extracorporeal shock wave lithotripsy

The extracorporeal shock wave lithotripsy that has been popularized in recent years is the first choice for the treatment of urinary calculi. It has a unique advantage over the drug drainage and surgical stone removal. The principle of the lithotripter is to use the huge energy generated by the liquid-electric high-position discharge. The wheel ball metal and the reflector are focused on the B-superimposed stone. After repeated multiple discharge shocks, the stone is crushed and then excreted. It is suitable for the treatment of kidney, bladder, ureteral stones, middle and lower stones. Treatment of diseases: kidney stones, bladder stones, urethra stones Indication 1. Kidney stones: a single calculus of the renal pelvis or renal pelvis with a diameter less than or equal to 2 cm, or multiple stones in total. 2. Ureteral stones: stones with an optimal diameter of less than or equal to 1.0 cm. Incarcerated ureteral stones with long stone residence time or large volume have poor effect. 3. Bladder stones: primary bladder stones less than 3 cm in diameter. 4. Urinary calculi: generally not used as a first-line treatment option. Contraindications In theory, in addition to the uncorrectable hemorrhagic disease and the obstruction of the distal end of the stone is an absolute contraindication to extracorporeal lithotripsy, other conditions can enter the extracorporeal shock wave lithotripsy within the control range. However, during the clinical operation and treatment, the following conditions need special treatment. 1. Pregnant women with stones are generally not suitable for gravel, especially the lower ureteral stones are not suitable for ESWL treatment, to avoid the impact of shock waves and radiation on the fetus, can be broken after delivery. For the upper and middle ureteral calculi, which are unbearable for pain, ESWL can be treated under strict control. Many reports on ESWL treatment for pregnant women have been reported at home and abroad, and the effects of ESWL treatment on infants have not been found. 2. Patients with diabetes, if the condition is not controlled, is not suitable for gravel, so as to prevent uncontrolled infection after gravel. 3. Patients with severe or acute infection should be carefully considered before crushing stones. ESWL may aggravate the degree of infection and cause serious symptoms such as bacteremia and toxemia. 4. High-risk patients and patients with single or multiple organ dysfunction, such as heart failure, renal insufficiency, and kidney disease, can be treated with EWSL under the control of medical conditions in case of emergency. Should be handled in a timely manner. 5. Obese patients may not be able to carry out gravel because of difficulty in positioning. Preoperative preparation 1. Do a good job of related systemic examinations, such as clotting time, platelet count, liver and kidney function, electrocardiogram, etc., to know the true state of the body in advance to facilitate symptomatic treatment. 2. Understand the urinary system, which is an essential preparation before the treatment of urinary calculi with ESWL. It must be exhaustive. If you don't understand the urinary system, you should avoid rushing the gravel. The following checks must be made before the gravel. (1) Abdominal plain film (KUB): More than 95% of urinary calculi are positive stones, so for patients suspected of having urinary calculi, KUB examination should be the first choice. The advantage is that you can fully understand the location and size of the stone. The location, number and density, and most importantly, can not miss the middle and lower ureteral stones. (2) B-ultrasound: mainly for the diagnosis of negative stones, has a good display effect on intra-renal stones and intra-renal water, the detection rate of ureteral stones, especially the middle and lower ureteral stones is extremely low, and it is difficult to judge the composition of stones. (3) urography: including intravenous urography (IVP) and retrograde urography, intravenous urography commonly used, can accurately locate the stone, to determine whether it is a diverticulum stone or renal stenosis is very helpful Retrograde urography is the application of poor renal urinary function and kidney development. The purpose is to clearly understand whether the urinary tract is obstructed after the failure of intravenous urography. (4) Kidney chart examination: For patients with allergic stones, renal diagram should be used to understand renal function. (5) Trinity joint examination: I specialize in the combination of B-ultrasound, abdominal plain film (KUB) and abdominal electroporation to monitor the whole urinary tract stones, dynamic electro-optics and static plain film with B-ultrasound exploration, the advantages of the three, the big In most cases, it is not worse than the results of angiography and CT scans. (1) Eliminate the patient's nervousness: The psychology of the patient before treatment is mostly very tense. It is necessary to pay attention to let the patient relax, and it is a very good choice for the patient who has received treatment to communicate directly with the patient. In addition, pay special attention to rest before treatment, the spirit is not good, the pain will be particularly sensitive. (2) Intestinal preparation: low-density ureteral stones, especially in the middle and lower ureteral stones, the day before the treatment of laxatives to clean the intestines to reduce intestinal gas and feces, not only facilitates positioning, but also avoids intestinal gas loss shock waves. The energy can make the gravel effect the best. (3) Preparation of skin: Before the treatment of bladder stones, the pubic pubic hair should be shaved. Surgical procedure The principle of the crusher is to use the huge energy generated by the liquid-electric high-position discharge, focus on the B-super-positioned stone through the wheel ball metal and the reflector, and after successive multiple discharge shocks, the stone is crushed and then discharged. complication Almost all patients have varying degrees of hematuria, mostly cleared the next day, without the use of hemostatic drugs and any other treatment. Some other limited treatments are as follows. (a) pain relief After ESWL, the area of the patient's shock wave is often discomfort and pain, but sometimes it is difficult to quantify and locate. Some manifested as low back pain, which may be caused by shock wave shock of the back muscles, especially in patients with thin body, which is usually more likely to occur after long-term treatment with high voltage. After 2 weeks of topical hot water bathing, the symptoms were significantly relieved. Renal colic is rarely seen within 6-8 hours after treatment. If the patient complains of severe pain in the first few hours, suggesting that there may be intrarenal or perirenal hematoma, abdomen and lumbar physical examination must be performed immediately, and if necessary, a B-ultrasound should be performed to determine if there is retroperitoneal bleeding. About 4% to 9% of patients may have renal colic after surgery. Analgesic treatment can be given during the onset of renal colic. It is generally not recommended to use antispasmodic drugs such as atropine, because these drugs can slow the motility of the ureter, which is not conducive to row stone, and the pain relief effect is not good. If within 12 hours after crushing, a large number of crushed stones have fallen to the lower ureter, especially the proximal bladder segment, the symptoms are more obvious. This is mainly caused by sputum caused by ureter and ureter at the junction of the ureter and bladder. It can be treated with bladder smooth muscle spasm such as phlebenone. (two) row of stones Attention should be paid to observing the patient's stone removal and its corresponding various adverse reactions. Most patients can begin to discharge stone fragments within 12 hours of treatment. In general, the greater the force (such as younger people), the stronger the creeping force of the urinary tract, the stronger the removal of the gravel, and the faster and safer the gravel discharge. Most of the stones are intermittently excluded about 4-6 weeks after treatment. Patient activity and positional drainage are helpful for rowing, depending on the volume, location, and anatomy of the kidney. For some small stones, after the hematuria is stopped, the patient can be encouraged to do jumping activities to promote the early discharge of stones; for other large stones or special parts of the stones, vigorous exercise should not be promoted to avoid causing stone lanes or aggravating hematuria; After the kidney stone surgery, the upper side of the affected side is taken; the lower part of the kidney is located below the outlet of the renal pelvis, and the stone is difficult to discharge. The postoperative position should be inverted, and the spine at the level of the kidney area is attacked, but the elderly and those with cardiovascular disease The patient can not be used to avoid accidents; the ureter of the horseshoe kidney is located in front of the kidney. Therefore, the prone position after the horseshoe kidney stone is more favorable for the stone. Patients drink more water, which is good for removing stones and preventing urinary tract infections. Stone-discharging drugs can be used to promote stone drainage and prevent recurrence. (three) anti-inflammatory

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