Lin Chih-Chieh, Hsu Yen-Shen, Chen Kuang-Kuo
Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2008 Oct;71(10):496-501. doi: 10.1016/S1726-4901(08)70157-6.
This study was carried out to determine whether or not there is a significant relationship between the radiologic anatomy of the lower calyx, as seen on preoperative intravenous urography (IVU), and the outcome of stone clearance after extracorporeal shockwave lithotripsy (ESWL) for lower renal calyceal stones.
Between June 1998 and April 2007, 112 patients with a solitary lower renal calyceal stone measuring 20 mm or less in size were enrolled in this retrospective study. Pretreatment IVU was reviewed for measuring the anatomical predictors, such as lower pole infundibular length, infundibular width (IW) and infundibulopelvic angle, while the stone location and size were determined on plain abdominal X-ray. All patients were treated with ESWL using a Siemens Lithostar Plus lithotriptor and were followed-up for the outcome of stone clearance 3 months after ESWL with plain abdominal X-ray films and ultrasonography.
Three months after ESWL, only 49 (43.7%) patients were stone-free. Under multivariate analysis with logistic regression, smaller stone size (10 mm or less, p = 0.005) and greater IW (4 mm or more, p = 0.029) were significant favourable predictors for better stone clearance.
In addition to the influence of stone size, lower pole anatomy, especially IW, has a significant impact on stone clearance for lower calyceal stone after ESWL.
本研究旨在确定术前静脉肾盂造影（IVU）所示下肾盏的放射学解剖结构与体外冲击波碎石术（ESWL）治疗下肾盏结石后的结石清除结果之间是否存在显著关系。
在1998年6月至2007年4月期间，112例孤立性下肾盏结石大小在20mm及以下的患者纳入本回顾性研究。回顾术前IVU以测量解剖学预测指标，如下极漏斗部长度、漏斗部宽度（IW）和漏斗肾盂角，同时在腹部平片上确定结石位置和大小。所有患者均使用西门子Lithostar Plus碎石机进行ESWL治疗，并在ESWL后3个月通过腹部平片和超声检查对结石清除结果进行随访。
ESWL后3个月，仅49例（43.7%）患者结石清除。经逻辑回归多因素分析，较小的结石大小（10mm及以下，p = 0.005）和较大的IW（4mm及以上，p = 0.029）是结石清除效果较好的显著有利预测指标。
除结石大小的影响外，下极解剖结构，尤其是IW，对ESWL治疗下肾盏结石后的结石清除有显著影响。
