Begun F P
Department of Urology, Medical College of Wisconsin, Milwaukee 53226.
Semin Urol. 1994 Feb;12(1):39-50.
It seems apparent, from the previous discussion, that no form of intracorporeal lithotripsy represents the perfect treatment modality for all upper urinary-tract calculi. In fact, the role of endoscopic techniques for treatment for upper-tract calculi must be carefully considered given the success of SWL. However, not all stones are amenable to extracorporeal treatment. Therefore, ureteroscopy, with the various forms of intracorporeal lithotripsy, represents an alternative means for successfully treating patients without having to resort to surgical intervention. Ultrasonic lithotripsy is probably the least preferable of the three forms of treatment, primarily because it must be carried out with rigid endoscopic equipment. In the future, if flexible or semirigid devices can be developed, ultrasonic lithotripsy may become a more useful option for the treatment of ureteral calculi. Laser lithotripsy and EHL seem to be equally well suited for use with flexible, actively deflectable ureteroscopes. The relative risks and benefits of these two modalities make their use a matter of clinician's choice. The greater risk of ureteral injury may make EHL somewhat less attractive to endoscopists. However, this must be balanced with the increased cost of the laser lithotripter. It has become apparent that a direct comparison of these three types of intracorporeal lithotripsy is difficult because of the lack of standardized data and the scarcity of randomized comparative trials. Despite this, it appears that all three forms of intracorporeal lithotripsy play an integral part in the treatment of upper-tract urinary calculus disease. Certainly, one of the more exciting areas in the field of endourology will be the continued emergence and development of new technologies and devices for these purposes.
从之前的讨论中似乎可以明显看出，没有任何一种体内碎石术是治疗所有上尿路结石的完美方法。事实上，鉴于体外冲击波碎石术（SWL）的成功，必须仔细考虑内镜技术在上尿路结石治疗中的作用。然而，并非所有结石都适合体外治疗。因此，输尿管镜检查结合各种形式的体内碎石术，是一种无需手术干预就能成功治疗患者的替代方法。超声碎石术可能是三种治疗方法中最不理想的，主要是因为它必须使用硬性内镜设备进行操作。未来，如果能开发出柔性或半刚性设备，超声碎石术可能会成为治疗输尿管结石更有用的选择。激光碎石术和液电碎石术（EHL）似乎同样适用于可主动偏转的柔性输尿管镜。这两种方法的相对风险和益处使得临床医生在使用时需做出选择。输尿管损伤风险较高可能使液电碎石术对内镜医生的吸引力有所降低。然而，这必须与激光碎石设备成本的增加相权衡。由于缺乏标准化数据以及随机对照试验较少，显然很难对这三种体内碎石术进行直接比较。尽管如此，这三种体内碎石术似乎在治疗上尿路结石疾病中都发挥着不可或缺的作用。当然，腔内泌尿外科领域更令人兴奋的领域之一将是继续出现并开发用于这些目的的新技术和设备。
