Carr L K, D'A Honey J, Jewett M A, Ibanez D, Ryan M, Bombardier C
Department of Surgery, University of Toronto, Ontario, Canada.
J Urol. 1996 May;155(5):1565-7. doi: 10.1016/s0022-5347(01)66127-5.
There is theoretical concern that stone recurrence rates may be higher following extracorporeal shock wave lithotripsy (ESWL) compared to other techniques because of residual stone debris.
We documented all new stone formations in 298 consecutive patients who initially achieved a stone-free status following ESWL for renal calculi less that 2 cm in largest dimension, and compared the findings to those of 62 patients treated with percutaneous nephrolithotomy without ultrasonic fragmentation. Stone-free status was assessed by a centrally reviewed plain abdominal film and renal tomograms at 3 months. A plain abdominal film was repeated at 12 and 24 months to detect recurrence.
New stones formed in 22.2% of patients after ESWL and 4.2% after percutaneous nephrolithotomy at 1 year (p = 0.004), and in 34.8% versus 22.6%, respectively, at 2 years (p =0.190). Furthermore, more new stones recurred in the lower and mid calices compared to baseline location in the ESWL group (chi-square <0.0001), which was not observed in the percutaneous nephrolithotomy group.
Our data support a trend toward higher stone recurrence rates in ESWL treated patients, which may be due to microscopic sand particles migrating to dependent calices and acting as a nidus for new stone formation.
理论上担心，与其他技术相比，体外冲击波碎石术（ESWL）后结石复发率可能更高，因为存在残留结石碎片。
我们记录了298例连续患者中所有新形成的结石，这些患者最初在接受ESWL治疗最大直径小于2 cm的肾结石后达到无结石状态，并将结果与62例未进行超声碎石的经皮肾镜取石术患者的结果进行比较。在3个月时通过中央审查的腹部平片和肾脏断层扫描评估无结石状态。在12个月和24个月时重复进行腹部平片以检测复发情况。
ESWL治疗后1年，22.2%的患者形成新结石，经皮肾镜取石术后为4.2%（p = 0.004）；2年时分别为34.8%和22.6%（p = 0.190）。此外，与ESWL组的基线位置相比，下盏和中盏出现更多新的复发结石（卡方检验<0.0001），而经皮肾镜取石术组未观察到这种情况。
我们的数据支持ESWL治疗患者结石复发率较高的趋势，这可能是由于微小沙粒迁移至依赖的肾盏并成为新结石形成的病灶。
