Eden C G, Mark I R, Gupta R R, Eastman J, Shrotri N C, Tiptaft R C
Lithotripter Centre, Department of Urology, St. Thomas' Hospital, London, United Kingdom.
J Endourol. 1998 Aug;12(4):307-12. doi: 10.1089/end.1998.12.307.
Over a period of 57 months, 404 patients with distal ureteral calculi were treated by in situ SWL on a Storz Modulith SL 20 lithotripter and 163 by ureteroscopy (URS) and Swiss Lithoclast stone fragmentation. The case notes on these patients were reviewed for comparison of the initial stone number and individual length and for the calculation of the stone-free, treatment, retreatment, secondary procedure, and complication rates. Complete data were available on 447 patients. The median stone length was 7.0 (range 4-25) mm in the SWL group and 8.0 (range 5-13) mm in the URS group. The single-treatment stone-free rates for the SWL and URS groups were 74.8% and 89.7%, respectively, for single stones and 50.0% and 88.9%, respectively, for multiple (>1) stones. The mean treatment rates for the SWL and URS groups were 1.97 and 1.03, respectively, for single stones and 2.83 and 1.00, respectively, for multiple stones. The mean treatment rate for single stones subjected to SWL increased with increasing stone length (1.57 for stones <8 mm and 2.38 for stones >8 mm), whereas this was not the case for patients submitted to URS (1.20 and 1.27, respectively). The re-treatment rate for each group showed a reciprocal trend. Of the SWL group, 25.9% of the patients eventually required URS to render them stone-free. Nearly all (96%) of the patients undergoing SWL were treated as outpatients. The mean hospitalization in the URS group was 1.1 days. Three patients who underwent URS sustained a ureteral perforation, which was managed successfully by double-J stent insertion. The ideal primary treatment for small (<8 mm) distal ureteral calculi is in situ SWL, with URS plus Lithoclast fragmentation being reserved for failed SWL, single stones >8 mm in length, and multiple stones.
在57个月的时间里，404例远端输尿管结石患者在Storz Modulith SL 20型碎石机上接受了原位冲击波碎石术（SWL）治疗，163例患者接受了输尿管镜检查（URS）及瑞士碎石清石系统碎石治疗。回顾这些患者的病历，以比较初始结石数量、单个结石长度，并计算结石清除率、治疗率、再次治疗率、二次手术率及并发症发生率。447例患者有完整数据。SWL组结石中位长度为7.0（范围4 - 25）mm，URS组为8.0（范围5 - 13）mm。SWL组和URS组单颗结石单次治疗的结石清除率分别为74.8%和89.7%，多颗（>1颗）结石的清除率分别为50.0%和88.9%。SWL组和URS组单颗结石的平均治疗次数分别为1.97次和1.03次，多颗结石分别为2.83次和1.00次。SWL治疗的单颗结石平均治疗次数随结石长度增加而增加（<8 mm结石为1.57次，>8 mm结石为2.38次），而URS治疗的患者则不然（分别为1.20次和1.27次）。每组的再次治疗率呈现相反趋势。SWL组中，25.9%的患者最终需要接受URS治疗以清除结石。几乎所有（96%）接受SWL治疗的患者为门诊治疗。URS组的平均住院时间为1.1天。3例接受URS治疗的患者发生输尿管穿孔，通过置入双J支架成功处理。对于小（<8 mm）的远端输尿管结石，理想的初始治疗方法是原位SWL，URS联合碎石清石系统治疗则用于SWL失败、长度>8 mm的单颗结石及多颗结石。
