体外冲击波碎石治疗泌尿系结石治疗效果的影响因素分析

发布时间：2018-04-09 08:16

  本文选题：体外冲击波碎石　切入点：泌尿系结石　出处：《天津医科大学》2017年硕士论文

【摘要】：目的:探讨影响体外冲击波碎石(ESWL)治疗尿路结石效果的相关因素,为临床实践提供参考。方法:选取我院自2011年1月至2016年10月应用白云山BYS液电式B超定位体外冲击波碎石机及西门子MODULARIS Variostar电磁式双定位体外冲击波碎石机行体外冲击波碎石(ESWL)治疗的4101例尿路结石的患者,其中男性2740例,女性1361例,年龄9~84岁,平均43.05±13.13岁,其中肾结石745例,输尿管结石3180例,膀胱结石176例。体外冲击波碎石的绝对禁忌症有:结石远端伴有炎性息肉等造成的梗阻,血液性疾病导致出血性疾病、伴有脑梗塞、脑出血等脑部疾病,妇女有妊娠的同时患者泌尿系结石,体重过于肥胖,患者先天性的骨骼畸形导致肢体畸形发育,伴有严重心脏疾病安置心脏起搏器等。本组研究将输尿管狭窄、无功能肾等特殊情况纳入体外冲击波碎石禁忌。本组所有患者均经泌尿系统超声、腹部X线平片或静脉肾盂造影,以及泌尿系CT平扫等检查。每个患者均进行手术前疾病信息资料搜集整理,术中影像学图像保存与记录,术后随访资料包括完整的影像学检查资料以及临床症状等随访内容。所有患者均在术后1周开始随访,随访时间3个月。结石完全排出或残石≤3mm并伴有肾积水缓解视为治疗成功,结石未排出或残石3mm且肾积水无减轻或加重视为治疗失败。应用统计学方法分析影响体外冲击波碎石治疗泌尿系结石效果的因素。结果:所有行ESWL治疗的患者术后随访3个月,治疗成功3403例,净石率(成功率)为82.98%;体外冲击波碎石失败包括结石质地坚硬,未能击碎并排出体外,或者伴有较多的碎块化结石残余698例,碎石的失败率为17.02%。在698例碎石失败的的患者中,因结石质地坚硬所致结石不能被粉末化或碎块化者有595例,所占比例为85.24%。结石碎块化后的各个部分较大,导致结石不能排出体外者占14.76%。接受ESWL的所有患者中6例患者术后出现肾包膜下血肿,经保守治疗后半年复查CT,血肿消失。以治疗效果为依据,将患者分为2组,结石完全排出或残石≤3mm为手术成功组,结石质地坚硬导致碎石失败或者碎块化的结石各部分较大,未能顺利排出体外,通常各部分结石直径3mm为治疗失败组。应用χ~2检验以及t检验来比较两组患者的资料。结论:分析表明,碎石机的种类、患者的年龄、体重指数(BMI)、结石的位置、皮肤距离结石距离(SSD)、定位方式及冲击波源的入路、冲击波的频率及碎石过程中能量递增方式是影响ESWL治疗效果的重要因素。泌尿系结石患者在接受体外冲击波碎石前需要选择合适的体外碎石机,对泌尿系结石患者的综合情况进行分析,争取采取个体化的治疗方案,取得最佳碎石效率。
[Abstract]:Objective: to explore the factors influencing the effect of ESWL on urinary calculi and to provide reference for clinical practice.Methods: from January 2011 to October 2016, patients with extracorporeal shock wave lithotriptor (ESWL) were treated with Baiyunshan BYS ultrasonic lithotriptor and Siemens MODULARIS Variostar electromagnetic double location extracorporeal shock wave lithotriptor.4101 patients with urinary calculi,Among them, 2740 cases were male, 1361 cases were female, the age was 984 years old (mean 43.05 卤13.13 years), including 745 cases of renal calculi, 3180 cases of ureteral calculi and 176 cases of bladder stones.The absolute contraindications of extracorporeal shock wave lithotripsy include obstruction caused by distal stone with inflammatory polyps, hemorrhagic diseases caused by blood diseases, cerebral infarction, cerebral hemorrhage and other brain diseases.Overweight, congenital skeletal deformities lead to limb deformity and severe heart disease with pacemakers.In this study, ureteral stricture, non-functional kidney and other special conditions were included in extracorporeal shock wave lithotripsy taboo.All patients were examined by urography, plain film or intravenous pyelography, and CT scan of urinary system.Each patient underwent pre-operation information collection, intraoperative imaging image preservation and recording, and follow-up data including complete imaging data and clinical symptoms.All patients were followed up 1 week after operation for 3 months.Complete excretion of stone or residual stone 鈮，

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