低脉冲次数体外冲击波碎石治疗上尿路结石疗效报告

Report on therapeutic effects of extracorporeal shock-wave lithotripsy with lower pulse frequency on upper urinary tract stones

目的探讨低脉冲次数(1 000次以内)体外冲击波碎石(ESWL)治疗上尿路结石的疗效。方法从2003年6月至2010年6月接受体外电磁波碎石机治疗的患者中,根据结石分布部位共选出1 200例,其中碎石机改进前、后治疗的患者各600例,每组肾结石、上段、中段、下段输尿管结石150例。回顾性分析入选患者的临床资料,对比两组患者的疗效和并发症发生情况。结果改进前组486(81%)例患者获得随访,平均冲击次数(1 987±326)次,碎石时间(36±17)min,碎石成功477例(98.1%);改进后组498(83%)例患者获得随访,平均冲击次数(683±186)次,碎石时间(21±6)min,碎石成功492例(98.8%)。碎石术后肾绞痛、输尿管石街、肉眼血尿的发生率两组间无显著差异。结论低脉冲次数ESWL治疗上尿路结石疗效肯定,与高脉冲次数碎石相比,减少了患者的治疗时间和机器的运行时间,减轻了操作者的劳动强度和冲击波、X线辐射对患者机体的损伤,是治疗最大直径小于等于2.0 cm上尿路结石的首选方法。

Objective To investigate the therapeutic effect extracorporeal shock-wave lithotripsy（ESWL） with lower pulse frequency（within 1 000 times） on the upper urinary tract stones.Methods Totally 1 200 patients who underwent ESWL in our institution from June 2003 to June 2010 were recalled and divided into pre-improvement group（n=600） and post-improvement group（n=600） according to the machine used.Each group contains 150 patients with renal stone,upper,middle,lower ureteral stone respectively.The clinical data of the enrolled patients were retrospectively analyzed and the therapeutic effects as well as the occurrences of complications of the two groups were compared.Results The follow up was conducted for 486（81%） patients in pre-improvement group and 498（83%） patients in post-improvement group.In pre-improvement group,the mean pulse times were（1 987±326）,the mean performing time was（36±17）minutes and the stones of 477（98.1%）patients were cleaned successfully.In post-improvement group,the mean pulse times were（683±186）,the mean performing time was（21±6） minutes and the stones of 492（98.8%） patients were cleaned successfully.There was no difference in the occurrence rates of renal colic,stone street of the ureter and gross hematuria between the two groups.Conclusion The therapeutic effects of ESWL with lower pulse frequency on upper urinary tract stones is positive.It decreases performing time of the surgery and working time of the machine,reduces doctors＇ working intensity as well as the injuries of shock wave and X ray to the body compared with those treated by ESWL with higher pulse frequency.It is the first choice in the treatment of upper urinary tract stone with diameter less than or eqneal to 2.0 cm.