在 COVID-19 大流行期间，比较冲击波碎石术和输尿管镜取石术治疗近端输尿管结石的效果。
Comparison of shock wave lithotripsy and ureteroscopy in patients with proximal ureteral stones under the COVID-19 pandemic.
机构信息
Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, Liaoning, People's Republic of China.
出版信息
World J Urol. 2023 Mar;41(3):797-803. doi: 10.1007/s00345-023-04307-0. Epub 2023 Feb 2.
PURPOSE
To compare the effectiveness, safety, and cost between ultrasound-guided shock wave lithotripsy (SWL) with an early second session protocol and ureteroscopy (URS) in patients with proximal ureteral stones using the propensity score matching (PSM) method based on a large prospective study.
METHODS
This prospective study was conducted in a tertiary hospital from June 2020 to April 2022. Patients who underwent lithotripsy (SWL or URS) for proximal ureteral stones were enrolled. The stone-free rate (SFR), complications, and cost were recorded. PSM analysis was performed.
RESULTS
A total of 1230 patients were included, of whom 81.1% (998) were treated with SWL and 18.9% (232) were treated with URS. After PSM, the SWL group had an equivalent SFR at one month (88.7 vs. 83.6%, P = 0.114) compared with the URS group. Complications were rare and comparable between the two groups, while the incidence of ureteral injuries was higher in the URS group compared with the SWL group (1.4 vs. 0%, P = 0.011). The hospital stay was significantly shorter (1 day vs. 2 days, P < 0.001), and the cost was considerably less (2000 vs. 25,053, P < 0.001) in the SWL group compared with the URS group.
CONCLUSION
This prospective PSM cohort demonstrated that ultrasound-guided SWL with an early second session protocol had equivalent effectiveness but better safety and lower cost compared with URS in the treatment of patients with proximal ureteral stones, whether the stones were radiopaque or radiolucent. These results will facilitate treatment decisions for proximal ureteral stones.
目的
通过基于大样本前瞻性研究的倾向评分匹配（PSM）方法，比较超声引导下冲击波碎石术（SWL）与输尿管镜碎石术（URS）治疗输尿管上段结石的有效性、安全性和成本。
方法
本前瞻性研究于 2020 年 6 月至 2022 年 4 月在一家三级医院进行。纳入接受碎石术（SWL 或 URS）治疗输尿管上段结石的患者。记录结石清除率（SFR）、并发症和成本。进行 PSM 分析。
结果
共纳入 1230 例患者，其中 81.1%（998 例）接受 SWL 治疗，18.9%（232 例）接受 URS 治疗。PSM 后，SWL 组一个月时的 SFR 与 URS 组相当（88.7%比 83.6%，P=0.114）。两组并发症均少见且相似，而 URS 组输尿管损伤的发生率高于 SWL 组（1.4%比 0%，P=0.011）。SWL 组的住院时间明显更短（1 天比 2 天，P<0.001），成本显著更低（2000 元比 25053 元，P<0.001）。
结论
本前瞻性 PSM 队列研究表明，对于有或无放射不透性的输尿管上段结石患者，超声引导下 SWL 采用早期二次治疗方案在有效性方面与 URS 相当，但具有更好的安全性和更低的成本。这些结果将有助于治疗输尿管上段结石的决策。
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