Theiss M, Wirth M, Frohmüller H
Urologische Klinik und Poliklinik, Universität Würzburg.
Urologe A. 1993 Nov;32(6):486-8.
From January 1988 to February 1992, a total of 26 patients with calculi in the middle third of the ureter underwent primary in situ ESWL in the prone position. All treatments were performed in sedoanalgesia using the Dornier HM 3 lithotriptor. During and after ESWL in the prone position, severe complications did not occur. Of the 26 patients, 10 (38%) were treated by a single application of ESWL. No auxiliary measures were necessary, and they became stone-free within 3 months following treatment. In another 9 patients (35%) auxiliary measures were required for visualization of radiolucent calculi or to relieve a urinary tract obstruction with incipient septicemia. All these auxiliary measures could be performed in sedoanalgesia. In the remaining 7 patients (27%), in whom stone disintegration following ESWL was incomplete, ureteroscopic lithotripsy techniques had to be applied. One of these 7 patients had to undergo an additional open operative procedure. The results of the present study demonstrate that a majority of patients with calculi in the middle portion of the ureter can become stone-free without invasive lithotripsy techniques following ESWL in the prone position, if necessary plus auxiliary measures, in sedoanalgesia. From these results it can be concluded that primary ESWL in the prone position should be considered for patients with calculi in the middle third of the ureter before invasive lithotripsy techniques are applied.
1988年1月至1992年2月，共有26例输尿管中段结石患者在俯卧位接受了原位体外冲击波碎石术（ESWL）。所有治疗均在镇静镇痛下使用多尼尔HM 3碎石机进行。在俯卧位ESWL期间及之后，未发生严重并发症。26例患者中，10例（38%）单次ESWL治疗后结石清除。无需辅助措施，治疗后3个月内结石消失。另外9例患者（35%）需要辅助措施来显影透光结石或缓解伴有早期败血症的尿路梗阻。所有这些辅助措施均可在镇静镇痛下进行。其余7例患者（27%）ESWL后结石破碎不完全，必须采用输尿管镜碎石技术。这7例患者中有1例不得不接受额外的开放手术。本研究结果表明，大多数输尿管中段结石患者在俯卧位ESWL后，必要时加用辅助措施并在镇静镇痛下，无需侵入性碎石技术即可实现结石清除。从这些结果可以得出结论，在应用侵入性碎石技术之前，对于输尿管中段结石患者应考虑采用俯卧位原位ESWL。
