Choi Hyeung Joon, Jung Jin-Hee, Bae Jungbum, Cho Min Chul, Lee Hae Won, Lee Kwang Soo
Department of Urology, Dongguk University Ilsan Hospital, Goyang, Korea.
Korean J Urol. 2012 Dec;53(12):853-9. doi: 10.4111/kju.2012.53.12.853. Epub 2012 Dec 20.
To compare efficacy and safety between early extracorporeal shock wave lithotripsy (eESWL) and deferred ESWL (dESWL) in colic patients with ureteral stones and to investigate whether eESWL can play a critical role in improving treatment outcomes.
A total of 279 patients who underwent ESWL for single radio-opaque ureteral stones of 5 to 20 mm in size were included in this retrospective study. The patients were categorized into two groups according to the time between the onset of colic and ESWL: eESWL (<48 hours, n=153) and dESWL (≥48 hours, n=126). Success was defined as stone-free status as shown on a plain radiograph within 1 month of the first session.
For all patients, the success rate in the eESWL group was significantly higher than that in the dESWL group. The eESWL group required significantly fewer ESWL sessions and less time to achieve stone-free status than did the dESWL group. For 241 patients with stones <10 mm, all treatment outcomes in the former group were superior to those in the latter group, but not for 38 patients with stones sized 10 to 20 mm. The superiority of eESWL over dESWL in the treatment outcomes was more pronounced for proximal ureteral stones than for mid-to-distal ureteral stones. Post-ESWL complication rates were comparable between the two groups. In the multivariate analysis, smaller stone size and a time to ESWL of <48 hours were independent predictors of success.
Our data suggest that eESWL in colic patients with ureteral stones is an effective and safe treatment with accelerated stone clearance.
比较早期体外冲击波碎石术（eESWL）与延期体外冲击波碎石术（dESWL）治疗输尿管结石绞痛患者的疗效和安全性，并研究eESWL是否能在改善治疗效果方面发挥关键作用。
本回顾性研究纳入了279例因5至20毫米大小的单个不透X线输尿管结石接受ESWL治疗的患者。根据绞痛发作与ESWL之间的时间将患者分为两组：eESWL（<48小时，n = 153）和dESWL（≥48小时，n = 126）。成功定义为在首次治疗后1个月内平片显示结石清除状态。
对于所有患者，eESWL组的成功率显著高于dESWL组。eESWL组达到结石清除状态所需的ESWL治疗次数显著少于dESWL组，且所需时间更短。对于241例结石<10毫米的患者，前一组的所有治疗效果均优于后一组，但对于38例结石大小为10至20毫米的患者则不然。eESWL在治疗效果上优于dESWL，对于近端输尿管结石比中远端输尿管结石更明显。两组ESWL后并发症发生率相当。在多变量分析中，较小的结石尺寸和ESWL时间<48小时是成功的独立预测因素。
我们的数据表明，输尿管结石绞痛患者的eESWL是一种有效且安全的治疗方法，可加速结石清除。
