Planz B, Wolff J M, Gutersohn A, Stampfer D S, Jakse G
Department of Urology, Technical University of Aachen, Germany.
Urol Int. 1997;59(3):174-6. doi: 10.1159/000283056.
In this study we attempt to evaluate the advantages and disadvantages of extracorporeal shock wave lithotripsy (ESWL) in situ versus retrograde stone manipulation before ESWL (ESWL+push back) in patients with proximal ureteral stones with regard to tissue damage and inflammatory processes. Several studies have revealed that C-reactive protein (CRP) is a useful marker for tissue damage and inflammation. Thirty patients following primary ESWL in situ, with residual calculi, were randomized to retreatment with ESWL in situ or ESWL+push back. Four of 15 patients in the ESWL+push back group demonstrated an increase in CRP levels after treatment compared with no significant increase in 15 patients in the ESWL in situ group. We conclude that ESWL+push back did not cause significantly higher CRP values than ESWL in situ. ESWL+push back may cause irritation, inflammation, and slight tissue damage in some cases; however, these effects are probably minor and would not contraindicate its use. The implications of this study are that serum CRP levels may be utilized to monitor tissue injury in patients undergoing auxiliary procedures.
在本研究中，我们试图评估对于近端输尿管结石患者，在组织损伤和炎症过程方面，体外冲击波碎石术（ESWL）原位治疗与ESWL前逆行推石操作（ESWL+推回）的优缺点。多项研究表明，C反应蛋白（CRP）是组织损伤和炎症的有用标志物。30例初次ESWL原位治疗后有残余结石的患者被随机分为ESWL原位再治疗组或ESWL+推回组。ESWL+推回组15例患者中有4例治疗后CRP水平升高，而ESWL原位组15例患者无明显升高。我们得出结论，ESWL+推回导致的CRP值并不比ESWL原位治疗显著更高。ESWL+推回在某些情况下可能会引起刺激、炎症和轻微的组织损伤；然而，这些影响可能较小，并不构成其使用的禁忌证。本研究的意义在于，血清CRP水平可用于监测接受辅助治疗的患者的组织损伤。
