X线定位体外冲击波碎石术23年15019例疗效观察

Efficacy of X-ray localization in ESWL （ report of 15 019 cases in 23 years）

目的总结X线定位ESWL治疗上尿路结石的经验，进一步提高碎石成功率以及减少并发症的发生。方法回顾性分析1988年10月至2011年9月对15019例上尿路结石应用X线定位下行ESWL的患者资料，并进行随访。结石最大径0．8-3．2cm，其中≤2．0cm者13794例（A组），〉2．0cm者1225例（B组）。患者肾功能均正常或接近正常，56．0％（8410／15019）有不同程度的肾积水。结果首次碎石治疗有效率为84．5％（12691／15019），再次治疗有效率为12．0％（1802／15019），313例需行第3次碎石治疗。术后3个月A组结石清除率为90．2％（12443／13794），B组为50．9％（623／1225），总体结石清除率为87．0％（13066／15019）。术后93％出现一过性肉眼血尿，大量饮水后消失，46例（0．3％）术后出现发热，应用抗感染药物后体温恢复正常，未见肾脏血肿、持续高热、持续肉眼血尿、输尿管石街形成等严重并发症发生。结论用X线定位电磁式体外冲击波碎石机治疗上尿路结石具有能量低、损伤小、易于定位、碎石颗粒均匀细小等优点，可减少术后发热、输尿管石街形成、持续性肉眼血尿等并发症，可作为10-20mm上尿路结石的首选治疗疗法。

Objective To summarize the experience of management of upper urinary tract calculi by Extracorporeal Shock Wave Lithotripsy （ESWL） in our department in order to improve the gravel success rate and decrease the incidence of complications. Methods 15 019 patients with upper urinary calculi from October 1988 to September 2011 treated by ESWL with X-ray localization were analyzed retrospectively. The maximum diameter of the stones ranged from 0.8 cm to 3.2 cm, with 13 794 cases with maximum stone diameter less than 2 cm （guoup A）, and with 1225 cases with maximum stone diameter more than 2 cm （guoup B）. All patients had normal or nearly normal renal function, and 56.0% patients （8 410/15 019） had varying degrees of hydronephrosis. Results The effective rate of first ESWL was 84.5% （ 12 691/ 15 019） and the effective rate of second ESWL was 12.0% （1 802/15 019） , and 313 cases need a third ESWL. The clearance rate in group A was 90.2% （ 12 443/13 794 ） , in group B was 50.9% （623/1225） , and the overall stone clearance rate within three months was 87.0% （13 066/15 019）. The majority of pa- tients （about 93% ） had postoperative gross hematuria, which disappeared after drinking lots of water. 46 cases （0.3%） of patients had postoperative fever, which returned to normal after usage of antibiotics. There were no serious complications such as kidney hematoma, continuous high fever, continuous hematuria, ureteral stones jams. Conclusions ESWL with X-ray localization had the advantage of low energy, minor injury, easy localization, uniform stone fragment, because of which it could reduce the complications such as continuity fever, ureter stone james, continuious hematuria. ESWL with X-ray localization could be preferredtreatment for upper urinary calculi with diameters between 10 to 20 mm.