Nafie Shady, Dyer James Edward, Minhas Jatinder Singh, Mills Jonathan Arthur, Khan Masood Ahmed
Department of Urology, University Hospitals of Leicester NHS Trust , Leicester , UK.
Scand J Urol. 2014 Jun;48(3):324-7. doi: 10.3109/21681805.2014.886288. Epub 2014 Feb 12.
Extracorporeal shockwave lithotripsy (ESWL) is the management of choice for ureteric and renal stones 20 mm or smaller, with a stone clearance rate of up to 89%. This study determined whether such a high success rate could apply to centres using mobile ESWL, by reviewing the performance at one centre that provides such a service.
Between July 2011 and July 2012, 222 patients (median age 51 years, range 18-90 years) underwent one to five sessions of ESWL for ureteric and renal stones (mean size 15 mm, range 4-22 mm). Stone clearance was regarded as residual fragments 2 mm or smaller after completion of sessions.
In total, 110 out of 222 patients (49%) were clear of stones. Stones were radiopaque in 198 (89%) and radiolucent in 24 patients (11%), with clearance rates of 48% and 63%, respectively. Regarding size, 36 (16%) were 1-5 mm, 144 (65%) 5-10 mm, 28 (12%) 10-15 mm, eight (4%) 15-20 mm and six (3%) larger than 20 mm, with clearance rates of 61%, 55%, 18%, 13% and 50%, respectively. In total, 173 (78%) were renal stones and 49 (22%) ureteric, with respective clearance rates of 49% and 51%. For kidney stones, 15 (9%) were in the upper, 32 (18%) in the mid, 75 (43%) in the lower pole and 51 (30%) in the pelvis, with clearance rates of 52%, 59%, 49% and 41%; for ureteric stones, 32 (65%) were in the upper, 10 (20%) in the mid and seven (15%) in the lower ureter, with clearance rates of 47%, 70% and 43%, respectively.
The performance of mobile ESWL was significantly poorer than expected, and this may be related to a lack of clinical ownership. The authors believe that such a service should be permanently placed on site.
体外冲击波碎石术（ESWL）是治疗20毫米及以下输尿管和肾结石的首选方法，结石清除率高达89%。本研究通过回顾一家提供此类服务的中心的治疗情况，确定如此高的成功率是否适用于使用移动ESWL的中心。
2011年7月至2012年7月期间，222例患者（中位年龄51岁，范围18 - 90岁）因输尿管和肾结石接受了1至5次ESWL治疗（平均大小15毫米，范围4 - 22毫米）。结石清除定义为治疗结束后残留碎片为2毫米及以下。
222例患者中共有110例（49%）结石清除。198例（89%）结石为不透X线，24例（11%）为透X线，清除率分别为48%和63%。结石大小方面，36例（16%）为1 - 5毫米，144例（65%）为5 - 10毫米，28例（12%）为10 - 15毫米，8例（4%）为15 - 20毫米，6例（3%）大于20毫米，清除率分别为61%、55%、18%、13%和50%。总共173例（78%）为肾结石，49例（22%）为输尿管结石，清除率分别为49%和51%。肾结石中，15例（9%）位于上极，32例（18%）位于中极，75例（43%）位于下极，51例（30%）位于肾盂，清除率分别为52%、59%、49%和41%；输尿管结石中，32例（65%）位于上段，10例（20%）位于中段，7例（15%）位于下段，清除率分别为47%、70%和43%。
移动ESWL的治疗效果明显低于预期，这可能与缺乏临床自主性有关。作者认为此类服务应永久设置在现场。
