输尿管镜气压弹道碎石术与ESWL治疗输尿管结石的疗效比较

目的:比较输尿管镜气压弹道碎石术(URSL)与ESWL治疗输尿管结石的疗效及副作用。方法:分别使用URSL与ESWL治疗输尿管结石患者各200例,治疗后应用腹部平片或B超评估其疗效,随访3个月,了解结石清除率,观察并记录治疗后并发症。结果:URSL有效率为91.5%,明显高于ESWL治疗者的总有效率73.5%(P<0.01);其中上段结石有效率87.72%,低于ESWL的93.33%(P<0.05),中下段结石有效率93%,明显高于ESWL的65%(P<0.01);其肾绞痛、恶心、呕吐、发热低于后者(P<0.05)。接受URSL的患者1.5%有输尿管穿孔。结论:URSL治疗输尿管结石的疗效优于ESWL;URSL较适合于输尿管中、下段结石的治疗,而ESWL较适合于输尿管上段结石的治疗。

Comparison of ureteroscopic pneumatic lithotripsy and extracorporeal shock-wave lithotripsy for ureteric calculi

Objective:To investigate the efficacy and side effects of ureteroscopic pneumatic lithotripsy(URSL) and extracorporeal shock-wave lithotripsy(ESWL) in the treatment of ureteric calculi.Methods:During January 2003 and March 2004, 400 patients with ureteral calculi were divided into two groups randomly and treated respectively with URSL or ESWL; The therapeutic efficacy was evaluated by plain abdominal fime (KUB) or ultrasound after lithotripsy; All cases were followed up for 3 months. The side effects were also recorded.Results:The total efficacy rate of the URSL group and ESWL group were 91.5% and (73.5)% respectively. The difference was of great significance (P<(0.01)). While The efficacy rate of the upper ureteric calculi treated with URSL was poor than that of ESWL group ((87.72)% versus (93.33)%, P<(0.05)). On the other hand, the efficacy rate of URSL in the middle and lower ureteric calculi group was 93%,which is much higher than that of ESWL group (65%, P<(0.01)). The side effects sush as kidney colic, nausea, vomiting, fever in URSL group was lower than that in ESWL group(P<(0.05)). URSL has risk of ureter perforation.Conclusions:For the management of ureteric calculi, URSL has a higher stone free rate, URSL is suitable for the patients with middle and lower ureteric calauli, ESWL is the treatment of choice for patients with upper ureteric calculi.