冲击波碎石术与半硬性输尿管镜治疗小于2厘米上段输尿管结石的前瞻性随机对照研究：单中心经验

A prospective randomized comparison between shockwave lithotripsy and semirigid ureteroscopy for upper ureteral stones <2 cm: a single center experience.

作者信息

Kumar Anup, Nanda Biswajit, Kumar Niraj, Kumar Rohit, Vasudeva Pawan, Mohanty Nayan K

机构信息

Department of Urology, Vardhman Mahaveer Medical College and Safdarjang Hospital , New Delhi, India .

出版信息

J Endourol. 2015 Jan;29(1):47-51. doi: 10.1089/end.2012.0493.

DOI:10.1089/end.2012.0493

PMID:23914770

Abstract

BACKGROUND AND PURPOSE

The best management of upper ureteral calculi is undefined. We performed a prospective randomized comparison between semirigid ureteroscopy (URS) and shockwave lithotripsy (SWL) for upper ureteral stones <2 cm to evaluate safety and efficacy of both procedures.

PATIENTS AND METHODS

Patients with a single radiopaque upper ureteral stone <2 cm undergoing treatment between January 2010 and May 2011 in our department were included. Randomization was performed into two groups-group A: SWL performed as an outpatient procedure using an electromagnetic lithotripter (Dornier Compact Delta); group B: URS performed using an 6/7.5F semirigid ureteroscope with holmium laser intracorporeal lithotripsy. Statistical analysis was performed regarding demographic profile, success rates, retreatment rates, auxiliary procedures, and complications.

RESULTS

There were 90 patients enrolled in each group. Mean stone size: 12.3 mm in group A vs 12.5 mm in group B (P=0.52). The overall 3-month stone-free rate was (74/90) 82.2% for group A vs (78/90) 86.6% for group B (P=0.34). For stone size <10 mm, 3-month stone-free rates were (45/53) 84.9% for group A vs (43/49) 87.7% for group B (P=0.32). For 10 to 20 mm stones, 3-month stone-free rates were (29/37) 78.4% for group A vs (35/41) 85.4% for group B (P=0.12).The re-treatment rate was significantly greater in group A than group B (61.1% vs 1.1%, respectively; P<0.001). The auxiliary procedure rate was comparable in both groups (21.1% vs 17.7%; P=0.45). The complication rate was 6.6% in group A vs 11.1% in group B (P=0.21).

CONCLUSIONS

Both SWL and semirigid URS are safe and highly efficacious for treating patients with proximal ureteral stones <20 mm. For stones <10 mm, SWL was safer, less invasive, and of comparable efficacy with URS. For stones between 10 and 20 mm, however, URS was more effective, with a lesser re-treatment rate.

摘要

背景与目的

上段输尿管结石的最佳治疗方法尚无定论。我们对<2 cm的上段输尿管结石患者进行了半硬性输尿管镜检查（URS）与冲击波碎石术（SWL）的前瞻性随机对照研究，以评估两种手术的安全性和有效性。

患者与方法

纳入2010年1月至2011年5月在我科接受治疗的单颗不透X线的上段输尿管结石<2 cm的患者。随机分为两组：A组：使用电磁碎石机（多尼尔Compact Delta）作为门诊手术进行SWL；B组：使用6/7.5F半硬性输尿管镜及钬激光体内碎石术进行URS。对人口统计学资料、成功率、再治疗率、辅助手术及并发症进行统计分析。

结果

每组纳入90例患者。平均结石大小：A组为12.3 mm，B组为12.5 mm（P = 0.52）。A组3个月时的总体无石率为（74/90）82.2%，B组为（78/90）86.6%（P = 0.34）。对于<10 mm的结石，A组3个月无石率为（45/53）84.9%，B组为（'43/49）87.7%（P = 0.32）。对于10至20 mm的结石，A组3个月无石率为（29/37）78.4%，B组为（35/41）85.4%（P = 0.12）。A组的再治疗率显著高于B组（分别为61.1%和1.1%；P<0.001）。两组的辅助手术率相当（21.1%对17.7%；P = 0.45）。A组并发症发生率为6.6%，B组为11.1%（P = 0.21）。