输尿管镜碎石术联合体外冲击波碎石治疗较大肾盂结石疗效分析

Analysis of Ureteroscopic Lithotripsy Plus Extracorporeal Shock Wave Lithotripsy for Treating Renal Pelvis Calculi

目的:本研究旨在比较输尿管镜钬激光碎石术或气压弹道碎石术合并体外冲击波碎石术(ESWL)与单一使用ESWL两种方法处理较大肾盂结石(2～3cm)的手术效果和并发症。方法:治疗肾盂结石为2～3 cm的总共12例患者。被随机分为两组,其中1组为18例,2组为24例。对1组患者首先行钬激光或气压弹道碎石治疗,并于术后置双J管,于2～4周后行ESWL。2组患者,置双J管后行ESWL。3个月后评估两组间结石清除率、并发症和总治疗费用。结果:1组患者中,6例患者(33.3%)行输尿管镜碎石术后,结石被完全击碎,无需继续ESWL处理;7例患者(38.8%)输尿管镜碎石术后需一期ESWL,2例患者(12.5%)术后需二期ESWL,结石才能被完全清除。2组患者一期ESWL成功处理结石为5例(20.8%),二期ESWL成功处理结石为7例(29.1%)。两组结石清除率,1组明显高于2组(83.3%与50.0%,P<0.05)。1组输尿管镜手术时间平均为27 min,2组输尿管镜置输尿管导管平均用时15 min。两组间均未出现严重并发症。两组平均治疗费用分别为3200元和2800元。结论:输尿管镜碎石术联合ESWL治疗肾盂较大结石是一种合理而且有效的治疗方法。

Objective：The prupose of our study was to compare the outcomes and complications of extracorpo- real shock wave lithotripsy （ESWL） combining retrograde ureteroscopic lithotripsy using laser and pneumatic lith- otriptors and ESWL monotherapy for renal pelvic calculi between Z cm and 3 cm. Methods：We selected 42 patients with 2 to 3 cm pelvic calculi. All patients were divided into group 1 and 2, including 18 and 24 patients, respec- tively. Patients in group 1 firstly accepted laser or pneumatic lithotripsy and insertion of a double-J ureteral catheter and then underwent SWL 2 to 4 weeks later. In group 2, the patients accepted treatment of SWL after double-J catheter insertion. The stone-free rate, complications, and cost effectiveness were Compared 3 months later. Re- suits： 6 patients （33.3 ~） in group 1, had their calculi completely fragmented after operations with no need for ES- WL. In 7 patients （38.8%）, after a single session of ESWL, and in 2 （12.5%）, after 2 sessions, the stone com- pletly fragmented. In group 2, successful treatment was achieved after 1 and 2 SWL sessions in 5 （20.8%） and 7 （29.1%） patients, respectively. The stone-free rate of groupl was significantly higher than those in group 2 （83. 3%versus 50.0%, respectively; P d0.05）. The period of procedure was 27 minutes in group 1 and 15 minutes in group 2. No severe complication was found in both groups. The mean costs of the treatment were RMB 3 200 and RMB 2 800 in groups 1 and 2, respectively. Conclusions： Ureteroscopic ]ithotripsy combining Extracorporeal Shock Wave Lithotripsy is a reasonable and effective method for renal pelvis calculi sized bettwen 2 and 3 cm.