Ehreth J T, Drach G W, Arnett M L, Barnett R B, Govan D, Lingeman J, Loening S A, Newman D M, Tudor J M, Saada S
University of Arizona, Tucson.
J Urol. 1994 Nov;152(5 Pt 1):1379-85. doi: 10.1016/s0022-5347(17)32425-4.
Six institutions throughout the United States participated in this study. Each center used a multifunctional flat table lithotriptor (Dornier MFL-5000) to treat 658 patients with kidney and upper ureteral stones (766 treatments) and 323 with middle and lower ureteral stones (391 treatments), for a total of 925 patients (1,157 treatments). Some patients received more than 1 treatment (that is the kidney and ureter), for a total of 981 patient events. Complete followup was available for 81% of the patients. The overall stone-free rate at followup of approximately 90 days was greater in the middle and lower ureter group (83%) than in the kidney and upper ureter group (67%). The proportion of single stones treated was greater for the former group (89.5%) than for the latter group (72%). A larger proportion (18%) of the middle and lower ureter group required 2 or more treatments to the targeted stone than did the kidney and upper ureter group (13%). Anesthesia was required or selected in only 26.7% of the kidney and upper ureteral stone patients and in 18.5% of those with middle and lower ureteral calculi, usually at the request of the patient or physician, or for performance of an adjunctive procedure. The relative safety of this treatment is demonstrated by a low overall rate of complications reported during and after treatment, including a ureteral obstruction rate of 2.1% for kidney and upper ureteral stones and 2.5% for middle and lower ureteral stones. There were no demonstrated trends in a review of laboratory data to suggest significant treatment side effects. The diastolic blood pressure increased to more than 95 mm. Hg after extracorporeal shock wave lithotripsy (ESWL*) in 6% of the kidney and upper ureteral and 4% of the middle and lower ureteral stone patients, while pretreatment hypertension resolved after ESWL in 11% of both groups. The results of this clinical evaluation indicate somewhat greater effectiveness for the specified indications of ESWL of stones in the ureter below the upper rim of the bony pelvis, as opposed to those in the kidney and upper ureter, with a low incidence of complications and side effects.
美国的六家机构参与了这项研究。每个中心使用多功能平板式碎石机（多尼尔MFL - 5000）治疗658例肾和输尿管上段结石患者（共766次治疗）以及323例输尿管中下段结石患者（共391次治疗），总计925例患者（1157次治疗）。一些患者（即肾和输尿管均有结石的患者）接受了不止一次治疗，患者事件总数为981例。81%的患者获得了完整的随访。在大约90天的随访期，输尿管中下段结石组的总体无石率（83%）高于肾和输尿管上段结石组（67%）。前一组治疗的单发结石比例（89.5%）高于后一组（72%）。输尿管中下段结石组中需要对目标结石进行2次或更多次治疗的比例（18%）高于肾和输尿管上段结石组（13%）。仅26.7%的肾和输尿管上段结石患者以及18.5%的输尿管中下段结石患者需要麻醉，通常是应患者或医生要求，或者是为了进行辅助操作。治疗期间及之后报告的总体并发症发生率较低，证明了该治疗方法的相对安全性，其中肾和输尿管上段结石的输尿管梗阻率为2.1%，输尿管中下段结石为2.5%。实验室数据回顾未显示出表明有显著治疗副作用的趋势。6%的肾和输尿管上段结石患者以及4%的输尿管中下段结石患者在体外冲击波碎石术（ESWL*）后舒张压升高至95毫米汞柱以上，而两组中均有11%的患者在ESWL后术前高血压得到缓解。这项临床评估结果表明，对于骨盆上缘以下输尿管结石的特定适应证，ESWL的有效性略高于肾和输尿管上段结石，且并发症和副作用发生率较低。
