Efficacy of Extracorporeal Shock Wave Lithotripsy (ESWL) versus Pneumatic Ureteroscopic Lithotripsy (URSL) for Lower Ureteral Stones Therapy in Asia: A Meta-Analysis

Objective: To assess the efficacy and safety of extracorporeal shock wave lithotripsy or pneumatic ureteroscopic lithotripsy for lower ureteral stones therapy, we sought to identify and summarize randomized controlled trials that were used to treat distal ureteral stone. Methods: Eligible studies were identified from electronic databases. Database search, quality assessment, and data extraction were performed by two reviewers independently. Our primary outcome was the stone-free rate. Secondary outcomes were the fragmentation rate, complications and the rate of re-treatment and secondary procedures. The results were assessed by Review Manager 5.0. Publication bias was evaluated by Stata 11.0. Results: 13 trials were included. Meta-analysis of pooled data showed that pneumatic ureteroscopic lithotripsy demonstrated a significant advantage over extracorporeal shock wave lithotripsy (OR = 0.14, 95% CI [0.09, 0.23], P < 0.00001) in the stone-free rate;the extracorporeal shock wave lithotripsy had statistical disadvantages over pneumatic ureteroscopic lithotripsy in the fragmentation rate of ureteral stones (OR = 0.14, 95% CI [0.05, 0.39], P = 0.0002);and the rate of re-treatment and secondary procedure was lower in pneumatic ureteroscopic lithotripsy than in extracorporeal shock wave lithotripsy (OR = 5.37, 95% CI [2.61, 11.07], P < 0.00001). Our pooled results showed that there was no statistical difference between extracorporeal shock wave lithotripsy and pneumatic ureteroscopic lithotripsy in hematuresis, ureteral stricture and urosepsis or fever. Finally extracorporeal shock wave lithotripsy had a higher incidence of colic pain than pneumatic ureteroscopic lithotripsy. Conclusion: The present meta-analysis suggested that pneumatic ureteroscopic lithotripsy had large advantages over extracorporeal shock wave lithotripsy in the treatment of lower ureteral stones.

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.

Epidural anesthesia is effective for extracorporeal shock wave lithotripsy of pancreatic and biliary calculi

AIM: To evaluate the efficacy of thoracic epidural analgesia for extracorporeal shock wave lithotripsy (ESWL). METHODS: ESWL is an effective, non-invasive technique for the treatment of difficult pancreatic and large bile duct calculi. The procedure is often painful and requires large doses of analgesics. Many different anesthetic techniques have been used. Patients with either large bile duct calculi or pancreatic duct calculi which could not be extracted by routine endoscopic methods were selected. Thoracic epidural anesthesia (TEA) was routinely used in all the subjects unless contraindicated. Bupivacaine 0.25% with or without clonidine was used to block the segments D6 to D12. The dose was calculated depending on the age, height and weight of the patient. It was usually 1-2 mL per segment blocked.RESULTS: Ninety eight percent of the 1509 patients underwent ESWL under TEA. The subjects selected were within American Society of Anesthesiologists grade Ⅰ to Ⅲ. ESWL using EA permitted successful elimination of bile duct or pancreatic calculi with minimal morbidity. The procedure time was shorter in patients with TEA than in those who underwent ESWL under total intravenous anesthesia. CONCLUSION: Almost all patients undergoing ESWL with EA had effective blocks with a single catheter insertion and local anesthetic injection.

Outcome of a session of extracorporeal shock wave lithotripsy before endoscopic retrograde cholangiopancreatography for problematic and large common bile duct stones

AIM To compare the efficacy of a session of extracorporeal shock wave lithotripsy(ESWL) before endoscopic retrograde cholangiopancreatography(ERCP) vs ERCP only for problematic and large common bile duct(CBD) stones.METHODS Adult patients with CBD stones for whom initial ERCP was unsuccessful because of the large size of CBD stones were identified. The patients were randomized into two groups,an "ESWL + ERCP group" and an "ERCP-only" group. For ESWL + ERCP cases,ESWL was performed prior to ERCP. Clearance of the CBD,complications related to the ESWL/ERCP procedure,frequency of mechanical lithotripsy use and duration of the ERCP procedure were evaluated in both groups.RESULTS There was no significant difference in baseline characteristics between the two groups. A session of ESWL before ERCP compared with ERCP only resulted in similar outcomes in terms of successful stone removal within the first treatment session(74.2% vs 71.0%,P = 0.135),but a higher clearance rate within the second treatment session(84.4% vs 51.6%,P = 0.018) and total stone clearance(96.0% vs 86.0%,P = 0.029). Moreover,ESWL prior to ERCP not only reduced ERCP procedure time(43 ± 21 min vs 59 ± 28 min,P = 0.034) and the rate of mechanical lithotripsy use(20% vs 30%,P = 0.025),but also raised the clearance rate of extremely large stones(80.0% vs 40.0%,P = 0.016). Post-ERCP complications were similar for the two groups.CONCLUSION Based on the higher rate of successful stone removal and minimal complications,ESWL prior to ERCP appears to be a safe and effective treatment for the endoscopic removal of problematic and large CBD stones.

ACUPUNCTURE ANAESTHESIA IN TREATING URINARY TRACT STONE WITH EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY

The anaesthetic effect of acupuncture on 40 patients during extracorporeal shockwave lithotripsy was observed in this study.The anaesthetic rate in 20 eases under manual acupunc-ture was 85％,and that in the other 20 patients under electro-acupuncture anaesthesia was 90％.Under the anaesthesia the patients were conscious and in normal physical conditions.The observationsindicate that the electro-acupuncture anaesthesia is safe,economical and effective.Additionally.it lib-erates acupuncturists from heavy needling manipulation.The relationship between the analgesic ef-fects antI the ages is analysed as well.

Effect of extracorporeal shock wave lithotripsy for the postoperative residual bilestone of choledocholithiasis

Objective To explore the effect of extracorporeal shock wave lithotripsy(ESWL) for the postoperative residual bilestone of choledocholithiasis.Method Inject contrast medium of biligrafin via T tube.After accurate apposition with X ray,take lithotripsy with extracorporeal shock wave. In some cases T tube washing and transcutaneous choledochoscope were used to take out bilestones.Results The lithotripsies were successful in all the 48 patients and the lithotriptic rate was 100%.The removing rate of bilestones was over 90% with washing method.Choledochoscope was used in 6 cases,and 48 patients were completely healed.In them 24 suffered from slight expanding pain in right upper abdomen or nausea and no any complications and sequelae in others.Conclusion ESWL is an effect method to heal patients with the postoperative residual bilestones of choledocholithiasis.

Extracorporeal Shock Wave Lithotripsy in the Treatment of Single Ureteric Stone. Initial Data from Iraq

Background: Extracorporeal shock wave lithotripsy (ESWL) became the first line in the treatment of ureteric stone after failure of conservative treatment because of its safety, simplicity and effectiveness. It is not invasive procedure and can be done on outpatient basis without anesthesia and with few complications which is most probably temporary and treatable. The objective of this study is to evaluate the efficiency and safety of ESWL in treatment of ureteric stone in Iraq. Materials and Methods: A total of 112 Iraqi patients with ureteric stones were participated in this prospective observational study in which patients scheduled for ESWL treatment for a period of 6 months. Patients were divided into 2 groups: 1) Group 1: 52 patients with proximal ureteric stone;2) Group 2: including 60 patients with distal ureteric stone. Preoperatively all patient underwent bowel preparation and were asked to fast for 8 hours before the procedure. Results: The age ranged between 22 and 55 with mean of 42 (SD = 5) years. Around 46% had proximal ureteric stone and the rest were in distal ureter. Around 44% needed one session and 40% needed two sessions to be stone-free respectively. In regards to associated symptoms, 74% had ureteric colic, 3% haematuria, 43% microhematuria and 12% UTI. Mild hydronephrosis was found in 90% of the cases and 30 reported had previous intervention. Success rate was 90%. Conclusions: ESWL is safe and effective in treatment of ureteric stone with few complications and must be regarded first choice after conservative treatment in a patient with uncomplicated ureteric stone.

Changes of serum β2-MG, Cys C and urine mAlb levels in patients with ureteral calculi before and after extracorporeal shock wave lithotripsy and their clinical significance

Objective:To investigate the changes of serumβ2 microglobulin(β2-MG),cystatin C(CysC)and urine microalbumin(mAlb)levels in patients with ureteral calculi before and after extracorporeal shock wave lithotripsy and their clinical significance.Methods Sixty-eight patients with ureteral calculi admitted to the hospital between June 2018 and June 2019 were selected as the observation group.35 volunteers who received physical elimination in the hospital during the same period were selected as the control group.Levels ofβ2-MG,Cys C and urine mAlb in the observation group were compared before and after treatment,and compared with those in the control group.Changes in serumβ2-MG,Cys C and urine mAlb levels and renal function indicators[blood urea nitrogen(BUN),serum creatinine(SCr)]in patients with different prognosis in the observation group after treatment were analyzed.The value of serumβ2-MG,Cys C and urine mAlb levels in the diagnosis and treatment of ureteral calculi was analyzed with ROC curve.The correlations between serumβ2-MG,Cys C and urine mAlb levels and renal function indexes were analyzed.Results Serumβ2-MG,Cys C and urine mAlb levels in the observation group before treatment were significantly higher than those in the same group after treatment or those in the control group(P<0.05).Serumβ2-MG,Cys C and urine mAlb levels,BUN and SCr in patients with residual stones were significantly higher than those in patients without(P<0.05).ROC curve analysis showed that the sensitivity and the area under the curve of combined detection of serumβ2-MG,Cys C and urine mAlb levels for evaluating the curative effect of extracorporeal shock wave lithotripsy on ureteral calculi were significantly higher/larger than those of single detection of the three(P<0.05).Partial correlation analysis showed that serumβ2-MG,Cys C and urine mAlb levels were positively correlated with BUN and SCr(P<0.05).Conclusion There are obvious changes of serumβ2-MG,Cys C and urine mAlb levels in patients with ureteral calculi before and after extracorporeal shock wave lithotripsy.The combined detection of the three indexes is helpful for the early diagnosis of ureteral calculi and the evaluation of renal function after lithotripsy.They can provide reference for protecting renal function in patients with ureteral calculi treated by extracorporeal shock wave lithotripsy.

Indications and contraindications for shock wave lithotripsy and how to improve outcomes

For over 35 years shock wave lithotripsy has proven to be an effective,safe and truly minimally invasive option for the treatment of nephrolithiasis.Various technical factors as well as patient selection can impact the success of the procedure.We used published work focusing on outcomes of shock wave lithotripsy,risk of complications,and strategies for improving stone fragmentation to create this review.Multiple patient and technical factors have been found to impact success of treatment.Skin to stone distance,stone density and composition,size and location of the stone within the urinary system all influence stone free rates.A slower rate with a gradual increasing voltage,precise targeting,proper coupling will improve stone fragmentation and decrease risk of complications.The selection of appropriate patients through a shared decision making process and attention to the technical factors that improve stone free rates is key to providing an effective treatment and patient satisfaction.

The Relationship Between the Energy Levels of Shock Waves and the Degree of Renal Damage After ESWL:A Prospective Clinical Matching Trail

In an attempt to understand the effects of high energy shock wave (HESW)on renal function, we studied prospectively 40 patients with nephrolithiasis in 4 groups,using same voltage with different numbers of shock wave therapy to identify the difference of effects on renal function. Stone burdens and posit ion were similar in these groups. Each group received 1500, 2000, 2500 or 3000 puises at 12. 5 KV on JT-3lithotripotor respectively. All the groups had significantly increased the levels of urinary NAG, β2MG, ALB and serum β2MG, which reached the highest values on 1-3days after ESWL (P<0. 001), and then decreased to the pre-ESWL levels except urinary NAG in group Cand D and serum β2MG which were still significantly higher (P<0.05) than those before-ESWL on the 7th day after ESWL. There was significant correlation between either urinary NAG (γ=0. 977, P<0. 05) or β2MG (γ=0. 933, P<0. 001) with the number of shock wave. In addition, urinary NAG and β2MG increased significantly when the number of shock waves was over 2500 shots.These above findings suggest that shock wave had induced acute changes in renal functions and transient renal tubular damages, although these functional changes recovered within one week, and the tubular damage might last longer than 7 days , In order to avoid serious renal damage, it’s necessary to limit the energy level of shock waves under 12. 5 KV×2500 shots by using JT-3 lithotriptor.

血清β2-MG、ACTH及降钙素原水平预测肾结石患者ESWL术后肾损伤的价值

目的探讨血清β2微球蛋白(β2-MG)、促肾上腺皮质激素(ACTH)及降钙素原水平预测肾结石患者体外冲击波碎石术(ESWL)后肾损伤的价值。方法前瞻性选取2021年6月至2023年6月青岛市第五人民医院收治的100例肾结石患者作为研究对象。患者均行ESWL,对患者进行术后7 d随访,根据是否发生肾损伤分为发生组(n=8)与未发生组(n=92)。收集患者基线资料,包括性别、年龄、体重指数、肾损伤史、吸烟、饮酒、结石直径、结石位置、结石数量、手术时间,检测实验室指标(甘油三酯、总胆固醇、β2-MG、ATCH、皮质醇、降钙素原)。比较两组基线资料及实验室指标;采用非条件Logistic逐步回归分析肾结石患者ESWL术后发生肾损伤的危险因素;通过受试者操作特征(ROC)曲线分析β2-MG、ACTH、皮质醇、降钙素原预测肾结石患者ESWL术后肾损伤的价值。结果两组性别构成比、年龄、体重指数、肾损伤史、吸烟、饮酒、结石直径、结石位置、结石数量、手术时间、甘油三酯、总胆固醇组间比较,差异均无统计学意义(P>0.05);发生组β2-MG、ACTH、皮质醇、降钙素原水平分别为(3.45±0.89)mg/L、(36.29±6.08)ng/L、(139.06±19.74)μg/L、(2.92±0.95)ng/mL,均显著高于未发生组[(2.31±0.72)mg/L、(26.71±5.02)ng/L、(121.15±16.93)μg/L、(1.48±0.41)ng/mL],差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,β2-MG、ACTH、皮质醇、降钙素原是肾结石患者ESWL术后发生肾损伤的危险因素(P<0.05)。ROC曲线分析结果显示,β2-MG、ACTH、皮质醇、降钙素原预测肾结石患者ESWL术后肾损伤发生的曲线下面积分别为0.819、0.933、0.834、0.838,敏感度分别为0.875、0.875、0.750、0.750,且P<0.05。结论肾结石ESWL术后发生肾损伤的患者β2-MG、ACTH、皮质醇、降钙素原水平显著上升,以上指标可用于预测肾结石患者ESWL术后发生肾损伤。

宁泌泰胶囊对输尿管结石患者ESWL术后排石率及疼痛程度的影响

目的探讨宁泌泰胶囊对输尿管结石患者体外冲击波碎石术(ESWL)术后排石率及疼痛程度的影响。方法选取萍乡市第三人民医院2021年1月至2022年12月收治的输尿管结石患者95例,以抽签法分为对照组(48例)、研究组(47例)。两组均行ESWL治疗,对照组术后予常规治疗,研究组基于常规治疗予宁泌泰胶囊治疗;对比两组排石率,症状消退时间,疼痛程度,血清炎性因子水平及不良反应。结果研究组排石率(74.47%)较对照组(58.33%)高,但组间比较差异无统计学意义(P>0.05);研究组血尿消失、腰痛减轻时间较对照组短,差异有统计学意义(P<0.05);研究组术后1周视觉模拟法(VAS)评分、白细胞介素6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平较对照组低,差异有统计学意义(P<0.05);组间不良反应发生率对比,差异无统计学意义(P>0.05)。结论宁泌泰胶囊治疗输尿管结石患者可提高ESWL术后排石率,促使症状消退,降低疼痛程度,减轻炎症损伤,且安全性好。

输尿管结石ESWL术后应用穴位灸法联合耳穴压豆的效果分析

目的:探讨输尿管结石体外冲击波碎石术(ESWL)后患者采用穴位灸法联合耳穴压豆的效果。方法:按照随机数表法将医院收治的80例输尿管结石患者分为两组,各40例患者。两组患者均行ESWL,对照组患者术后实施常规护理,基于此,观察组患者加用穴位灸法联合耳穴压豆,均干预7d。比较两组术后疼痛程度、恢复情况、护理满意度及并发症。结果:观察组肉眼血尿消失时间、腰痛缓解时间、结石排净时间均比对照组短(P<0.05);观察组患者术后6h、12h及术后1d、3d、7d时的VAS评分均低于对照组,差异有统计学意义(P<0.05);观察组患者并发症发生率低于对照组(P<0.05);观察组患者护理满意度高于对照组(P<0.05)。结论:穴位灸法联合耳穴压豆可减轻输尿管结石患者ESWL术后的疼痛程度,减少并发症发生,促进患者术后恢复,提高护理满意度。

ESWL联合EPVL对输尿管结石患者氧化应激反应及并发症的影响

目的探讨体外震波碎石(ESWL)联合体外物理振动排石(EPVL)对输尿管结石患者氧化应激反应及并发症发生率的影响。方法选取2020年1月至2022年1月就诊于本院的100例输尿管结石患者作为观察对象,根据随机数字表法分为对照组和观察组,各50例。对照组采用ESWL治疗,观察组在其基础上联合EPVL治疗。比较两组治疗2、3、5周后排石率,结石排尽时间、疼痛消失时间及住院时间,血清丙二醛(MDA)、8-羟基脱氧鸟苷(8-OHdG)、超氧化物歧化酶(SOD)水平,以及并发症发生率。结果与对照组比较,观察组治疗2、3、5周后排石率显著升高(P<0.05);与对照组比较,观察组结石排尽时间、疼痛消失时间及住院时间显著减少(P<0.05);与治疗前比较,观察组血清MDA、8-OhdG水平显著降低,SOD水平显著升高,观察组MDA、8-OhdG水平显著低于对照组,SOD水平显著高于对照组(P<0.05);两组并发症发生率比较差异无统计学意义(P>0.05)。结论ESWL联合EPVL能够有效治疗输尿管结石,同时还能减轻氧化应激反应及降低并发症发生率,具有临床参考价值。

通淋排石汤辅助治疗肾结石ESWL术后结石残留的临床研究

目的:探究通淋排石汤辅助治疗肾结石体外冲击波碎石(ESWL)术后结石残留的疗效及对尿白细胞(WBC)、红细胞(RBC)水平的影响。方法:选取2020年1月至2021年12月期间河南科技大学第一附属医院新区医院收治的肾结石ESWL术后结石残留患者共72例,采用随机数表法将研究对象分为观察组(36例)以及对照组(36例)。对照组患者接受常规去结石治疗,观察组患者在对照组基础上联合使用通淋排石汤辅助治疗;比较两组患者治疗后结石清除时间、碎石直径、住院时间;治疗前后腰腹痛、尿频尿急、血尿中医证候积分、尿WBC、RBC水平;统计不良反应发生情况。结果:治疗后观察组患者结石清除时间、总住院时间均短于对照组,碎石直径小于对照组,差异具有统计学意义(P<0.05)。治疗后两组患者腰腹痛、尿频尿急、尿血的中医证候积分均有不同程度降低,且治疗后观察组患者腰腹痛、尿频尿急、尿血的中医证候积分均低于对照组,差异具有统计学意义(P<0.05)。术后(治疗前)两组患者尿WBC、RBC均有不同程度上升,治疗14 d后两组患者尿WBC、RBC均有不同程度下降,且观察组患者尿WBC、RBC低于对照组,差异具有统计学意义(P<0.05)。两组患者治疗期间均未出现明显不良反应。结论:通淋排石汤能够有效帮助清除残余碎石、缓解临床症状、降低ESWL术后尿WBC、RBC水平,且不引发明显不良反应。

Investigation of infection risk and the value of urine endotoxin during extracorporeal shock wave lithotripsy

Objective To clarify the infection risks and the value of endotoxin determination in urine during extracorporeal shock wave lithotripsy (ESWL).Methods According to the distribution and complications of upper urinary calculi, 164 patients were divided into five groups. Group A consisted of 48 patients with 1 to 4 renal calculi, which were or less than 2 crn in diameter. Group B was composed of 24 patients with renal calculus larger than 2 cm in diameter or one to multiple renal calculi. Group C wes composed of 22 patients with 1 to 3 renal calculi accompanied by 1 to 2 ureteric calculi. Group D consisted of 51 patients with 1 to 3 ureteric calculi that were 0.5 to 1.2 cm in diameter, respectively. Group E included 19 patients with complicated renal calculus, such es casting and staghom renal calculus. Urine and blood samples of these patients were obtained before and after ESWL, respectively. Their urine samples were proven sterile prior to treatment. All samples were cultured for bacteria and investigated for endotoxin concentration by the limulus lysate test.Results No significant difference in serum endotoxin wes noted before and after ESWL. Blood bacterial cultures were all negative in all patients after ESWL, similar to those before ESWL. Significant increases in urine endotoxin after ESWL compared with that before ESWL in patients of Groups B, C and E were observed, respectively (P ＜ 0.05). There was no significant difference in urine endotoxin after ESWL compared with that before ESWL in patients of Groups A and D. The positive incidences of urine bacterial culture were significantly increased (P ＜ 0.05) in Groups B and C and very significantly increased ( P ＜ 0.01 ) in Group E compared with those in Groups A and D.Conclusions Urinary infection risk following ESWL was lower in patients with one to several renal calculi,which were less than 2 cm in diameter and did not interfere obviously with the urine flow or in patients with 1 to 3 ureteric calculi that were 0. 5 to 1.2 cm in diameter. The risk was higher in those with complicated calculi, such as casting, staghom renal calculus, renal calculus larger than 2 cm in diameter or renal calculi accompanied by ureteric calculi. For patients with higher infection risk after ESWL, prophylactic antibiotics are necessary even if bacteriuria is not present before ESWL. Endotoxin determination in urine is a reliable,sensitive and simple method for the diagnosis of bacterial infection in patients undergoing ESWL.

直径1~2 cm肾上盏结石经ESWL治疗无效后行FURL或PCNL的临床疗效对比

目的比较体外冲击波碎石术(ESWL)治疗直径1~2 cm肾上盏结石无效后行输尿管软镜碎石术(FURL)或经皮肾镜碎石术(PCNL)的临床治疗效果以及住院周期和住院费用的差异性。方法回顾性分析2017年1月—2021年11月就诊于徐州医科大学附属医院的101例ESWL治疗无效的肾上盏结石患者,结石直径大小为1~2 cm。根据手术方式的不同将患者分为FURL组(n=48)和PCNL组(n=53),对比2组患者术中出血量、手术时间、术后住院时间、住院费用,术前和术后1 d的炎症指标,术后6 h、24 h的疼痛视觉模拟评分(VAS),术后并发症情况以及术后1个月、术后3个月的结石清除率。结果与PCNL组相比,FURL组术中出血量更少,术后住院时间更短,术后6 h、24 h的VAS评分以及术后并发症发生率更低(P<0.05);与FURL组相比,PCNL组手术时间更短,住院费用更低(P<0.05);2组术后1 d外周血白细胞计数(WBC)、中性粒细胞和淋巴细胞比值(NLR)、C-反应蛋白(CRP)水平均升高(P<0.01),但FURL组术后WBC、NLR和CRP水平显著低于PCNL组(P<0.01);2组术后1个月、术后3个月结石清除率比较差异均无统计学意义(P>0.05)。结论直径1~2 cm肾上盏结石患者ESWL治疗失败后,选择FURL或PCNL均能有效清除结石。但FURL出血量少、住院周期短、疼痛轻微、术后并发症少,且能减轻患者术后炎症反应;而PCNL手术时间短,总体住院费用低,临床中患者可根据自身情况合理选择手术方案。

以快速康复理论为基础的量化护理干预在ESWL患者预后转归和预防复发中的作用

目的:分析以快速康复理论为基础的量化护理干预在体外冲击波碎石(ESWL)患者预后转归和预防复发中的作用。方法:选取2018年11月—2021年10月开封市人民医院收治的180例拟行体外冲击波碎石患者作为研究对象,随机将其分为研究组和对照组,每组各90例。对照组实施常规量化护理干预,研究组实施以快速康复理论为基础的量化护理干预,对比两组患者术后血尿、出血、感染发生率、住院时间、住院费用、复发率及术后生活质量相关指标评分。结果:研究组患者碎石后血尿、出血及感染发生率低于对照组,差异有统计学意义(χ^(2)=4.709、4.745、4.091,P<0.05)。研究组患者住院时间、住院费用及复发率低于对照组,差异有统计学意义(t=4.414、9.459,P<0.05;χ^(2)=5.714,P<0.05)。研究组患者术后各项生活质量评分高于对照组,差异有统计学意义(t=2.999、9.990、6.465、6.629、5.210,P<0.05)。结论:体外冲击波碎石患者实施以快速康复理论为基础的量化护理干预,可有效控制在患者碎石后血尿、出血及感染发生率,缩短住院时间和降低复发率及住院费用,改善生活质量。

ESWL和URSHL在输尿管中下段结石患者中的应用价值研究

为探讨体外冲击波碎石术(简称ESWL)与输尿管镜下钬激光碎石术(简称URSHL)在输尿管中下段结石患者中的应用价值。回顾性选取2013年9月—2017年9月在贵阳市第三人民医院接受治疗的82例输尿管中下段结石患者,按照随机数表法分为对照组和观察组,每组各41例患者。对照组接受ESWL治疗,观察组接受URSHL治疗。比较两组患者临床指标(术中出血量、手术时间、住院时间);并发症发生情况(输尿管穿孔、结石上行、发热);以及两组患者治疗有效率。结果显示,观察组患者治疗后术中出血量、手术时间、住院时间数据均明显低于对照组(P<0.05)。观察组患者并发症发生率(7.00%)低于对照组(17.00%)(P<0.05)。观察组患者的治疗总有效率(98.00%)明显高于对照组(78.00%)(P<0.05)。研究表明,采用URSHL治疗输尿管中下段结石效果较好,手术速度快、创伤小、患者术后恢复快、并发症较少、治疗有效率高,值得临床应用。

能谱CT结石成分分析在泌尿系结石体外冲击波碎石中的应用

目的:探讨能谱CT结石成分分析在泌尿系结石体外冲击波碎石(ESWL)中的应用效果。方法:选取2022年5月—2023年8月惠州市中心人民医院门诊治疗的160例泌尿系结石患者,按照随机数表法将其分为两组,各80例。两组均接受ESWL治疗,在此之前,对照组采用常规CT平扫进行结石密度计算,试验组采用能谱CT进行结石成分评估。比较两组手术相关情况、结石清除率及并发症发生率。结果:试验组一次碎石成功率高于对照组,平均体外冲击波次数、最高工作电压平均值低于对照组,平均碎石时间短于对照组,差异有统计学意义(P<0.05)。试验组结石清除率为95.00%,高于对照组的83.75%,差异有统计学意义(P<0.05)。试验组>24 h肉眼血尿发生率均低于对照组,差异有统计学意义(P<0.05);但两组其余并发症发生率比较,差异无统计学意义(P>0.05)。结论:在泌尿系结石ESWL中应用能谱CT结石成分分析能为手术创造有利条件,确保一次碎石成功,提高术后结石清除率,并减少平均体外冲击波次数,缩短手术时间,降低>24 h肉眼血尿发生率。