双波源体外碎石机治疗上尿路结石的有效性和安全性  

Clinical efficacy and safety of a dual shockwave lithotripter in treating upper urinary calculi

作　　者：许晓波[1] 王帅[1] 周密[1] 廖国栋[1] 章越龙[1] 何翔[1] 俞蔚文[1] Xu Xiaobo Wang Shuai Zhou Mi Liao Guodong Zhang Yuelong He Xiang Yu Weiwen(Department of Urology,Zhejiang Provincial People＇s Hospital,People＇s Hospital of Hangzhou Medical College, Hangzhou 310014, China)

机构地区：[1]浙江省人民医院杭州医学院附属人民医院泌尿外科,杭州310041

出　　处：《中华泌尿外科杂志》2017年第9期675-678,共4页Chinese Journal of Urology

摘　　要：目的 探讨Direx-Magna双波源碎石机治疗上尿路结石的疗效及安全性.方法 回顾性分析2016年7月至2017年6月收治的371例泌尿系结石患者的病例资料.男263例,女108例,年龄15 ～ 66岁,平均（36.5±11.0）岁.肾结石117例,输尿管上段结石183例,输尿管中下段结石71例.结石直径6.9～16.3 mm,平均（11.3± 1.5）mm.371例行体外冲击波碎石术（ESWL）,按照碎石模式分为双波源组106例和单波源组265例.患者仰卧或斜卧紧贴水囊,行双波源模式碎石者需紧贴两个水囊.操作者以X线或B超定位目标结石,两个独立反射杯的焦点同时定位,设置每个波源的冲击波频率均为60次/min.所有患者碎石术后1、2周复查KUB或CT平扫检查明确碎石效果.比较两组患者的碎石次数、碎石时间、碎石能级、术中疼痛情况、一期碎石成功率及术后并发症情况.结果 371例的平均碎石次数为（1 419 ±440）次,平均碎石时间为（25.2±8.4）min,平均碎石能级为（10.2 ±2.7）kV.双波源组与单波源组比较,平均碎石次数[（833±149）次与（1 654 ±261）次]、平均碎石能级[（8.9±2.0）kV与（10.7 ±2.8）kV]、平均碎石时间[（15.7 ±3.8）min与（29.0 ±6.5） min]差异均有统计学意义（均P＜0.01）.371例的一期碎石成功率为87.3％ （324/371）.双波源组一期碎石成功率为93.4％ （99/106）,单波源组为84.9％ （225/265）,差异有统计学意义（P＜0.05）.双波源组和单波源组中体重指数18.5 ～ 24.9 kg/m2患者的肾、输尿管上段结石的碎石成功率分别为100.0％（15/15）和71.4％ （10/14）、94.7％（54/57）和72.7％（8/11）,差异有统计学意义（P＜0.05）;输尿管中下段结石的碎石成功率分别为81.8％ （9/11）和75.0％ （12/16）,差异无统计学意义（P＞0.05）.双波源组和单波源组中轻度疼痛、中度疼痛、重度疼痛分别为83例（78.3％）和168例（63.4％）、22例（20.8％）和82例（30.9％）、1�Objective To evaluate the clinical efficacy and safety of dual shockwave lithotripter in treating urinary calculi.Methods Data of 371 cases treated with Direx-Magna dual shockwave lithotripter was retrospectively collected from July 2016 to June 2017,including 263 male and 108 female.Their age ranged from 15 to 66 years old （mean 36.5 ± 11.0）.There was 117 patients with kidney stone,183 patients with upper ureteral and 71 patients with middle or lower stone.The average diameter of stones was （11.3 ± 1.5）mm （ranging 6.9-16.3 mm）.The lithotripter was set at 60 times/min/head.Comparative analysis was made between 106 cases in dual mode and 265 cases in single mode.Comparative items included shock frequency,treating time,treating energy,pain scale,stone clear successive rate and complication.Patients were followed by KUB or NCCT at 1 and 2 weeks after the procedure.Stone clear successfully was defined as stone free or with fragment 〈4 mm.Results The overall success rate was 87.3% （324/371）.Among the patients who failed in first session,21 cases were successful with a second session,7 cases were treated with retrograde intrarenal surgery.There were 19 cases lost.Clavien grade Ⅲ complication rate was 0.8% and no server grade complications.The average treating time was （25.2 ± 8.4） minutes and the average shock was （1419 ±440）times.The dual shockwave subgroup achieved higher success rate [93.4% （99/106） vs.84.9% （225/265）,P 〈 0.05] with less treating time [（15.7 ± 3.8） min vs.（29.0 ± 6.5） min],lower energy [（8.9 ± 2.0） kV vs.（10.7 ± 2.8） kV] and fewer shocks （833 ± 149 vs.1 654 ± 261）,compared with that of the single shockwave subgroup （P 〈 0.01）.Also,pain scales and other complications were less than those of single shockwave subgroup （P 〈 0.01）.Conclusions Our study shows the new dual shockwave lithotripsy is safe and effective in both dual and single shock wave mode.Dual mode has higher success rate and fewer complications.

关 键 词：体外冲击波碎石术 双波源碎石机 泌尿系结石 

分 类 号：R699[医药卫生—泌尿科学]