法。
Objective To evaluate the value of Ureteral Stent Placement before Extracorporeal Shock Wave Lithotripsy (ESWL). Methods We searched the Cochrane Central Register of Controlled Trials (Issue 4, 2010), MEDLINE (OVID 1950 to April 2010), EMbase (1979 to April 2010), CBM (1978 to April 2010), CNKI (1979 to April 2010), and VIP (1989 to April 2010), and manually searched journals as well. All the randomized controlled trials (RCTs) of treating ureteral stone with ESWL after stent placement were included. We evaluated the risk of the bias of the included RCTs according to the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. The Cochrane Collaboration’s software RevMan 5.0 was used for meta-analysis. Results Three RCTs with C-level evidence involving 319 ureteral stone patients were identified. The results of meta-analyses showed that: a) Effect of treatment: The ureteral stent placement before ESWL did not take better effects in aspects of the complete clearance rate (WMD= 1.10, 95%CI 0.87 to 1.38), the quantity of lithotripsy (WMD= 0.43, 95%CI – 1.05 to 0.19), the frequency of shock wave (WMD= 0.00, 95%CI – 0.25 to 0.25), and the power of shock wave (WMD= 0.20, 95%CI – 0.05 to 0.46); and b) Postoperative complications: The ureteral stent placement were prone to cause dysuria (RR= 2.30, 95%CI 1.62 to 3.26), microscopic hematuria (RR= 2.66, 95%CI 1.97 to 3.58), gross hematuria (RR= 6.50, 95%CI 1.50 to 28.15), pyuria (RR= 1.78, 95%CI 1.44 to 2.21), positive urine culture (RR= 2.13, 95%CI 1.71 to 2.64), and suprapubic pain (RR= 3.10, 95%CI 1.59 to 6.04). Conclusions Ureteral stent placement before ESWL is inadvisable. Multi-factors which lead to bias affected the authenticity of our review, such as low-quality and small amount of RCTs. Further large-scale trials are required.
目的 探讨腹腔镜下胆道镜联合微爆破碎石术仪治疗肝胆管结石的安全性及治疗效果。 方法 回顾分析2008年7月－2012年6月183例胆道结石患者，行腹腔镜下胆道镜联合微爆破碎石仪治疗或单纯经内镜Oddi括约肌切开取石治疗的临床资料。87例患者在术中均应用微爆破碎石仪碎石（微爆破组），96例患者行单纯经内镜Oddi括约肌切开术或经内镜乳头切开术碎石（对照组）。 结果 微爆破组碎石成功率100%，结石取净率85.06%（74/87），微爆破组的碎石时间、平均住院时间、平均住院总费用、并发症发生率均明显低于对照组（P＜0.05）。 结论 腹腔镜下胆道镜联合微爆破碎石术在治疗肝胆管结石病方面，具有微创、安全、经济有效的优点，能降低结石残留率及取石次数，值得临床推广。
【摘要】 目的 探讨肾镜结合气压弹道碎石治疗膀胱结石的临床疗效。 方法 分析2004年9月－2011年3月男性膀胱结石患者87例的临床资料。结石直径1.5~6.7 cm，使用肾镜结合气压弹道碎石术治疗，统计手术时间、手术并发症。随访3个月，观察有无尿道狭窄。 结果 所有患者碎石成功，平均手术时间为37 min，无残留结石，无膀胱穿孔、感染性休克、膀胱大出血等并发症；术后3个月随访，经尿道手术者均未发现尿道狭窄。 结论 肾镜下气压弹道碎石术是治疗膀胱结石安全、有效的方法。【Abstract】 Objective To explore the clinical efficacy of pneumatic ballistic lithotripsy via nephroscope in treating patients with bladder stones. Methods We retrospectively analyzed the clinical data of 87 patients with bladder stones from September 2004 to March 2011. The diameter of the stones were ranged from 1.5 to 6.7 cm. The patients underwent peneumatic ballistic lithotripsy via nephroscope. We recorded the operation time and complications, and observed the incidence of urethrostenosis 3 months after the beginning of the follow-up. Results All stones were fragmented and removed successfully. The average operation time was 37 minutes. No residual stone, bladder perforation, infective shock or severe bleeding of the bladder occurred. During the 3-month follow-up, no utethrostenosis occurred. Conclusion Pneumatic ballistic lithotripsy via nephroscope is a safe and efficient technique in treating bladder stones.
【摘要】 目的 探讨良性前列腺增生（benign prostatic hyperplasia，BPH）伴膀胱结石的有效腔内治疗方法。〖HTH〗方法 2003年6月-2009年12月，使用F26号电切镜外鞘作为撑开器，气压弹道和（或）钬激光粉碎膀胱结石，经尿道前列腺电切术 （transurethral resection of the prostate，TURP） 治疗BPH伴膀胱结石86例。患者年龄58～83岁，平均68.6岁；病程2～8年，平均5.2年。术前患者国际前列腺症状评分（international prostate symptom score，IPSS）为（24.6±3.9）分，生活质量（5.7±0.6）分；前列腺重量（46.5±6.8） g，剩余尿量（185±58） mL，最大尿流率（5.7±2.3） mL/s。 结果 86例均一次手术成功。碎石时间为16~58 min，平均38 min；前列腺电切时间40~100 min，平均65 min。术中无并发症发生。术后 5~8 d拔除尿管，平均6.5 d。术后4 例出现前尿道狭窄，经治疗后痊愈。54例获随访，随访时间2~6个月，平均3个月。术后2个月，54例最大尿流率升至（18.5±4.1） mL/s，剩余尿量下降至（16±22） mL，IPSS评分下降至（7.8±1.6）分，生活质量（2.5±0.3）分，与术前比较差异均有统计学意义（Plt;0.01）。 结论 经尿道碎石术和TURP一次性治疗BPH伴膀胱结石安全、有效、经济。【Abstract】 Objective To explore an effective endourologic treatment method for benign prostatic hyperplasia (BPH) with bladder calculi. Methods From June 2003 to December 2009, ballistic or holmium laser lithotripsy by outer sheath resectoscope and transurethral resection of the prostate (TURP) were performed on 86 patients with BPH and bladder calculi. The patients aged 58 to 83 years old, averaging at 68.6 years. Duration of their disease course ranged from 2 to 8 years, averaging 5.2 years. Before surgery, the international prostate symptom score (IPSS) was 24.6±3.9; the score of quality of life (QOL) was 5.7±0.6; prostatic weight was (46.5±6.8) g; residual urine (RU) volume was (185±58) mL; and the peak urine flow rate (Qmax) was (5.7±2.3) mL/s. Results The operations were completed successfully in all cases with a mean lithotripsy time of 38 min (16-58 minutes) and a mean TURP time of 65 min (40-100 minutes). No complications occurred during the operation. Urethral catheter was withdrawn 5-8 days after operation, with a mean period of 6.5 days. Four patients had anterior urethral stricture after operation, but recovered through treatment. Fifty-four patients were followed up for 2 to 6 months with an average follow-up time of 3 months. Two months after the operations, IPSS decreased to 7.8±1.6; Qmax increased to (18.5±4.1) mL/s; RU decreased to (16±22) mL and QOL was 2.5±0.3. Compared with preoperative conditions, the differences were all statistically significant (P＜0. 01). Conclusion Transurethral lithotripsy combined with TURP is an effective, safe and economical treatment for benign prostatic hyperplasia with bladder calculi.