Lechevallier E, Siles S, Ortega J C, Coulange C
Department of Urology, Timone's Hospital, Marseille, France.
J Endourol. 1993 Dec;7(6):465-7. doi: 10.1089/end.1993.7.465.
Some renal calculi are borderline indications for either extracorporeal shock wave lithotripsy (ESWL) or percutaneous nephrolithotomy (PCNL). Our purpose was to quantify by single photon emission computed tomography (SPECT) the parenchymal lesions of these two procedures to make the choice easier. The SPECT study was done before and 30 days after the stone treatment. The scan was carried out 10 hours after injection of 99mTc-DMSA using a GE400 rotative gamma camera, which data were reconstructed in three planes. The local uptake and scar of the treated area were evaluated in 22 patients with symptomatic kidney stones without previous treatment or renal failure. Twelve patients (mean stone size 12 x 9 mm) were treated on a piezoelectric (EDAP LT-01) lithotripter (mean shock wave number 3420), and ten patients (mean stone size 24 x 17 mm) were treated by PCNL (32F Amplatz sheath in a lower calix). There were no complications, and the stone-free rate at day 30 was 50% in both groups. In the ESWL group, all of the kidneys demonstrated a loss of local uptake, whereas 7 of the 10 in the PCNL group did so. In the ESWL group, 4 of the 12 kidneys had a local loss exceeding 4% but only 2 of 10 kidneys in the PCNL group. There were 7 scars in the treated area in the ESWL group and 6 in the PCNL group. Extracorporeal lithotripsy does not seem to be a nontraumatic procedure for the kidney. For stones that would require several sessions of ESWL, the use of PCNL must be preferred.
一些肾结石对于体外冲击波碎石术（ESWL）或经皮肾镜取石术（PCNL）来说属于临界适应症。我们的目的是通过单光子发射计算机断层扫描（SPECT）对这两种手术的实质损伤进行量化，以便更轻松地做出选择。SPECT研究在结石治疗前及治疗后30天进行。在注射99mTc - DMSA 10小时后，使用GE400旋转γ相机进行扫描，数据在三个平面重建。对22例有症状的肾结石且未接受过治疗或无肾衰竭的患者，评估治疗区域的局部摄取和瘢痕情况。12例患者（平均结石大小12×9mm）接受了压电式（EDAP LT - 01）碎石机治疗（平均冲击波次数3420），10例患者（平均结石大小24×17mm）接受了PCNL治疗（在较低肾盏使用32F安普瑞鞘）。未出现并发症，两组在第30天时结石清除率均为50%。在ESWL组中，所有肾脏均显示局部摄取减少，而PCNL组10例中有7例如此。在ESWL组中，12例肾脏中有4例局部摄取减少超过4%，而PCNL组10例中只有2例。ESWL组治疗区域有7处瘢痕，PCNL组有6处。体外碎石术对肾脏似乎并非无创手术。对于需要多次ESWL治疗的结石，应优先选择PCNL。
