Lingeman J E, Coury T A, Newman D M, Kahnoski R J, Mertz J H, Mosbaugh P G, Steele R E, Woods J R
J Urol. 1987 Sep;138(3):485-90. doi: 10.1016/s0022-5347(17)43236-8.
Two new therapies, percutaneous nephrostolithotomy and extracorporeal shock wave lithotripsy, are revolutionizing the treatment of upper urinary tract calculi. We report the success and morbidity rates in 110 patients undergoing percutaneous nephrostolithotomy and 982 patients treated with extracorporeal shock wave lithotripsy. Staghorn calculi were excluded from this series. The over-all success rate (free of stones plus small asymptomatic residual fragments) was comparable with both modalities (percutaneous nephrostolithotomy 98 per cent and extracorporeal shock wave lithotripsy 95 per cent), although the presence of residual fragments was more common in kidneys treated with extracorporeal shock wave lithotripsy (24 versus 7 per cent). Patient morbidity as measured by temperature elevation, length of postoperative stay, pain and blood loss was significantly less (p less than 0.05) with extracorporeal shock wave lithotripsy than with percutaneous nephrostolithotomy. Re-treatment rates were similar with both procedures, and tended to increase in relation to increasing stone size and stone number. Post-treatment ancillary procedures (cystoscopy and stone manipulation, and percutaneous nephrostomy) were used more frequently with extracorporeal shock wave lithotripsy. Because of its efficacy and low morbidity, we conclude that extracorporeal shock wave lithotripsy is the treatment of choice for upper urinary tract calculi less than 2 cm. in diameter. However, percutaneous nephrostolithotomy will continue to have a primary role in the management of larger stones and cystine stones, and it will be used as a secondary procedure after unsuccessful extracorporeal shock wave lithotripsy treatments. In addition, because of the complimentary nature of these 2 new technologies certain complex stones, such as staghorn calculi, may be handled best by a combination of the 2 techniques.
两种新疗法，经皮肾镜取石术和体外冲击波碎石术，正在彻底改变上尿路结石的治疗方法。我们报告了110例行经皮肾镜取石术患者和982例接受体外冲击波碎石术治疗患者的成功率及发病率。本系列研究排除了鹿角形结石。总体成功率（无结石加上小的无症状残留碎片）在两种治疗方式中相当（经皮肾镜取石术为98%，体外冲击波碎石术为95%），尽管体外冲击波碎石术治疗的肾脏中残留碎片更为常见（24% 对7%）。以体温升高、术后住院时间、疼痛和失血衡量的患者发病率，体外冲击波碎石术显著低于经皮肾镜取石术（P<0.05）。两种手术的再治疗率相似，且往往随着结石大小和结石数量的增加而升高。体外冲击波碎石术更频繁地使用治疗后的辅助程序（膀胱镜检查和结石处理，以及经皮肾造瘘术）。由于其有效性和低发病率，我们得出结论，体外冲击波碎石术是直径小于2cm的上尿路结石的首选治疗方法。然而，经皮肾镜取石术在较大结石和胱氨酸结石的治疗中仍将发挥主要作用，并且在体外冲击波碎石术治疗失败后将作为二线手术使用。此外，由于这两种新技术具有互补性，某些复杂结石，如鹿角形结石，可能最好通过两种技术联合处理。
