Albala D M, Assimos D G, Clayman R V, Denstedt J D, Grasso M, Gutierrez-Aceves J, Kahn R I, Leveillee R J, Lingeman J E, Macaluso J N, Munch L C, Nakada S Y, Newman R C, Pearle M S, Preminger G M, Teichman J, Woods J R
J Urol. 2001 Dec;166(6):2072-80. doi: 10.1016/s0022-5347(05)65508-5.
The efficacy of shock wave lithotripsy and percutaneous stone removal for the treatment of symptomatic lower pole renal calculi was determined.
A prospective randomized, multicenter clinical trial was performed comparing shock wave lithotripsy and percutaneous stone removal for symptomatic lower pole only renal calculi 30 mm. or less.
Of 128 patients enrolled in the study 60 with a mean stone size of 14.43 mm. were randomized to percutaneous stone removal (58 treated, 2 awaiting treatment) and 68 with a mean stone size of 14.03 mm. were randomized to shock wave lithotripsy (64 treated, 4 awaiting treatment). Followup at 3 months was available for 88% of treated patients. The 3-month postoperative stone-free rates overall were 95% for percutaneous removal versus 37% lithotripsy (p <0.001). Shock wave lithotripsy results varied inversely with stone burden while percutaneous stone-free rates were independent of stone burden. Stone clearance from the lower pole following shock wave lithotripsy was particularly problematic for calculi greater than 10 mm. in diameter with only 7 of 33 (21%) patients becoming stone-free. Re-treatment was necessary in 10 (16%) lithotripsy and 5 (9%) percutaneous cases. There were 9 treatment failures in the lithotripsy group and none in the percutaneous group. Ancillary treatment was necessary in 13% of lithotripsy and 2% percutaneous cases. Morbidity was low overall and did not differ significantly between the groups (percutaneous stone removal 22%, shock wave lithotripsy 11%, p =0.087). In the shock wave lithotripsy group there was no difference in lower pole anatomical measurements between kidneys in which complete stone clearance did or did not occur.
Stone clearance from the lower pole following shock wave lithotripsy is poor, especially for stones greater than 10 mm. in diameter. Calculi greater than 10 mm. in diameter are better managed initially with percutaneous removal due to its high degree of efficacy and acceptably low morbidity.
确定冲击波碎石术和经皮取石术治疗有症状的下极肾结石的疗效。
进行了一项前瞻性随机多中心临床试验，比较冲击波碎石术和经皮取石术治疗直径30毫米及以下仅位于下极的有症状肾结石的效果。
在128例纳入研究的患者中，60例平均结石大小为14.43毫米的患者被随机分配至经皮取石术组（58例接受治疗，2例等待治疗），68例平均结石大小为14.03毫米的患者被随机分配至冲击波碎石术组（64例接受治疗，4例等待治疗）。88%的接受治疗患者有3个月的随访数据。术后3个月时，经皮取石术的总体无石率为95%，而冲击波碎石术为37%（p<0.001）。冲击波碎石术的结果与结石负荷呈反比，而经皮取石术的无石率与结石负荷无关。对于直径大于10毫米的结石，冲击波碎石术后下极结石清除尤其困难，33例患者中只有7例（21%）无石。10例（16%）接受冲击波碎石术的患者和5例（9%）接受经皮取石术的患者需要再次治疗。冲击波碎石术组有9例治疗失败，经皮取石术组无治疗失败病例。13%接受冲击波碎石术的患者和2%接受经皮取石术的患者需要辅助治疗。总体并发症发生率较低，两组之间无显著差异（经皮取石术22%，冲击波碎石术11%，p = 0.087）。在冲击波碎石术组中，结石完全清除和未完全清除的肾脏在下极解剖测量方面无差异。
冲击波碎石术后下极结石清除效果较差，尤其是对于直径大于10毫米的结石。直径大于10毫米的结石最初采用经皮取石术治疗效果更好，因为其疗效高且并发症发生率可接受且较低。
