输尿管镜气压弹道与体外震波碎石术治疗输尿管结石疗效比较

Comparison of ureteroscopic pneumatic lithotripsy and extracorporeal shock-wave lithotripsy for ureteral calculus

目的 比较输尿管镜气压弹道碎石术（URSL）与体外震波碎石（ESWL）治疗输尿管结石的疗效和不良反应。方法分别使用URSL与ESWL治疗输尿管结石患者各120例，治疗后应用腹部平片评估其疗效，随访1-3月。了解结石排净率，观察并记录不良反应和并发症。结果URSL有效率为88．3％，ESWL有效率77．5％。差异有显著性意义（P〈0．05）；URSL上段结石有效率76．3％，ESWL有效率94．9％，差异有显著性意义（P〈0．05）：URSL中下段结石有效率93．9％，ESWL有效率69．1％，差异有显著性意义（P〈0．05）；其肾绞痛、恶心呕吐、发热URSL低于ESWL（P〈0．05），URSL的并发症为1．7％的输尿管穿孔。结论URSL治疗输尿管结石优于ESWL；URSL适用于中下段输尿管结石的治疗，ESWL较适用于上段输尿管结石。

Objective To investigate the efficacy and side effects of ureteroscopic pneumatic lithotripsy （URSL） and extracorporeal shock-wave lithotripsy （ESWL） in the treatment of ureteral calculus. Methods During August 2003 and July 2005, 240 cases of ureteral calculus were divided into two groups randomly and treated respectively with URSL or ESWL. The therapeutic efficacy was evaluated by plain abdominal film after lithntripsy. All cases were followed up for 1 to 3 months. Results The total efficacy rate of the URSL group and ESWL group was 88.3% and 77.5% respectively （P 〈 0.05 ）. The efficacy rate for upper ureteral calculus treated with URSL was poor than that of ESWL （ 76.3% versus 94.9%, P 〈 0.05 ）, but the efficacy rate of URSL for middle and lower ureteral calculus was much higher than that of ESWL （ 93.9% versus 69.1%, P 〈 0.05 ）. The side effects such as kidney Colic, nausea, vomiting, and fever in URSL group were lower than those in ESWL group （P 〈0. 05）. The complication of URSL was 1.7% ureteral perforation. Conclusion URSL is superior to ESWL in the management of ureteral calculus. URSL is suitable for treatment of middle and lower ureteral calculus, and ESWL however, upper ureteral calculus.