Department of Urology, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan.
Mackay Medical College, No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City, 252, Taiwan.
BMC Urol. 2020 Nov 10;20(1):183. doi: 10.1186/s12894-020-00756-6.
In this study, we aimed to compare the efficacy and clinical outcomes of shock wave lithotripsy (SWL) for patients with renal stones using pure fluoroscopy (FS) or ultrasound-assisted (USa) localization with two lithotripters.
We retrospectively identified 425 patients with renal calculi who underwent SWL with either a LiteMed LM-9200 ELMA lithotripter (209 cases), which combined ultrasound and fluoroscopic stone targeting or a Medispec EM-1000 lithotripter machine (216 cases), which used fluoroscopy for stone localization and tracking. The patient demographic data, stone-free rates, stone disintegration rates, retreatment rates and complication rates were analyzed.
The USa group had a significantly higher overall stone-free rate (43.6 vs. 28.2%, p < 0.001) and stone disintegration rate (85.6 vs. 64.3%, p < 0.001), as well as a significantly lower retreatment rate (14.8 vs. 35.6%, p < 0.001) and complication rate (1.9 vs. 5.5%, p = 0.031) compared with the FS group. This superiority remained significant in the stone size < 1 cm stratified group. In the stone size > 1 cm group, the stone-free rate (32.4 vs. 17.8%, p = 0.028), disintegration rate (89.2 vs. 54.8%, p = 0.031) and retreatment rate (21.6 vs. 53.4%, p < 0.001) were still significantly better in the USa group, however there was no significant difference in the complication rate. The most common complication was post-SWL-related flank pain.
SWL is a safe and non-invasive way of treating renal stones. This study compared two electromagnetic shock wave machines with different stone tracking systems. LiteMed LM-9200 ELMA lithotripter, which combined ultrasound and fluoroscopic stone targeting outperformed Medispec EM-1000 lithotripter, which used fluoroscopy for stone localization and tracking, with better stone-free rates and disintegration rates, as well as lower retreatment rates and complications with possible reduced radiation exposure.
本研究旨在比较两种碎石机（一种碎石机采用纯荧光透视定位，另一种碎石机采用超声辅助定位）对肾结石患者进行体外冲击波碎石术（SWL）的疗效和临床结局。
我们回顾性地确定了 425 例肾结石患者，他们分别使用 LiteMed LM-9200 ELMA 碎石机（209 例）和 Medispec EM-1000 碎石机（216 例）进行 SWL。前者结合了超声和荧光透视结石靶向定位，后者仅使用荧光透视进行结石定位和跟踪。分析患者的人口统计学数据、无结石率、结石粉碎率、再次治疗率和并发症发生率。
超声辅助组的总体无结石率（43.6% vs. 28.2%，p<0.001）和结石粉碎率（85.6% vs. 64.3%，p<0.001）显著更高，再次治疗率（14.8% vs. 35.6%，p<0.001）和并发症发生率（1.9% vs. 5.5%，p=0.031）显著更低。在结石大小<1cm 的分层组中，这种优势仍然显著。在结石大小>1cm 的组中，超声辅助组的无结石率（32.4% vs. 17.8%，p=0.028）、粉碎率（89.2% vs. 54.8%，p=0.031）和再次治疗率（21.6% vs. 53.4%，p<0.001）仍显著更好，但并发症发生率无显著差异。最常见的并发症是碎石后相关的腰部疼痛。
SWL 是一种安全且非侵入性的治疗肾结石的方法。本研究比较了两种具有不同结石跟踪系统的电磁冲击波碎石机。结合超声和荧光透视结石靶向定位的 LiteMed LM-9200 ELMA 碎石机在无结石率和粉碎率方面表现优于仅使用荧光透视进行结石定位和跟踪的 Medispec EM-1000 碎石机，同时具有更低的再次治疗率和并发症发生率，可能减少了辐射暴露。
