Matin S F, Yost A, Streem S B
Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
J Urol. 2001 Dec;166(6):2053-6. doi: 10.1016/s0022-5347(05)65504-8.
We determined the results of shock wave lithotripsy with a newer electromagnetic lithotriptor and compared them with those in a contemporary series of cases managed by an electrohydraulic lithotriptor using identical treatment and followup criteria at a single center.
Between 1995 and 1999, 356 patients (375 renal units, 483 upper urinary tract stones) meeting study inclusion criteria were treated with an MFL 5000 electrohydraulic shock wave lithotripsy unit (Dornier Medical Systems, Inc., Marietta, Georgia). From 1999 to 2000, 173 patients (175 renal units; 218 upper urinary tract stones) meeting identical study inclusion criteria were treated using an electromagnetic Modulith SLX shock wave lithotripsy unit (Karl Storz Lithotripsy, Atlanta, Georgia). In each group stone-free results were determined by plain abdominal x-ray and renal ultrasound 1 month after lithotripsy and efficiency quotients were developed. Baseline patient and stone characteristics were compared by the Wilcoxon rank sum and Fisher exact tests. All variables significant at p <0.05 were included in subsequent outcome analysis using multivariate logistic regression.
Baseline characteristics were equivalent, including patient age, gender, stone number and location, although patients treated with the electrohydraulic unit had a significantly larger median stone burden (103 versus 71 mm.2, p = 0.015). Multivariate regression analysis demonstrated a higher stone-free rate in the electrohydraulic group (77% versus 67%, p = 0.01) but also a higher rate of total adjunctive measures (56% versus 47%, p = 0.04). Consequently the efficiency quotients were comparable for the electrohydraulic and electromagnetic lithotripsy units (0.45 and 0.42, respectively, p = 0.43).
Electrohydraulic lithotripsy resulted in a higher stone-free rate at 1 month, although it was associated with a higher rate of auxiliary measures. Ultimately the efficiency quotients were equivalent, implying that these 2 contemporary energy sources are acceptable. According to single center treatment and followup criteria they are equally efficacious.
我们确定了使用新型电磁碎石机进行冲击波碎石术的结果，并将其与在同一中心采用相同治疗和随访标准、由液电碎石机治疗的当代系列病例的结果进行比较。
1995年至1999年间，356例（375个肾单位，483颗上尿路结石）符合研究纳入标准的患者接受了MFL 5000液电冲击波碎石机（多尼尔医疗系统公司，佐治亚州玛丽埃塔）治疗。1999年至2000年间，173例（175个肾单位；218颗上尿路结石）符合相同研究纳入标准的患者使用电磁Modulith SLX冲击波碎石机（卡尔·史托斯碎石机，佐治亚州亚特兰大）治疗。每组在碎石术后1个月通过腹部平片和肾脏超声确定结石清除结果，并计算效率商数。通过Wilcoxon秩和检验和Fisher精确检验比较患者和结石的基线特征。所有p<0.05有显著意义的变量均纳入随后使用多因素逻辑回归的结果分析。
基线特征相当，包括患者年龄、性别、结石数量和位置，尽管接受液电碎石机治疗的患者结石负荷中位数显著更大（103对71mm²，p = 0.015）。多因素回归分析显示液电碎石组结石清除率更高（77%对67%，p = 0.01），但辅助措施总发生率也更高（56%对47%，p = 0.04）。因此，液电碎石机和电磁碎石机的效率商数相当（分别为0.45和0.42，p = 0.43）。
液电碎石术在1个月时结石清除率更高，尽管其辅助措施发生率也更高。最终效率商数相当，这意味着这两种当代能量源都是可以接受的。根据单中心治疗和随访标准，它们同样有效。
