Carlsson P, Kinn A C, Tiselius H G, Ohlsén H, Rahmqvist M
Center for Medical Technology Assessment, Linköping University, Sweden.
Scand J Urol Nephrol. 1992;26(3):257-63. doi: 10.3109/00365599209180879.
To evaluate percutaneous nephrolithotomy (PNL) and extracorporeal shock wave lithotripsy (ESWL) for their clinical effects, their cost effectiveness, their complication rates, and the patients' experiences, 55 consecutive patients were randomised to have one or other operation between October 1986 and October 1988. Six patients were excluded, 21 were treated with PNL and 28 with ESWL as primary treatment. Mean hospital stay and length of treatment were longer for PNL than for ESWL. Since 1 July 1987 all patients having ESWL have been treated without anaesthesia (n = 15), whereas epidural anaesthesia was used for all PNL. Slightly more of the ESWL patients experienced some pain during treatment. Minor complications or pain were more common after ESWL during the first 10 days after discharge from hospital. If patients with stone fragments of 4 mm or less were regarded as having a successful outcome, the success rates after one year were 94% for PNL and 77% for ESWL. The overall total cost was lower for ESWL than for PNL, the cost per successfully treated patient being 2172 pounds for PNL and 1810 pounds for ESWL. Medium sized kidney stones (6-30 mm, or 2-3 stones of 20 mm or less) can be efficiently and cheaply treated by both PNL and ESWL, though the cost of ESWL is lower. Even if effects other than cost (such as complications and patients' experience) are borne in mind, ESWL was superior to PNL for this group of patients.
为评估经皮肾镜取石术（PNL）和体外冲击波碎石术（ESWL）的临床效果、成本效益、并发症发生率以及患者体验，1986年10月至1988年10月期间，连续55例患者被随机分配接受其中一种手术。6例患者被排除，21例接受PNL作为主要治疗，28例接受ESWL作为主要治疗。PNL的平均住院时间和治疗时长比ESWL更长。自1987年7月1日起，所有接受ESWL的患者均在无麻醉情况下接受治疗（n = 15），而所有PNL患者均采用硬膜外麻醉。接受ESWL的患者在治疗期间略多有一些疼痛体验。出院后头10天内，ESWL后轻微并发症或疼痛更为常见。如果将结石碎片4毫米及以下的患者视为治疗成功，那么PNL术后一年的成功率为94%，ESWL为77%。ESWL的总体总成本低于PNL，PNL每例成功治疗患者的成本为2172英镑，ESWL为1810英镑。中等大小的肾结石（6 - 30毫米，或2 - 3颗20毫米及以下的结石），PNL和ESWL均可有效且低成本地进行治疗，不过ESWL成本更低。即便考虑成本以外的因素（如并发症和患者体验），对于这组患者而言，ESWL仍优于PNL。
