Effects of repeated extracorporeal shock wave lithotripsy treatment on renal and ureteral calculi during period of stone fragments expelling
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摘要: 目的 探讨重复行体外冲击波碎石术(extracorporeal shock wave lithotripsy,ESWL)治疗肾结石、输尿管结石的疗效及相关并发症情况。 方法 选取蚌埠医学院第一附属医院2010-2015年间采用ESWL治疗肾结石、输尿管结石208例患者进行回顾性分析,其中肾结石128例,输尿管上段结石80例,结石直径介于0.6~2.5 cm之间。于碎石治疗2周后,给予肾脏、输尿管、膀胱平片(plain film of kidney-ureter-bladder,KUB)及彩超复查,对碎石效果差的病例及时进行重复ESWL治疗,并根据患者情况,给予相应的治疗措施,促进结石的排出。同时观察患者重复碎石后并发症情况并总结并发症的预防和处理方法。 结果 重复ESWL对首次碎石失败的病例具有良好的疗效:肾结石组104例(81.2%)成功排石;输尿管结石组58例(72.5%)成功排石。重复ESWL同样存在感染、严重血尿、肾绞痛、输尿管石街形成等并发症风险。根据个体化情况选择诸如特殊体位排石、钙离子拮抗剂、α-1受体阻滞剂、抗感染、调解尿液p H值、双J管置入术等治疗和干预方法,能够应对和减少严重并发症的发生。 结论 首次ESWL后2周复诊,对碎石效果差的患者进行重复ESWL,可以提高第1个排石期的结石排出率。对重复ESWL,应严格掌握适应症,配合个性化的辅助措施,减少重复ESWL次数,采取措施预防和处理并发症,提高其安全性、有效性,缩短结石排出时间,加快结石排出,减少肾功能损害。重复ESWL可以提高结石排出率,并不增加并发症的发生率,值得临床推广应用。Abstract: Objective To summarize the effect of repeated extracorporeal shock wave lithotripsy (ESWL) treatment on renal calculi and ureteral calculi and the incidence of complications. Methods The clinical data of 208 patients with renal calculi (128 cases) and upper ureteral calculi (80 cases) undergoing ESWL in our hospital between 2010 and 2015 were reviewed.The stone size was between 0.6 cm and 2.5 cm in diameter.Two weeks after ESWL,a kidney,ureter,and bladder (KUB) X-ray and color Doppler ultrasound were performed to evaluate the status of stone-breaking,and then ESWL procedure was repeated for the patients which stone-breaking was not enough,and the corresponding treatment measures were implemented to promote the discharge of stones according to the situation of the patients.The occurrence of complications after repeated ESWL was observed and the prevention and treatment of complications were summarized. Results A satisfied result for repeated ESWL had been achieved in the patients with failure of first lithotripsy.One hundred and four (81.2%) of 128 cases of kidney stone and 58(72.5%) of 80 cases of ureteral calculi expelled stones successfully.The infection,serious hematuria,renal colic,and formation of ureteral "stone street" were the common complications.The expelling stone a special position,use of calcium antagonists and α-1 receptor blockers,anti-infection,adjusting urine p H,double J stent placement and other interventions could reduce the occurrence of serious complications according to the situation of patients. Conclusion The repeated ESWL for patients with poor stone-breaking in the first ESWL two weeks ago can improve the chances to discharge the stone in the first stone-expelling period.The repeated ESWL following the indications strictly combined with personalized auxiliary measures can decrease the times of treatment.The effective prevention and treatment of complications with improve the security and effectiveness of ESWL,shorten the time of the stone-expelling,and minify impairments of renal function.The repeated ESWL can increase the rate of stone expelling,but not increase the incidence of complications,which is worthy of clinical popularization and application.
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