Wilson W T, Preminger G M
University of Texas Southwestern Medical Center, Dallas.
Urol Clin North Am. 1990 Feb;17(1):231-42.
Extracorporeal shock wave lithotripsy has revolutionized the treatment of urinary calculi. It should be considered the treatment of choice for renal stones smaller than 2 cm and for the majority of ureteral calculi, under which circumstances success rates approaching 80 to 90 per cent may be anticipated. Larger renal calculi or impacted ureteral stones probably should be managed by endoscopic techniques with or without adjunctive intracorporeal (ultrasonic or electrohydraulic) lithotripsy or laser fragmentation. Recent modifications in lithotripter design have been focused on the development of pain-free lithotripsy. Concomitant with a decrease in power, however, is an attendant decrease in the efficiency with which stones can be fragmented, resulting in an increase in the number of lithotripsy treatments required for adequate stone fragmentation. Additionally, sonography is assuming an increasing role in stone localization, and its use will require sonographic training on the part of the urologist. Biliary lithotripsy has been promising in preliminary European studies, with success rates approaching 90 per cent. It must be noted, however, that the U.S. experience has not been as impressive. Moreover, only 20 to 30 per cent of patients referred for biliary lithotripsy appear to be optimal candidates for this new technique. Adjunctive dissolution of gallstones with chronic oral medical therapy may be required after biliary lithotripsy, and long-term follow-up studies still need to be performed. Finally, the potential deleterious effects of extracorporeal shock wave lithotripsy must always be kept in mind. Although the majority of clinical and animal investigations have documented no significant long-term alterations in renal function, care must still be exercised when performing lithotripsy with the knowledge of the potential for long-term injurious effects on the functioning renal parenchyma.
体外冲击波碎石术彻底改变了尿路结石的治疗方式。对于小于2厘米的肾结石和大多数输尿管结石，应将其视为首选治疗方法，在这种情况下，成功率有望达到80%至90%。较大的肾结石或嵌顿性输尿管结石可能应采用内镜技术治疗，可联合或不联合体内（超声或液电）碎石术或激光碎石术。碎石机设计的最新改进主要集中在无痛碎石术的开发上。然而，随着能量的降低，结石破碎的效率也随之降低，导致为使结石充分破碎所需的碎石治疗次数增加。此外，超声检查在结石定位中的作用越来越大，这就要求泌尿外科医生接受超声检查培训。欧洲的初步研究表明，胆道碎石术前景良好，成功率接近90%。然而，必须指出的是，美国的经验并不那么令人印象深刻。此外，接受胆道碎石术治疗的患者中，只有20%至30%似乎是这项新技术的最佳候选人。胆道碎石术后可能需要采用慢性口服药物辅助溶解胆结石，而且仍需进行长期随访研究。最后，必须始终牢记体外冲击波碎石术可能产生的有害影响。尽管大多数临床和动物研究表明肾功能没有明显的长期改变，但在进行碎石术时仍需谨慎，因为要考虑到对有功能的肾实质可能产生长期有害影响。
