输尿管结石三种碎石方法的疗效观察

目的:比较原位体外冲击波碎石(ESWL)、输尿管插管注水后ESWL与输尿管镜气压弹道碎石(URL)3种方法治疗输尿管结石的疗效。方法:采用DornierCompactS型低能量电磁式碎石机治疗输尿管结石450例,其中ESWL302例,输尿管插管注水后ESWL碎石148例。Storz8/9F硬质输尿管镜、气压弹道碎石装置治疗输尿管结石120例。结果:输尿管上段结石,原位ESWL组、插管注水ESWL组及URL组2周排净率分别为85.83%、89.66%和89.36%,各组间差异无统计学意义(P>0.05)。而对于输尿管中下段结石,输尿管插管注水ESWL组与输尿管镜气压弹道碎石组的2周排净率分别为97.78%、98.63%,二者差异无统计学意义(P>0.05),但均显著高于原位ESWL组87.91%的排净率(P<0.005)。结论:输尿管上段结石首选原位ESWL,而对于输尿管中下段结石,输尿管插管后ESWL是一种安全、有效的治疗方法,其疗效与URL相当,优于原位ESWL。

Comparison of three procedures for treatment of ureteral calculus

Objective： To compare the clinical effects of extracorporeal shock-wave lithotripsy （ESWL）, ESWL with ureteral catheterization and pneumatic ureteroscopic lithotripsy （URL） in treatment of ureteral calculi. Methods：Four-hundred and fifty patients with ureteral calculi received the therapy of Dornier Compact S electromagnetic lithotripter. Three-hundred and two of them were performed ESWL, 148 received ESWL with ureteral catheterization. One-hundred and twenty patients were treated with URL using Storz ureteroscope and pneumatic lithotriptor. Results： After two weeks, the stone-free rates for the calculi in the upper part of the ureter were 85.83% ,89.66% and 89.36% respectively in the three groups,and the difference was not significant（ P 〉 0.05 ）;the rates in the middle and lower part in the ESWL group with ureteral catheterization and URL group were 97.78 and 98.63% , respectively （ P 〉 0. 005 ） , which presented no obvious difference between them,but both were higher than that of 87.91% in the ESWL group （P 〈 0.005）. Conclusions：ESWL is the first choice for treatment of calculi in the upper ureter;ESWL with ureteral catheterization is effective and safe for treatment of calculi in the middle and lower part of ureteral,the effect of which is similar to URL,but superior to ESWL.