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体外冲击波碎石术前的输尿管结石处理

Ureteral stone manipulation before extracorporeal shock wave lithotripsy.

作者信息

Evans R J, Wingfield D D, Morollo B A, Jenkins A D

机构信息

Department of Urology, University of Virginia School of Medicine, Charlottesville.

出版信息

J Urol. 1988 Jan;139(1):33-6. doi: 10.1016/s0022-5347(17)42281-6.

Abstract

We randomized 75 patients with solitary ureteral calculi that could not be dislodged by ureteral catheterization to receive instillation of saline, 2 per cent lidocaine viscous solution or dilute surgical lubricant before repeat stone manipulation with ureteral catheters. Of the stones irrigated with saline 76 per cent were returned to the pelvis along with 60 per cent of the lidocaine group and 48 per cent of the surgical lubricant treated stones. There was no statistical significance among the 3 groups. The success rates for upper, mid and lower ureteral stones were 80, 54 and 30 per cent, respectively. Of stones 0.5 cm. or less and between 0.6 and 1.0 cm. 77 and 72 per cent, respectively, were manipulated successfully but only 38 per cent of the stones larger than 1.0 cm. could be dislodged. Extracorporeal shock wave lithotripsy was successful in treating pelvic and ureteral stones, although higher kilovolt settings and additional shocks were necessary to fragment the ureteral stones completely. Percutaneous nephrostomy or ureteral meatotomy was required in 10 per cent of the patients with impacted ureteral stones following in situ extracorporeal shock wave lithotripsy but in only 4 per cent of the patients with stones successfully returned to the pelvis. Of the ureteral stones 17 per cent were treated with repeat extracorporeal shock wave lithotripsy. No patient with pelvic stones required repeat treatment. Retrograde manipulation of ureteral stones is an effective adjunctive procedure before extracorporeal shock wave lithotripsy.

摘要

我们将75例经输尿管插管无法排出的孤立性输尿管结石患者随机分组,在使用输尿管导管进行再次结石处理前,分别给予生理盐水灌注、2%利多卡因粘性溶液或稀释的手术润滑剂。用生理盐水冲洗的结石中,76%回到肾盂,利多卡因组为60%,手术润滑剂处理的结石为48%。三组之间无统计学差异。输尿管上、中、下段结石的成功率分别为80%、54%和30%。直径0.5 cm及以下和0.6至1.0 cm的结石,成功处理率分别为77%和72%,但直径大于1.0 cm的结石只有38%能被排出。体外冲击波碎石术成功治疗了肾盂和输尿管结石,不过需要更高的千伏设置和额外的冲击才能完全击碎输尿管结石。原位体外冲击波碎石术后,10%的输尿管结石嵌顿患者需要行经皮肾造瘘术或输尿管肉阜切开术,但结石成功回到肾盂的患者中只有4%需要。17%的输尿管结石患者接受了再次体外冲击波碎石术。肾盂结石患者均无需重复治疗。输尿管结石的逆行处理是体外冲击波碎石术前有效的辅助操作。

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