ESWL后影响肾下盏结石排空的解剖学因素

Anatomical factors of influencing the stone clearance in lower calyx after extracorporeal shock wave lithotripsy

目的 探讨肾下盏解剖学因素对ESWL后结石排空的影响。 方法 1995年 4月～1999年 11月应用StorzModulithSL 2 0型碎石机治疗肾下盏结石 145例 ,测量碎石前IVU片肾下盏4项解剖指标 ,包括结石所在肾下盏肾盂夹角 ,肾下盏长度 ,盏颈宽度及肾下盏形状 (简单或复杂 )。随访 3个月 ,碎石后第 1天、2、4周及 3个月时复查B超及KUB ,分析肾下盏解剖因素与结石排空的关系。 结果 3个月总结石排空率为 6 5 %。肾下盏解剖因素与结石排空密切相关 ,结石排空率在肾下盏肾盂夹角≥ 90°者为 94% ,夹角 <90°者为 5 7% ;肾下盏长度≤ 30mm者为 80 % ,>30mm者为5 9 % ;肾下盏盏颈宽度 >4mm者为 73 % ,≤ 4mm者为 48% ;肾下盏形状简单者为 85 % ,复杂者为41%。 结论 肾下盏 4个解剖因素在肾下盏结石ESWL后排石过程中起重要作用 ,肾下盏肾盏夹角≥ 90°、盏长度≤ 30mm ,盏颈宽度 >4mm及形状简单者结石易于排空 ,反之结石排出则明显受影响。

Objective To investigate the anatomical factors influencing stone clearance in the lower calyx after extracorporeal shock wave lithotripsy (ESWL). Methods From Apr.1995 to Nov.1999,145 patients with lower caliceal calculi underwent ESWL with Storz Modulith SL 20 lithotriptor were reviewed.The pelvicalyceal angle,the lower pole calyceal length and the width,and the pattern of the stone-bearing calyx were measured according to pre ESWL intravenous urograms (IVU).Abdominal plain film and ultrasonography were undertaken in all the patients 1 day,2 and 4 weeks,and 3 months after the procedure. Results The overall stone-free rate was 65% after 3 months.The stone-free rate was significantly related to the anatomical configurations,being 94% in patients with a pelvicalyceal angle≥90° where as being 57% if <90°;80% in those with calyceal length≤30mm but 59% if >30mm;73% in those with calyceal width >4mm but 48% if ≤4mm;85% in those with a simple calyceal pattern and 41% with a complex one. Conclusions The 4 roentgenographic anatomical factors of the lower pole calyx (pelvicalyceal angle,calyceal length and width and calyceal pattern) play an important role in stone clearance after ESWL.Pelvicalyceal angle≥90°,calyceal length ≤30mm and width >4mm, and simple calyceal pattern are all noted to correlate with an improved stone-free status.In contrast,an acute pelvicalyceal angle,long calyceal length,narrow calyceal width and a complex calyceal pattern are unfavorable factors for stone clearance after ESWL.