急诊输尿管镜钬激光碎石与体外冲击波碎石治疗输尿管结石并急性肾绞痛的疗效比较  

Comparison of efficacy between emergency ureteroscopic holmium laser lithotripsy and extracorporeal shock wave lithotripsy in management of ureteral stones with acute renal colic

作　　者：章璟[1] 王国增[1] 石泉[1] 李健[1] 郑景存[1] 马杰[1] 姜宁[1] 

机构地区：[1]上海市浦东新区公利医院泌尿外科,200135

出　　处：《中华腔镜泌尿外科杂志（电子版）》2009年第4期26-29,共4页Chinese Journal of Endourology(Electronic Edition)

摘　　要：目的比较急诊输尿管镜钬激光碎石(URL)与急诊体外冲击波碎石(ESWL)两种方法治疗输尿管结石引起的急性肾绞痛的疗效。方法2006年1月至2008年9月,采用Storz 8/9 F硬质输尿管镜、钬激光碎石机和Dornier Compact S型低能量电磁式碎石机分别急诊治疗输尿管结石并肾绞痛175例和110例。所有病例均先行药物治疗症状无缓解后在急诊初诊12 h之内接受急诊URL或急诊ESWL。结果对于输尿管上段结石,术后疼痛缓解率URL组虽优于ESWL组(93.94%和66.67%,P<0.05),但碎石成功率(84.85%和83.33%,P>0.05)及二周结石排净率(81.81%和77.78%,P>0.05)均无显著差异。而对于输尿管中下段结石,术后疼痛缓解率(98.59%和92.39%)、碎石成功率(98.59%和91.30%)以及二周结石排净率(97.18%和94.78%)URL组均优于ESWL组(P<0.05)。最大径10 mm以内的结石URL组碎石成功率优于ESWL组(96.38和88.10%,P<0.05)。最大径10 mm以上的结石,术后疼痛缓解率及2周排净率URL组均优于ESWL组(97.30%和69.23%,91.89%和61.23%,P<0.05)。URL及ESWL组并发症率分别为3.46%和2.73%(P>0.05)。结论急诊URL和急诊ESWL均是输尿管结石并急性肾绞痛的安全、有效的治疗方法,对于输尿管上段结石或最大径不超过10mm的结石二者效果相当,而对于输尿管中下段结石或直径大于10 mm的结石来说,URL疗效优于ESWL。Objective To compare the clinical efficacy of emergency ureteroscopic holmium laser lithotripsy （eURL） and emergency extracorporeal shock wave lithotripsy （eESWL） for ureteral stones with renal colic. Methods From Jan.2006 to Sep. 2008, 175 patients with acute renal colic due to ureteral stones were managed with eURL, using Storz ureteroscope and holmium laser lithotriptor, and 110 patients were managed with eESWL, using Dornier Compact S electromagnetic lithotripter. All acute renal colic proved to be resistant to anti-inflammatory agents and the patients were received lithotripsy within 12 hours of first admission to the emergency room. Results The postoperative frank pain release rate of eURL was higher than eESWL （93.94% vs 66.67%, P〈O.05）, success rate （98.59% vs 91.30%） and stone-free rate after two weeks （97.18% vs 94.78%）were similar in two methods for upper ureteral stones（P〉0.05）.Those rates of eURL were higher than eESWL for middle and lower ureteral stones （98.59% vs 92.39%, 98.59% vs 91.30%, 97.18% vs 94.78%,respectively, P〈0.05）. The success rate of eURL was higher than eESWL （96.38% vs 88.10%,P〈0.05）for stone size less than 10mm.The postoperative frank pain release rate and stone-free rate of eURL were higher than eESWL for stone size more than 10mm （97.30% vs 69.23%,91.89% vs 61.23%, P〈0.05）. The complication rates of eURL and eESWL were 3.46% and 2.73%, respectively （P〉0.05）.Coneluaiona Both cURL and eESWL are effective and safe for the management of ureteral stones with a- cute renal colic. The c.inical etiqcacy of cURL and eESWL were similar for upper ureteral stones or stone size less than 10 ram. cURL is the better choice than eESWL for the management of middle and lower ureteral stones or stone size more than 10 ram.

关 键 词：输尿管结石 急性肾绞痛 输尿管镜 体外冲击波碎石 

分 类 号：R699.4[医药卫生—泌尿科学]