Teichman J M, Rao R D, Rogenes V J, Harris J M
Division of Urology, University of Texas Health Science Center, San Antonio, USA.
J Urol. 1997 Oct;158(4):1357-61. doi: 10.1016/s0022-5347(01)64214-9.
This study compared electrohydraulic and holmium:YAG lithotripsy for ureteral calculi.
Two cohorts of consecutive patients with ureteral calculi treated with ureteroscopic electrohydraulic or holmium:YAG lithotripsy were retrospectively compared. Electrohydraulic lithotripsy was done using a 1.9F fiber at energy settings between 50 and 100 v. Holmium:YAG lithotripsy was done using a 365 microm. fiber at energy settings of 0.6 to 1.5 J.
A total of 23 and 47 consecutive patients underwent electrohydraulic and holmium:YAG lithotripsy, respectively. For preoperative calculi less than 15 mm. mean stone size plus or minus standard deviation was 9 +/- 3 versus 9 +/- 3 mm. (p = 0.5), mean operative time was 72 +/- 21 versus 102 +/- 38 minutes (p = 0.004), stone-free rate at the end of ureteroscopy was 65 versus 97 (p < 0.01) and 3-month stone-free rate was 94 versus 97% (p = 0.4) for electrohydraulic versus holmium:YAG lithotripsy. For preoperative calculi 15 mm. or greater stone size was 19 +/- 5 versus 19 +/- 4 mm. (p = 0.9), operative time was 159 +/- 61 versus 108 +/- 27 minutes (p = 0.01), stone-free rate at the end of ureteroscopy was 33 versus 87% (p = 0.001) and 3-month stone-free rate was 67 versus 100% (p = 0.02). Complications were not significantly different in either comparison.
The overall likelihood that a patient would be rendered stone-free at ureteroscopy and 3 months after ureteroscopy favored holmium:YAG over electrohydraulic lithotripsy. For ureteral calculi less than 15 mm. electrohydraulic lithotripsy was more rapid than the holmium:YAG procedure but for ureteral calculi 15 mm. or greater the holmium:YAG technique was more rapid than electrohydraulic lithotripsy. The outcomes differences may have resulted from the different mechanisms of electrohydraulic and holmium:YAG lithotripsy.
本研究比较了输尿管结石的电液压碎石术和钬激光碎石术。
回顾性比较两组连续接受输尿管镜电液压碎石术或钬激光碎石术治疗的输尿管结石患者。电液压碎石术使用1.9F纤维，能量设置为50至100伏。钬激光碎石术使用365微米的纤维，能量设置为0.6至1.5焦耳。
分别有23例和47例连续患者接受了电液压碎石术和钬激光碎石术。对于术前结石小于15毫米的患者，平均结石大小加减标准差为9±3毫米与9±3毫米（p = 0.5），平均手术时间为72±21分钟与102±38分钟（p = 0.004），输尿管镜检查结束时的结石清除率为65%与97%（p < 0.01），电液压碎石术与钬激光碎石术的3个月结石清除率分别为94%与97%（p = 0.4）。对于术前结石15毫米或更大的患者，结石大小为19±5毫米与19±4毫米（p = 0.9），手术时间为159±61分钟与108±27分钟（p = 0.01），输尿管镜检查结束时的结石清除率为33%与87%（p = 0.001），3个月结石清除率为67%与100%（p = 0.02）。两种比较中的并发症无显著差异。
输尿管镜检查时及输尿管镜检查后3个月患者结石清除的总体可能性，钬激光碎石术优于电液压碎石术。对于小于15毫米的输尿管结石，电液压碎石术比钬激光碎石术更快，但对于15毫米或更大的输尿管结石，钬激光碎石术比电液压碎石术更快。结果差异可能源于电液压碎石术和钬激光碎石术的不同机制。
