Tligui M, El Khadime M R, Tchala K, Haab F, Traxer O, Gattegno B, Thibault P
Service d'Urologie, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.
Eur Urol. 2003 May;43(5):552-5. doi: 10.1016/s0302-2838(03)00086-1.
To evaluate emergency treatment of obstructing ureteral stones by in situ extracorporeal shock wave lithotripsy (ESWL) during acute renal colic.
From January 1994 to February 2000, 200 patients (mean age: 42 years) were treated by ESWL (EDAP LT-02) for obstructing ureteral stones causing acute renal colic refractory to medical treatment or recurring within 24hours of such treatment. Stones were visualised by fluoroscopic imaging and/or ultrasound. Follow-up included radiological and/or ultrasound examinations and lasted three months.
Mean stone size was 7mm (3-20mm). At three months, 164/200 (82%) patients were stone-free. This rate ranged from 79% to 83% according to the location of the stone, and from 75% to 86% according to the size of the stone. These differences in rate were not significant. Two or three ESWL sessions were required in 79 patients. ESWL was well tolerated in 90% of patients. The only complication was a case of pyelonephritis requiring the placement of a JJ stent, administration of antibiotics, and distant ureteroscopy. The 36 patients, in whom ESWL failed, underwent ureteroscopy (n=23) or lithotripsy with a Dornier machine (n=13).
Non-deferred ESWL for acute renal colic secondary to obstructing ureteral stones has a satisfactory success rate and very low morbidity.
评估在急性肾绞痛期间通过原位体外冲击波碎石术（ESWL）治疗输尿管梗阻性结石的急诊治疗效果。
1994年1月至2000年2月，200例患者（平均年龄：42岁）接受了ESWL（EDAP LT - 02）治疗，这些患者的输尿管梗阻性结石导致急性肾绞痛，药物治疗无效或在治疗后24小时内复发。通过荧光透视成像和/或超声对结石进行显影。随访包括放射学和/或超声检查，持续三个月。
结石平均大小为7mm（3 - 20mm）。三个月时，164/200（82%）的患者结石清除。根据结石位置，该比率在79%至83%之间；根据结石大小，该比率在75%至86%之间。这些比率差异不显著。79例患者需要进行两到三次ESWL治疗。90%的患者对ESWL耐受性良好。唯一的并发症是一例肾盂肾炎，需要放置双J支架、使用抗生素以及进行远端输尿管镜检查。ESWL治疗失败的36例患者接受了输尿管镜检查（n = 23）或使用多尼尔机器进行碎石术（n = 13）。
对于输尿管梗阻性结石继发的急性肾绞痛，不延迟进行ESWL治疗具有令人满意的成功率和极低的发病率。
