Kirkali Z, Esen A A, Mungan M U
Department of Urology, Dokuz Eylul University, School of Medicine, Inciralti/Izmir, Turkey.
J Endourol. 1996 Feb;10(1):13-5. doi: 10.1089/end.1996.10.13.
Although extracorporeal shockwave lithotripsy (SWL) has dramatically changed the management of urinary tract stone disease, the anatomic abnormalities of horseshoe kidneys cause some difficulties in the use of SWL in this disorder. In this study, 18 patients with stone-bearing horseshoe kidneys were investigated retrospectively in order to determine the effectiveness of SWL. Patients received an average of 11,437 + or - 3062 shocks at an average of 18.8 kV with the Siemens Lithostar. Ten patients were treated in the supine position; stones could be localized in the prone position in eight. Catheterization with a double-J stent was the only adjunctive procedure; it was used in four patients prior to SWL. Adequate stone fragmentation (smaller than 5 mm) was achieved in 14 of the 18 patients (78%). Although 5 of them (28%) became stone free within 6 months after the treatment, residual fragments persisted in 9 patients (50%) during the mean follow-up of 55 months. Stones of 4 patients (22%) were not fragmented adequately. We concluded that although adequate fragmentation can be achieved in stone-bearing horseshoe kidneys, the anatomic abnormalities prevent fragment passage in a substantial number of patients.
尽管体外冲击波碎石术（SWL）极大地改变了尿路结石疾病的治疗方式，但马蹄肾的解剖异常给SWL在该疾病中的应用带来了一些困难。在本研究中，对18例马蹄肾合并结石患者进行了回顾性调查，以确定SWL的有效性。患者使用西门子Lithostar平均接受了11437±3062次冲击，平均电压为18.8 kV。10例患者采用仰卧位治疗；8例患者的结石可在俯卧位定位。双J支架置入术是唯一的辅助操作；4例患者在SWL治疗前使用了该支架。18例患者中有14例（78%）实现了充分的结石碎裂（小于5 mm）。尽管其中5例（28%）在治疗后6个月内结石清除，但在平均55个月的随访期间，9例患者（50%）仍有残留碎片。4例患者（22%）的结石未充分碎裂。我们得出结论，尽管马蹄肾合并结石患者可以实现充分的碎裂，但解剖异常在相当数量的患者中阻碍了碎片的排出。
