功率指数、肾盂积水、结石大小及成分对原位增强体外冲击波碎石术治疗原发性近端输尿管结石疗效的影响

Impact of power index, hydroureteronephrosis, stone size, and composition on the efficacy of in situ boosted ESWL for primary proximal ureteral calculi.

作者信息

Singh I, Gupta N P, Hemal A K, Dogra P N, Ansari M S, Seth A, Aron M

机构信息

Department of Urology, All India Institute of Medical Sciences, New Delhi, India.

出版信息

Urology. 2001 Jul;58(1):16-22. doi: 10.1016/s0090-4295(01)01088-3.

DOI:10.1016/s0090-4295(01)01088-3

PMID:11445472

Abstract

OBJECTIVES

The efficacy, safety, feasibility, and outcome of in situ treatment applied to select proximal ureteral calculi was assessed and analyzed with a view to avoiding auxiliary interventions and providing high clearance rates in the shortest possible time. We studied the impact of several clinically important variables, including power index, degree of hydroureteronephrosis (HDUN), stone size, and composition on the efficacy of sequential in situ boosted extracorporeal shock wave lithotripsy (ESWL) in a select group. The power index requirement for the in situ boosted protocol and the impact of the stone size/composition, degree of HDUN, and clearance rates were also analyzed.

METHODS

An in situ (no instrumentation) boosted protocol was applied to 130 primary unimpacted proximal ureteral calculi with no prior intervention. A typical session with the Siemens Lithostar Plus comprised 3000 shock waves, in installments of 500, deployed at a power setting of 1 to 4 kV with a gradual stepwise escalation. Sequential boosted additional sessions of ESWL were administered on days 2, 7, and 14, tailored to the degree of fragmentation, clearance status, and amount of residual stone bulk. Several parameters (shock waves, kilovolts used, fluoroscopy time, number of sessions, stone size, composition, fragmentation, clearance, and HDUN) were recorded and the results analyzed statistically.

RESULTS

The results were excellent in 83.8%, with a mean duration to complete clearance of 11.3 days. In situ ESWL failed in 7.69%, and the auxiliary intervention rate was 10.7%. Pre-ESWL HDUN was present in 78.3%, the mean power index was 184.6/session/case, and the average stone burden was 8.9 mm(2). Calcium oxalate monohydrate was the most common stone (56%). Renal colic was the most common side effect observed. The power index, fragmentation at the first session, and stone size were found to be the most favorable significant variables affecting stone clearance. The degree of HDUN, number of sessions, and stone composition did not significantly impact the clearance rates.

CONCLUSIONS

In situ boosted ESWL should be the first-line therapeutic modality in select unimpacted primary proximal ureteral stones.

摘要

目的

评估并分析原位治疗应用于特定近端输尿管结石的疗效、安全性、可行性及治疗结果，以期避免辅助干预并在尽可能短的时间内实现高清除率。我们研究了几个临床重要变量，包括能量指数、输尿管肾积水程度（HDUN）、结石大小和成分对特定组中序贯原位增强体外冲击波碎石术（ESWL）疗效的影响。还分析了原位增强方案所需的能量指数以及结石大小/成分、HDUN程度和清除率的影响。

方法

对130例未经预先干预的原发性未嵌顿近端输尿管结石采用原位（无器械操作）增强方案。使用西门子Lithostar Plus进行的典型治疗包括3000次冲击波，每次500次，以1至4 kV的能量设置逐步递增。根据结石破碎程度、清除状态和残余结石量，在第2天、第7天和第14天进行序贯增强的额外ESWL治疗。记录了几个参数（冲击波、使用的千伏数、透视时间、治疗次数、结石大小、成分、破碎情况、清除情况和HDUN），并对结果进行统计学分析。

结果

83.8%的结果优异，平均完全清除时间为11.3天。原位ESWL治疗失败率为7.69%，辅助干预率为10.7%。78.3%的患者存在ESWL治疗前的HDUN，平均能量指数为184.6/次/病例，平均结石负荷为8.9 mm²。一水草酸钙是最常见的结石类型（56%）。肾绞痛是观察到的最常见副作用。发现能量指数、首次治疗时的结石破碎情况和结石大小是影响结石清除的最有利显著变量。HDUN程度、治疗次数和结石成分对清除率没有显著影响。