Harada M, Inaba Y, Okamoto M
Department of Urology, Shinsuma Hospital, Kobe, Japan.
J Endourol. 1994 Feb;8(1):9-11. doi: 10.1089/end.1994.8.9.
Many authors recommend that stone manipulation or catheter placement be attempted before SWL of ureteral stones. We tried to insert ureteral catheters before SWL on the unmodified Dornier HM3 machine in all patients treated for solitary ureteral stones between April 1986 and December 1991, succeeding in 77.5% (n = 395) of those for whom adequate follow-up is available for analysis. The stone-free rates with SWL alone in the series of 510 patients were 93% in patients with catheters and 75% in patients without catheters. An additional 6% of the patients in both groups became stone free with the aid of ureteroscopy. Eventually, only 0.5% of the patients with a catheter and 1.7% of the patients without a catheter had residual fragments. Among patients with a ureteral catheter after any procedure, 58.7% had no need for pain relief medication and no fever; the figure in the patients treated without a catheter was 74.4%. Although the success rate of SWL for ureteral stones is higher with a ureteral catheter in place, the incidence of complications also is higher. We recommend trying in situ SWL initially for patients with a ureteral stone.
许多作者建议，在输尿管结石进行体外冲击波碎石术（SWL）之前，应尝试进行结石操作或放置导管。1986年4月至1991年12月期间，我们对所有接受孤立性输尿管结石治疗的患者，在未改良的多尼尔HM3机器上进行SWL之前尝试插入输尿管导管，在有充分随访资料可供分析的患者中，成功率为77.5%（n = 395）。在这510例患者系列中，单纯SWL的结石清除率在插入导管的患者中为93%，未插入导管的患者中为75%。两组中另外6%的患者借助输尿管镜检查实现了结石清除。最终，插入导管的患者中只有0.5%，未插入导管的患者中只有1.7%有残留碎片。在任何操作后留置输尿管导管的患者中，58.7%的患者无需止痛药物且未发热；未留置导管治疗的患者这一比例为74.4%。尽管留置输尿管导管时输尿管结石SWL的成功率较高，但并发症的发生率也较高。我们建议对输尿管结石患者首先尝试原位SWL。
