Kashima Soki, Horikawa Yohei, Obara Takashi, Muto Yumina, Koizumi Atsushi, Honma Naoko, Akihama Susumu, Shimoda Naotake
Department of Urology, Akita Red Cross Hospital.
Present address: Department of Urology, Akita University Graduate School of Medicine.
Nihon Hinyokika Gakkai Zasshi. 2016;107(2):93-99. doi: 10.5980/jpnjurol.107.93.
(Purpose) It has recently been suggested that a slow delivery rate of shockwaves by extracorporeal shock wave lithotripsy (SWL) improved treatment outcomes for urinary stones. We retrospectively analyzed the treatment outcomes of different shockwave delivery rates at 120 and 60 shockwaves per minute. (Patients and method) A total of 88 patients were treated at a fast delivery rate of 120 shockwaves per minute between July 2010 and April 2012, and 139 patients were treated at a slow delivery rate of 60 shockwaves per minute between May 2012 and May 2014 (n=227) using a Sonolith Praktis lithotripter. The treatment outcome of stone-free rate (SFR) after one SWL session was assessed at four weeks. (Result) SWL at 60 shockwaves per minute resulted in a significantly higher SFR compared with SWL at 120 shockwaves per minute (39.8% and 59.0%, respectively, p=0.0047), particularly for upper ureter (U1) stones (53.1% and 72.0%, respectively, p=0.028). Multivariate analysis showed that younger age, stone sizes of 10 mm or less, U1 stones, and slow delivery rate were significant predictors of a stone-free outcome. There were fewer adverse events after the delivery rate of 60 shockwaves per minute (p=0.058). (Conclusion) Our study suggests that SWL at 60 shockwaves per minute should be recommended to successfully treat urinary stones using the Sonolith Praktis lithotripter.
（目的）最近有研究表明，体外冲击波碎石术（SWL）采用较慢的冲击波递送速率可改善尿路结石的治疗效果。我们回顾性分析了每分钟120次和60次冲击波这两种不同递送速率的治疗效果。（患者与方法）2010年7月至2012年4月期间，共88例患者接受了每分钟120次冲击波的快速递送速率治疗，2012年5月至2014年5月期间，139例患者接受了每分钟60次冲击波的慢速递送速率治疗（n = 227），使用的是Sonolith Praktis碎石机。在四周时评估单次SWL治疗后的结石清除率（SFR）这一治疗效果。（结果）与每分钟120次冲击波的SWL相比，每分钟60次冲击波的SWL导致的SFR显著更高（分别为39.8%和59.0%，p = 0.0047），特别是对于上段输尿管（U1）结石（分别为53.1%和72.0%，p = 0.028）。多因素分析表明，年龄较小、结石大小为10毫米或更小、U1结石以及慢速递送速率是结石清除结果的显著预测因素。每分钟60次冲击波递送速率后的不良事件较少（p = 0.058）。（结论）我们的研究表明，使用Sonolith Praktis碎石机成功治疗尿路结石时，应推荐每分钟60次冲击波的SWL。
