Schmidt A, Rassweiler J, Gumpinger R, Mayer R, Eisenberger F
Department of Urology, Katharinenhospital Stuttgart, FRG.
Arch Esp Urol. 1990 Jun;43(5):582-8.
In a one year period from July 1985 to July 1986, 224 upper and 62 distal ureteric calculi were treated. In situ ESWL represents the therapy of first choice for upper and distal ureteric calculi with a success rate of 81% and 76%, respectively. Retrograde mobilization of the calculus was used only in cases where in situ ESWL was impossible because of localization difficulties (obesity, stone close to the spine, skeleton deformation). Although ESWL after successful mobilization succeeded in 95%, retrograde mobilization was possible only in 80%. Antegrade ureterorenoscopy via percutaneous nephrostomy was performed to avoid open surgery after impossible retrograde mobilization and succeeded in 90%. Two second generation lithotripters suitable for treatments without invasive forms of anesthesia, the modified Dornier HM3+ and the Wolf Piezolith 2200, were compared in terms of efficacy for ureteric calculi. In situ ESWL was successful for upper ureter calculi in 70.7% with the HM3+ and 37.9% with the Piezolith 2200. In situ ESWL of middle ureteric calculi was successful in 81.8% with the modified HM3+, while in situ treatment of middle ureteric calculi was impossible with the piezolith 2200 due to insufficient localization of middle ureteric calculi with ultrasound. Distal ureteric calculi were treated successfully in 71.4% with the modified Dornier HM3+ and in 64% with the Piezolith 2200. Our initial clinical experience with ESWL in the prone position for iliac ureteric calculi is reported. Eight of 10 cases were treated successfully in situ.
在1985年7月至1986年7月的一年时间里，共治疗了224例上段输尿管结石和62例下段输尿管结石。原位体外冲击波碎石术（ESWL）是治疗上段和下段输尿管结石的首选方法，成功率分别为81%和76%。仅在因定位困难（肥胖、结石靠近脊柱、骨骼变形）而无法进行原位ESWL的情况下才采用结石逆行移动法。尽管结石成功移动后进行ESWL的成功率为95%，但逆行移动仅在80%的病例中可行。对于逆行移动失败后避免开放手术的情况，采用经皮肾造瘘顺行输尿管镜检查，成功率为90%。比较了两种适用于无需侵入性麻醉形式治疗的第二代碎石机，即改良的多尼尔HM3+和狼牌Piezolith 2200对输尿管结石的治疗效果。使用HM3+时，上段输尿管结石原位ESWL的成功率为70.7%，使用Piezolith 2200时为37.9%。改良的HM3+对中段输尿管结石原位ESWL的成功率为81.8%，而使用Piezolith 2200时，由于超声对中段输尿管结石定位不足，无法对中段输尿管结石进行原位治疗。改良的多尼尔HM3+对下段输尿管结石的治疗成功率为71.4%，Piezolith 2200为64%。报告了我们对髂部输尿管结石俯卧位ESWL的初步临床经验。10例中有8例原位治疗成功。
