腹部加压法在超体重的上尿路结石患者行ESWL中的疗效分析  

Efficacy analysis of ESWL with abdominal compression for overweight patients of upper urinary calculus

作　　者：俞丽婷[1] YU Liting(Department of Urology,Jiaxing Hospital of Zhejiang Provincial Crops,Chinese People＇s Armed Police Forces,Jiaxing,Zhejiang,314000,China)

机构地区：[1]武警浙江省总队嘉兴医院泌尿外科,浙江嘉兴314000

出　　处：《临床泌尿外科杂志》2018年第9期748-750,共3页Journal of Clinical Urology

摘　　要：目的:探讨腹部加压法在超体重的上尿路结石患者中行体外冲击波碎石术(ESWL)治疗的效果。方法:2012年12月~2016年12月我院收治的超体重上尿路结石患者260例,随机分对照组和治疗组,每组130例。治疗组在整个碎石治疗过程中用自制的软海绵和束缚带加压固定在治疗床上行ESWL治疗。对照组按传统的碎石定位法行ESWL治疗,治疗过程中腹部不做任何束缚。观察两组患者结石破碎及碎石排出等情况。结果:治疗组局部皮肤破损2例;碎石颗粒最大直径<4 mm 104例,4~6 mm 23例,>6 mm 3例;结石在10~20min被击碎78例,21~30min被击碎46例,31~40min被击碎6例;冲击次数500~1 000次击碎26例,1 001~2000次击碎91例,2 001~3 000次击碎13例;术后2周内碎石排净117例,4周内排净8例,复碎5例。对照组局部皮肤破损23例;碎石后碎石颗粒最大直径<4mm 78例,4~6mm 39例,>6mm 13例;结石在10~20min被击碎39例,21~30min被碎石击碎59例,31~40 min被碎石击碎32例;冲击次数5 00~1 000次结石击碎21例,1 001~2 000次击碎65例,2 001~3 000次击碎44例;术后2周内结石排净92例,4周内排净25例,复碎13例。两组ESWL治疗电压9.0~13.5kV,频率1次/s,冲击次数最高3 000次。两组碎石颗粒大小、碎石时间、碎石的冲击次数、局部皮肤破损及碎石术后2周、4周碎石排净及复碎情况比较差异均有统计学意义(P<0.05)。结论:超体重的上尿路结石患者通过腹部加压固定法,能把结石精确定位到焦点。同时可以限制腹式呼吸,减少结石随呼吸的移动度,提高结石冲击波击中率,提高碎石效果,缩短碎石的时间,减少周围组织损伤。Objective： To assess the therapeutic efficacy of extracorporeal shock wave lithotripsy （ESWL） with abdominal compression fixation for overweight patients of upper urinary calculus. Method： Total 260 overweight patients of upper urinary calculus from Dec. 2012 to Dec. 2016 were enrolled and divided into two groups random- ly. Half of them were treated by ESWL with abdominal compression fixation as the study group and the other half were treated by ESWL alone as the control group. The therapeutic efficacy of lithotripsy and calculus discharging between the groups were compared. Result： In study group, there were 2 cases with local skin injury, 104 cases of stone fragmental maximum sizes〈4 mm, 23 cases of stone fragmental sizes 4-6 mm, 3 cases of stone fragmental sizes 〉6 mm. Stones were broken within 10-20 min for 78 cases, within 21-30 min for 46 cases, within 31-40 min for 6 cases. Stones were broken by hit 500-1 000 times for 26 cases, hit 1 001-2 000 times for 91 cases, hit 2 001- 3 000 times for 13 cases. The fragment removal time was within 2 weeks for 117 cases, within 4 weeks for 8 ca- ses, and 5 cases needed re-shock. While in the control group, there were 23 cases with local skin injury, 78 cases of stone fragmental maximum sizes 〈4 mm, 39 cases of stone fragmental sizes 4-6 mm, 13 cases of stone frag- mental sizes 〉6 mm. Stones were broken within 10-20 min for 39 cases, within 21-30 min for 59 cases, within 31-40 rain for 3Z eases. Stones were broken by hit 500-1 000 times for 21 cases, hit 1 001-2 000 times for 65 ea- ses, hit 2 001-3 000 times for 44 cases. The fragment removal time was within 2 weeks for 92 cases, within 4 weeks for Z5 cases, and 13 cases needed re-shock. The stone fragmental sizes, time of lithotripsy, frequencies of lithotripsy, skin injury, the rates of stone free of 2 or 4 weeks after lithotripsy, the rates of re-shock were signifi- cantly different between the two groups （P〈0.05）. Conclnsion.. Abdominal compression fixation could restrain the abdominal bre

关 键 词：上尿路结石 超体重 ESWL 定位技术 疗效 

分 类 号：R693[医药卫生—泌尿科学]