Lee Courtney, Ugarte Roland, Best Sara, Monga Manoj
Department of Urologic Surgery, University of Minnesota, Minneapolis, Minnesota 55455, USA.
J Endourol. 2007 May;21(5):490-3. doi: 10.1089/end.2006.0319.
Adequate urine production and excretion may be important for clearance of stone fragments after extracorporeal shockwave lithotripsy (SWL). This study evaluated the impact of renal function, measured by preoperative serum creatinine concentration, on the efficacy of SWL.
From 1986 to 2001, 27,299 patients with urolithiasis were treated with Medstone STS lithotripters. Seven hundred ninety-eight of these patients (2.92%) had serum creatinine concentrations >or=2.0 mg/dL. Perioperative renal function (serum creatinine), treatment parameters, stone-free success rate (no residual fragments on plain film), and perioperative complications and procedures were recorded.
The stone-free rate for patients with serum creatinine values from 2.0 to 2.9 mg/dL (56.69%) was significantly less than that seen in patients with a creatinine concentration <2.0 mg/dL (66.20%). The retreatment rate and secondary-procedure rate were significantly higher in patients with higher serum creatinine values (9.62% and 8.92%, respectively) than in those with serum creatinine within the normal range (6.07% and 4.27%, respectively). There was no significant difference in the stone-free rate, re-treatment rate, and secondary-procedure rate of patients with serum creatinine >or=3.0 mg/dL in comparison with patients with values <2 mg/dL. Complication rates were higher for patients with serum creatinine values >4.0 mg/dL (10.91%) than for patients with creatinine <2.0 mg/dL (2.62%).
The efficacy of SWL is decreased in patients with serum creatinine concentrations of 2.0 to 2.9 mg/dL, and the complication rate is higher in patients with serum creatinine >4.0 mg/dL. Preoperative counseling may include a discussion of the impact of renal insufficiency on success and complication rates associated with SWL.
体外冲击波碎石术（SWL）后，充足的尿液生成和排泄对于结石碎片的清除可能很重要。本研究评估了术前血清肌酐浓度所衡量的肾功能对SWL疗效的影响。
1986年至2001年期间，27299例尿路结石患者接受了Medstone STS碎石机治疗。其中798例患者（2.92%）血清肌酐浓度≥2.0mg/dL。记录围手术期肾功能（血清肌酐）、治疗参数、结石清除成功率（平片上无残留碎片）以及围手术期并发症和操作情况。
血清肌酐值在2.0至2.9mg/dL的患者结石清除率（56.69%）显著低于肌酐浓度<2.0mg/dL的患者（66.20%）。血清肌酐值较高的患者再治疗率和二次手术率（分别为9.62%和8.92%）显著高于血清肌酐在正常范围内的患者（分别为6.07%和4.27%）。血清肌酐≥3.0mg/dL的患者与血清肌酐<2mg/dL的患者相比，结石清除率、再治疗率和二次手术率无显著差异。血清肌酐值>4.0mg/dL的患者并发症发生率（10.91%）高于肌酐<2.0mg/dL的患者（2.62%）。
血清肌酐浓度在2.0至2.9mg/dL的患者SWL疗效降低，血清肌酐>4.0mg/dL的患者并发症发生率更高。术前咨询可能包括讨论肾功能不全对SWL成功率和并发症发生率的影响。
