Taub David A, Suh Ronald S, Faerber Gary J, Wolf J Stuart
Department of Urology, University of Michigan, Ann Arbor, Michigan 48109-0330, USA.
Urology. 2006 Apr;67(4):683-7. doi: 10.1016/j.urology.2005.10.041. Epub 2006 Mar 29.
To evaluate retrospectively the efficacy and durability of a novel approach using ureteroscopic laser papillotomy for the treatment of painful papillary calcifications. Chronic pain due to renal papillary calcifications has not been addressed by current techniques.
Ureteroscopic holmium laser lithotripsy and papillotomy were performed on patients with chronic pain and radiographically visible papillary calcifications without free collecting system calculi. The papillary urothelium overlying all cystic dilations and intraductal calcifications was vaporized. Treated patients answered a telephone survey to assess pain scores, duration of response, use of narcotics, and patient satisfaction. We reviewed the medical records to evaluate for procedure-related complications and serum creatinine measurements.
Of 20 patients who underwent laser papillotomy and responded to the telephone survey, 7 had bilateral procedures, yielding 27 renal units available for analysis. "Much less pain" was reported after 85% of the procedures, with a durable improvement reported after 59% of the procedures, at a median follow-up of 14.5 months. Significant improvements in the median pain scores were seen at 1 month (1.0, P <0.001), 6 months (2.0, P <0.001), and 1 year (1.5, P <0.001) compared with a median preoperative pain score of 9.0. The mean serum creatinine was unchanged after the procedure.
Ureteroscopic laser papillotomy appears to be an effective treatment option for the chronic pain associated with papillary calcifications. Laser papillotomy offers hope to patients who would otherwise have been denied an attempt at treatment because of a lack of free calculi within the collecting system.
回顾性评估采用输尿管镜激光乳头切开术治疗疼痛性乳头钙化的疗效和持久性。目前的技术尚未解决肾乳头钙化引起的慢性疼痛问题。
对患有慢性疼痛且影像学可见乳头钙化但无集合系统游离结石的患者进行输尿管镜钬激光碎石术和乳头切开术。汽化覆盖所有囊性扩张和导管内钙化的乳头尿路上皮。接受治疗的患者通过电话调查评估疼痛评分、反应持续时间、麻醉药物使用情况和患者满意度。我们查阅医疗记录以评估与手术相关的并发症和血清肌酐测量值。
20例行激光乳头切开术并回复电话调查的患者中，7例接受了双侧手术，共27个肾单位可供分析。85%的手术后报告“疼痛明显减轻”，59%的手术后报告有持久改善，中位随访时间为14.5个月。与术前中位疼痛评分为9.0相比，在1个月（1.0，P<0.001）、6个月（2.0，P<0.001）和1年（1.5，P<0.001）时中位疼痛评分有显著改善。术后平均血清肌酐未改变。
输尿管镜激光乳头切开术似乎是治疗与乳头钙化相关慢性疼痛的有效选择。激光乳头切开术为那些因集合系统内缺乏游离结石而原本无法尝试治疗的患者带来了希望。
