三种途径ESWL治疗输尿管上段结石的疗效比较

Comparative Study on the Therapeutic Efficacy of ESWL via three Kinds of Approach for Treatment of Proximal Ureter Stone

【目的】探讨体外冲击波碎石术(ESWL)治疗输尿管上段结石的较佳治疗途径,以提高临床疗效。 【方法】276例输尿管上段结石患者以腹部平片上结石离髂骨缘距离分为2组:距离>3cm的162例为A组, ≤3cm的114例为B组。每组患者随机分别经腹部、腰背部与侧腰部途径行ESWL,比较治疗后2周不同途 径的碎石效果。【结果】A组,经腹和侧腰部治疗途径结石排净率分别为93.1%和94.9%,明显高于经腰背部 途径(64.5%)(P<0.01);B组,经腹部途径的结石排净率为90.7%,高于经腰背(55.1%)与侧腰部途径( 58.3%)(P<0.01)。【结论】ESWL治疗输尿管上段结石,当腹部平片上结石离髂骨缘距离>3cm时宜选 择经腹或侧腰部治疗途径,距离≤3cm时宜选择经腹部治疗途径。

ObjectiveTo investigate a better therapeutic approach for proximal ureter stones (PUS) by extracorporeal shock wave lithotripsy(ESWL)in order to improve the clinical curative efficacy.Two hundred and seventy-six patients with PUS were divided into two groups according to the distance of the stones apart from the iliac crest on the KUB (kidney-ureter-bladder) plain film: ①Group A (n=162), the distance of stones exceeded 3 cm; ②Group B (n=114), the distance of stones was ≤3 cm. Patients in each group were randomly treated by ESWL via abdominal, lumbodorsal and lateral waist approach, respectively. The stone-free rates of different therapeutic approaches were compared in two weeks after ESWL.In Group A, the stone-free rates of ESWL via abdominal approach (93.1%) and lateral waist approach (94.9%) were higher than those via lumbodorsal approach (62.5%) (P<0.01);but as for Group B, the stone-free rate of ESWL via abdominal approach(90.7%) was higher than those via lumbodorsal (55.1%) and lateral waist approaches (58.3%) (P<0.01).[Conclusion]When the distance of PUS apart from the iliac crest exceeds 3 cm on the KUB plain film, the abdominal or lateral waist approaches should be taken during ESWL ; but in cases of PUS with a distance ≤3 cm apart from iliac crest, ESWL via abdominal approach is better.