Parr N J, Ritchie A W, Moussa S A, Tolley D A
Scottish Lithotriptor Centre, Deaconess Hospital, Edinburgh.
Br J Urol. 1991 Jan;67(1):18-23. doi: 10.1111/j.1464-410x.1991.tb15061.x.
The presentation and management of 153 patients with ureteric calculi requiring active treatment over a 12-month period were reviewed; 74% of patients had primary ureteric calculi and 26% had ureteric calculi composed of fragments resulting from extracorporeal piezoelectric shockwave lithotripsy (EPL) to renal calculi; 32 patients (21%) had more than 1 calculus or a steinstrasse. The primary procedures included were in situ EPL (n = 54), push-bang (44), retrograde ureteroscopy (40), Dormia basket extraction (6), push-pull (1), antegrade ureteroscopy (1) and combinations of these (7). The success of the primary procedure could not be predicted from stone size, site or duration in the ureter, but upper tract dilatation was significantly less (p less than 0.01) in the successful group. The overall success rate for complete stone extraction was 97%, but 54 patients (35%) required more than 1 procedure to achieve this. In situ EPL and push-bang, as either primary or secondary procedures, were successful in treating 79 patients (52%); 2 patients required ureterolithotomy (1.3%). The overall complication rate was 18%. Since EPL is only successful in treating approximately half of ureteric calculi, a range of other treatments should be available to maintain a low rate of open surgery.
回顾了153例在12个月期间需要积极治疗的输尿管结石患者的临床表现及治疗情况；74%的患者为原发性输尿管结石，26%的患者输尿管结石由体外压电冲击波碎石术（EPL）治疗肾结石后产生的碎片组成；32例患者（21%）有不止1块结石或石街。主要采用的治疗方法包括原位EPL（n = 54）、推撞法（44）、逆行输尿管镜检查（40）、Dormia网篮取石术（6）、推拉法（1）、顺行输尿管镜检查（1）以及这些方法的联合应用（7）。无法根据结石大小、位置或在输尿管内的存留时间预测初次治疗的成功率，但成功组的上尿路扩张明显较少（p < 0.01）。结石完全取出的总体成功率为97%，但54例患者（35%）需要不止1次治疗才能达到这一目标。原位EPL和推撞法，作为初次或二次治疗方法，成功治疗了79例患者（52%）；2例患者需要进行输尿管切开取石术（1.3%）。总体并发症发生率为18%。由于EPL仅能成功治疗约一半的输尿管结石，应提供一系列其他治疗方法以维持较低的开放手术率。
