体外冲击波碎石和输尿管软镜在治疗2cm以下肾下盏结石的前瞻性随机对照研究  

Aprospective randomized comparison between shock wave lithotripsy and flexible ureterorenoscopy for lower caliceal stones <2cm

作　　者：葛广成[1] 崔飞伦[2] 李中兴[3] 贾跃军[3] 冯瑞[3] 吴丹[3] 

机构地区：[1]江苏大学医学院,江苏镇江212000 [2]江苏大学附属人民医院泌尿外科,江苏镇江212000 [3]镇江市第二人民医院泌尿外科,江苏镇江212000

出　　处：《现代泌尿外科杂志》2016年第7期533-536,共4页Journal of Modern Urology

摘　　要：目的评估体外冲击波碎石（ESWL）和输尿管软镜（RIRS）在治疗2cm以下肾下盏结石的安全性和有效性。方法将2013年1月至2015年1月间在本院治疗的195例〈2cm、X线不透光肾下盏结石患者纳入研究。将所有患者随机分为两组：体外冲击波碎石治疗组（ESWL组,参数设置为120kV、240mA）97例;输尿管软镜钬激光碎石取石治疗组（RIRS组,奥林巴斯电子输尿管软镜）98例。分别对患者的基本信息、结石清除率、重复治疗率、辅助治疗方法以及并发症发生率进行分析统计。结果结石平均大小ESWL组为（12.1±1.2）mm,RIRS组为（12.3±1.1）mm（P=0.52）。术后3个月结石清除率：ESWL组为82.2%（74/90）,RIRS组为86.6%（78/90）,两组差异无统计学意义（P=0.34）。3个月清除率：对于〈10mm结石,ESWL组为84.9%（43/51）,RIRS组为87.7%（43/51）,差异无显著性统计学意义（P〉0.05）;对于10~20 mm结石,ESWL组为78.4%（29/35）,RIRS组为85.4%（35/39）,差异有显著性统计学意义（P〈0.05）。重复治疗率ESWL组显著大于RIRS组（61.1%vs.1.1%,P〈0.001）。辅助治疗（21.1%vs.17.7%）及并发症发生率（6.6%vs.11.1%）,两组差异均无显著性统计学意义（P均〉0.05）。结论 ESWL和RIRS均为治疗2cm以下肾下盏结石的安全有效的方法。对于〈1cm结石,ESWL治疗创伤小,安全性更高;对于1~2cm肾下盏结石,RIRS治疗效果更好,且重复治疗率更低。Objective To evaluate the efficacy and safety of shock wave lithotripsy（ESWL）and flexible ureteroscopy（RIRS）for lower caliceal calculus2 cm.Methods A total of 195 patients with single radio-opaque lower caliceal calculi2 cm treated during Jan.2013 and Jan.2015 were enrolled in the study.The patients were randomized into group A（n=97）and group B（n=98）.In Group A,ESWL was performed as an outpatient procedure using the electromagnetic lithotripter（Dornier compact delta）,while in Group B,RIRS was performed using the F6/F7.5 flexible ureteroscope（Richard Wolf）with holumium laser intracorporeal lithotripsy.Demographic characteristics,success,retreatment and auxiliary procedure rates and complications were analyzed statistically.Results The mean stone size was 12.1 mm in group A and 12.3 mm in group B（P=0.52）.The overall 3-month stone-free rate was 82.2%（74/90）for group A vs.86.6%（78/90）for group B（P=0.34）;for stones10 cm,it was 84.9%（45/55）for group Avs.85.4%（35/39）for group B（P=0.12）.Retreatment rate was significantly greater in group A compared with group B（61.1% vs.11.1%;P0.001）.Auxiliary procedure rate was comparable（21.1% vs.17.7%;P=0.45）.The complication rate was 6.6%in group Avs.11.1%in group B（P=0.21）.Conclusions Both ESWL and RIRS are safe and efficacious for lower caliceal calculi20 mm.For stones10 mm,ESWL is safer and less invasive than RIRS with efficacy comparable to it.However,for 10-20 mm stones,RIRS is more effective,with lesser retreatment rate.

关 键 词：体外冲击波碎石 输尿管软镜 2cm以下肾下盏结石 

分 类 号：R692.4[医药卫生—泌尿科学]