Reesink Daan J, Scheltema J M W, Barendrecht M M, Boeken Kruger A E, Jansonius A, Wiltink J, van der Windt F
a Urology Department , Tergooi Hospital Hilversum/Blaricum , Blaricum , The Netherlands.
Scand J Urol. 2018 Oct-Dec;52(5-6):453-458. doi: 10.1080/21681805.2018.1524398. Epub 2018 Nov 18.
In contrast to treatment with oral or intramuscular analgesics, extracorporeal shock wave lithotripsy (E.S.W.L.) can be performed with patients under sedation too. Besides the advantage of increased shock energy, patients tend to have more constant breathing excursions and are more idle during treatment, potentially increasing the stone-free ratio (S.F.R.) after treatment.
This study presents the results of 310 patients who underwent 400 E.S.W.L. procedures under sedation, with a stationary lithotripter.
After one procedure, the S.F.R. was 54.8% (170/310). A second treatment was successful in 42.1% (32/76), a third treatment in 21.4% (3/14). Therefore, 66.1% (205/310) of patients eventually became stone-free. Kidney stones were successfully treated in 65.4% (161/246), ureteral stones in 68.8% (44/64) of cases. Patients with stones ≤15 mm were successfully treated in 67.4% (194/288), patients with stones >15 mm in 50% (11/22) of cases. Considering each procedure individually, 45.3% (181/400) of procedures were successful after 3 weeks. Extending follow-up to 3 months is important, since 26.7% of stones (24/90) eventually still disappeared, increasing S.F.R. to 51.3% after one procedure. Complications occurred after 5.5% E.S.W.L.-procedures.
E.S.W.L. is a well-tolerated, non-invasive procedure that produces reasonable stone clearance of both upper and lower urinary tract calculi. Performing the procedure whilst patients are intravenously sedated results in an acceptable S.F.R. Strong selection based on unfavourable factors could increase the chance on successful treatment and spare patients a pointless procedure. However, considering E.S.W.L.'s elegant nature, sometimes a more tolerant approach seems justifiable.
与口服或肌肉注射镇痛药治疗不同，体外冲击波碎石术（E.S.W.L.）也可在镇静状态下的患者中进行。除了增加冲击波能量的优势外，患者在治疗期间往往呼吸波动更稳定且更安静，这可能会提高治疗后的结石清除率（S.F.R.）。
本研究呈现了310例在镇静状态下使用固定式碎石机接受400次体外冲击波碎石术治疗的患者的结果。
单次治疗后，结石清除率为54.8%（170/310）。第二次治疗成功的比例为42.1%（32/76），第三次治疗成功的比例为21.4%（3/14）。因此，66.1%（205/310）的患者最终结石清除。肾结石成功治疗的比例为65.4%（161/246），输尿管结石成功治疗的比例为68.8%（44/64）。结石≤15毫米的患者成功治疗的比例为67.4%（194/288），结石>15毫米的患者成功治疗的比例为50%（11/22）。单独考虑每次治疗，3周后45.3%（181/400）的治疗是成功的。将随访延长至3个月很重要，因为最终仍有26.7%的结石（24/90）消失，单次治疗后结石清除率提高到51.3%。5.5%的体外冲击波碎石术治疗后出现并发症。
体外冲击波碎石术是一种耐受性良好的非侵入性手术，对上尿路和下尿路结石都能产生合理的结石清除效果。在患者静脉镇静的情况下进行该手术可获得可接受的结石清除率。基于不利因素进行严格筛选可增加成功治疗的机会，并避免患者接受无意义的手术。然而，考虑到体外冲击波碎石术的简便特性，有时更宽容的方法似乎是合理的。
