Gupta N P, Singh D V, Hemal A K, Mandal S
Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
J Urol. 2000 Jan;163(1):24-7.
We evaluate the significance of inferior caliceal radiographic anatomy and determine its influence on successful fragmentation and clearance of inferior caliceal calculi with extracorporeal shock wave lithotripsy (ESWL).
Between November 1996 and February 1998, 88 patients and 90 renal units with single or multiple inferior caliceal calculi of all sizes and composition were treated with ESWL. The size, number and area of calculi, length and width of the stone bearing inferior calix and infundibulopelvic angle were determined on pretreatment excretory urography. The infundibulopelvic angle was measured by 2 methods using the angle between the inferior caliceal infundibular and ureteral axes (angle 1), and between the infundibular and ureteropelvic axes (angle 2). Cases with residual fragments not clearing within 6 months of satisfactory fragmentation after lithotripsy were considered failures.
Overall stone clearance at 6 months was achieved in about 72% of the renal units. Infundibular length was 30 mm. or less in 77% of successful cases and in 64% of failures. Similarly, the smallest infundibular width of 5 mm. or more was found in 75% of successful cases compared to 41% of failures. Angle 1 of 35 degrees or more was observed in 73% of cases with compared to 18% without clearance. Angle 2 of 45 degrees or more was seen in 71% of successful cases compared to 9% of failures. The chances of a patient becoming stone-free with all favorable criteria of infundibular length 30 mm. or less, infundibular width 5 mm. or greater and infundibular ureteropelvic angle 45 degrees or greater was 100% (23 patients).
Radiographic features of a stone bearing inferior calix and its relation to the renal pelvis can be easily measured on standard excretory urography. An infundibular width of 5 mm. or more and infundibulopelvic angle 1 of 35 degrees or more or angle 2 of 45 degrees or more were statistically significant factors of radiographic anatomy in stone clearance following ESWL. Inferior caliceal length was not statistically significant, although length of 30 mm. or less appeared to be more favorable for stone clearance. The ideal treatment of inferior caliceal calculi in patients with all 3 favorable criteria is ESWL.
我们评估下盏的放射学解剖结构的意义，并确定其对体外冲击波碎石术（ESWL）成功碎裂和清除下盏结石的影响。
1996年11月至1998年2月期间，88例患者的90个肾单位接受了ESWL治疗，这些肾单位存在各种大小和成分的单个或多个下盏结石。在治疗前的排泄性尿路造影上确定结石的大小、数量和面积，结石所在下盏的长度和宽度以及肾盂漏斗角。肾盂漏斗角通过两种方法测量，即下盏漏斗与输尿管轴之间的夹角（角度1），以及漏斗与输尿管肾盂轴之间的夹角（角度2）。碎石术后6个月内结石碎片未完全清除的病例被视为失败。
6个月时约72%的肾单位实现了结石完全清除。77%的成功病例和64%的失败病例漏斗长度为30毫米或更短。同样，75%的成功病例漏斗最小宽度为等于或大于5毫米，而失败病例中这一比例为41%。结石清除的病例中73%观察到角度1为35度或更大，未清除的病例中这一比例为18%。成功病例中71%观察到角度2为45度或更大，失败病例中这一比例为9%。当漏斗长度为30毫米或更短、漏斗宽度为5毫米或更大且漏斗输尿管肾盂角为45度或更大这些所有有利标准都满足时，患者结石完全清除的几率为100%（23例患者）。
在标准的排泄性尿路造影上可以很容易地测量结石所在下盏的放射学特征及其与肾盂的关系。漏斗宽度为5毫米或更大以及漏斗肾盂角1为35度或更大或角度2为45度或更大是ESWL术后结石清除的放射学解剖结构的统计学显著因素。下盏长度虽无统计学意义，但30毫米或更短的长度似乎更有利于结石清除。对于所有三个有利标准都满足的患者，下盏结石的理想治疗方法是ESWL。
