肾绞痛患者体外冲击波碎石术最佳治疗时机探讨

目的 寻找伴有肾绞痛的输尿管结石行体外冲击波碎石术(extracorporeal shockwave lithotripsy,ESWL)的最佳治疗时机.方法 跟踪观察行ESWL的伴有肾绞痛的输尿管结石患者505例,按肾绞痛发作至ESWL的时间间隔分为三组:A组(肾绞痛发作时行ESWL,或急诊ESWL)123例;B组(肾绞痛缓解后3～6d内行ESWL)162例;C组(肾绞痛缓解7d后行ES-WL)220例.观察三组一次碎石成功率、2周结石排净率、再发肾绞痛率及肾内感染发生率并进行比较.结果 A组所有患者经ESWL治疗约5～ 15 min肾绞痛症状明显缓解或消失,绞痛缓解率100％.虽然A组、B组的1次碎石成功率、2周结石排净率均优于C组,差异均有统计学意义(P＜0.05),但A组与B组比较,均无显著差异(P＞0.05).而A组术后再发肾绞痛率和并发肾内感染率分别为50.4％和17.1％,明显高于B组的4.9％和5.6％以及C组的6.8％和5.9％,差异均有统计学意义(P＜0.01).结论 输尿管结石伴有肾绞痛患者应尽早行ESWL治疗,疼痛缓解率高,但应用ESWL的最佳治疗时机为肾绞痛缓解后3～6d内.

The optimal treatmnt timing for extracorporeal shock wave lithotripsy in patients with renal colic

Objective To seek the optimal treatmnt timing for extracorporeal shock wave lithotripsy(ESWL) in patients with ureteral calculi-induced renal colic.Methods A total of 505 patients with ureteral calculi-induced renal colic were followed and observed,and all patients were divided into three groups according to the time interval from the first colic attack to ESWL,including 123patients treated by ESWL in the attack of colic or the emergency ESWL(group A),162 patients treated by ESWL in 3 ～ 6 days after pain relief (group B) and 220 patients treated by ESWL after 7 days of pain relief (group C).Success rate of fragmentation in the first time of ESWL,stone-free rate after 2 weeks of operation,pain recurrence rate and percentage of renal infection were evaluated.Results All patients with renal colic in group A were cured,the rate of renal colic relieving was 100％.The success rate of fragmentation,stone-free rate after 2 weeks of operation in the group A and the group B were higher than those in the group C(93.5％ vs.84.6％,94.4％ vs.84.6％,87.0％ vs.74.1％,85.8％ vs.74.1％),the difference was statistically significant,respectively(P ＜ 0.05),and there was no difference of those between the group A and the group B(93.5％ vs.94.4％,87.0％vs.85.8％,P ＞0.05).The pain recurrence rate and percentage of renal infection of the group A were 50.4％ and 17.1％,respectively,which were higher than those of the group B(4.9％ and 5.6％,respectively,P ＜ 0.01) and the group C (6.8％ and 5.9％,respectively,P ＜ 0.01).Conclusions ESWL should be used earlier in the patients with ureteral calculi-induced renal colic,and the application of it to renal colic at acute stage is effective with high rate of pain relief.The optimal treatmnt ti-ming for ESWL is within 3 ～6 days after pain relief.