输尿管镜钬激光碎石术与体外冲击波碎石术治疗输尿管结石的对比研究

Treatment of ureteric lithiasis with retrograde ureteroscopy and holmium: YAG laser lithotripsy vs extracorporeal lithotripsy.

作者信息

Arrabal-Polo Miguel A, Arrabal-Martín Miguel, Miján-Ortiz José L, Valle-Díaz Francisco, López-León Víctor, Merino-Salas Sergio, Zuluaga-Gómez Armando

机构信息

Urology Department, San Cecilio University Hospital, Granada, Spain.

出版信息

BJU Int. 2009 Oct;104(8):1144-7. doi: 10.1111/j.1464-410X.2009.08500.x. Epub 2009 Mar 13.

DOI:10.1111/j.1464-410X.2009.08500.x

PMID:19338552

Abstract

OBJECTIVE

To analyse the efficiency of extracorporeal shockwave lithotripsy (ESWL) vs retrograde ureteroscopy and holmium:YAG laser lithotripsy, as ESWL is successful in 67-90% of cases but endoscopic lithotripsy with pneumatic lithotrites or lasers is successful in 90-96% of distal ureteric calculi, and holmium:YAG lithotripsy is effective in proximal ureteric calculi.

PATIENTS AND METHODS

From April 2006 to April 2008 we assessed 164 patients undergoing ureteric lithiasis in two homogeneous groups: group A included 83 treated with retrograde ureteroscopy and holmium:YAG endoscopic lithotripsy, and group B, 81 treated by ESWL. For laser lithotripsy we used 2071 mJ pulses at 3-6 Hz, with a mean of 1105 pulses and 2.5 kJ of total energy. ESWL was carried out using 37.5-87.5 mJ shock waves, a mean of 3650 shock waves and 187.6 J, with a radioscopy time of 1-4 min. The results were assessed after 3 weeks with plain films and ultrasonography, or urography. The efficiency of each procedure was assessed by calculating the relative risk, and results compared using the chi-square or Student's t-test. The efficiency quotient (EQ) was determined for both procedures, and the focal applied energy quotient (FAEQ) used to assess ESWL.

RESULTS

The overall success rate for retrograde ureteroscopy and laser lithotripsy was 96.4% (80/83 patients), with an EQ of 0.52; a JJ catheter was placed in 67 patients. The success rate for the first ESWL session was 48%, and after repeat ESWL was 64% (52/81 patients), giving an EQ of 0.39. For successful treatments the FAEQ was 9.22, vs 6.47 for the failures (P < 0.005). There was a significant difference (P < 0.001) favouring laser lithotripsy, with an absolute benefit of 46% (95% confidence interval 33.8-57.9%), and number needed to treat of 2 (2-3), but no significant differences for lumbar ureteric calculi.

CONCLUSIONS

Endoscopic lithotripsy with the holmium laser is more effective than ESWL, but for lumbar ureteric calculi ESWL is therapeutically recommended as it is less invasive.

摘要

目的

分析体外冲击波碎石术（ESWL）与逆行输尿管镜钬激光碎石术的疗效，因为ESWL在67%至90%的病例中成功，而使用气动碎石器或激光的内镜碎石术在90%至96%的远端输尿管结石病例中成功，且钬激光碎石术对近端输尿管结石有效。

患者与方法

2006年4月至2008年4月，我们评估了164例接受输尿管结石治疗的患者，分为两个同质组：A组83例接受逆行输尿管镜钬激光内镜碎石术，B组81例接受ESWL治疗。对于激光碎石术，我们使用2071 mJ的脉冲，频率为3至6 Hz，平均1105个脉冲，总能量为2.5 kJ。ESWL使用37.5至87.5 mJ的冲击波，平均3650个冲击波，能量为187.6 J，透视时间为1至4分钟。3周后通过平片、超声或尿路造影评估结果。通过计算相对风险评估每种治疗方法的疗效，并使用卡方检验或学生t检验比较结果。确定两种治疗方法的效率商（EQ），并使用焦点应用能量商（FAEQ）评估ESWL。

结果

逆行输尿管镜钬激光碎石术的总体成功率为96.4%（80/83例患者），EQ为0.52；67例患者放置了双J导管。首次ESWL治疗的成功率为48%，重复ESWL后为64%（52/81例患者），EQ为0.39。成功治疗的FAEQ为9.22，失败的为6.47（P < 0.005）。钬激光碎石术有显著差异（P < 0.001），绝对获益为46%（95%置信区间33.8 - 57.9%），治疗所需人数为2（2 - 3），但对于腰段输尿管结石无显著差异。