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首页> 外文期刊>The Journal of Urology >The efficacy of extracorporeal shock wave lithotripsy for isolated lower pole calculi compared with isolated middle and upper caliceal calculi.
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The efficacy of extracorporeal shock wave lithotripsy for isolated lower pole calculi compared with isolated middle and upper caliceal calculi.

机译：体外冲击波碎石术治疗孤立的下极结石与孤立的中上钙结石的疗效。

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PURPOSE: We assess the efficacy of extracorporeal shock wave lithotripsy monotherapy for isolated lower pole nephrolithiasis, and compare it to that for isolated middle and upper caliceal calculi. MATERIALS AND METHODS: We treated 714 renal units in 687 patients with isolated caliceal stones using a Lithostar lithotriptor (Siemens Medical Systems, Erlangen, Germany). The stones were localized in the lower, mid and upper calices in 455, 104 and 128 patients, respectively. Stone load was recorded in cm.2. Patients were stratified into 3 groups based on stone burden. The energy and shock waves, use of anesthesia, number of treatment sessions, auxiliary measures and complications were noted. Patients were evaluated with intravenous urogram or plain film of kidneys, ureters and bladder, and ultrasonography when stone-free, or clinically significant residual fragment status, including nonobstructive and noninfectious insignificant fragments 4 mm. or less, was noted at the fluoroscopic control 2 to 4 weeks after the last session. Final clinically significant residual fragment decision was made 10 to 12 weeks after the last session. Extracorporeal shock wave lithotripsy was considered a failure if no fragmentation was noted after session 3 and continued if fragmentation was noted. Results regarding caliceal localization were compared. RESULTS: Complete data were available on 591 renal units. Auxiliary procedures were used in 81 (14%) units before treatment. Anesthesia was given to 101 (17%) patients. The mean number of shock waves and energy used were 2,022 and 17.4 kV., respectively. The difference in shock wave, energy and treatment rate among 3 caliceal locations reached statistical significance only for energy delivered to the lower and upper calices. The effectiveness quotient of extracorporeal shock wave lithotripsy was 36%, 46% and 41% for lower, middle and upper pole stone disease, respectively (p = 0.4). There was a highly significant correlation between stone-free and re-treatment rates, and stone burden. The overall stone-free rate was 66%, and 63%, 73% and 71% for lower, middle and upper caliceal stones, respectively (p = 0.1). For the group with stones greater than 2 cm.2 overall stone-free rate decreased to 49%, and 53%, 60% and 23% in lower, middle and upper caliceal locations, respectively. Overall, extracorporeal shock wave lithotripsy monotherapy failed in 46 (7.7%) renal units. Steinstrasse developed in 39 (6.5%) patients who were then treated with repeat lithotripsy. CONCLUSIONS: Extracorporeal shock wave lithotripsy appears to be successful for management of isolated caliceal stone disease. Treatment efficacy was not significantly different among stones localized in lower, middle and upper poles. We recommend it as the primary treatment of choice for stones less than 2.0 cm.2 in all caliceal locations. Treatment should be individualized for management of caliceal stones greater than 2.0 cm.2 until large prospective randomized trials comparing shock wave lithotripsy and percutaneous nephrolithotomy are available.
机译：目的：我们评估体外冲击波碎石术单一疗法对孤立的下极肾结石症的疗效，并将其与孤立的中上钙结石进行比较。材料与方法：我们使用Lithostar碎石仪（Siemens Medical Systems，Erlangen，Germany）治疗了687例孤立性钙质结石患者的714个肾单位。结石分别位于455、104和128位患者的下部，中部和上部。石材负荷以厘米2记录。根据结石负担将患者分为3组。记录了能量和冲击波，麻醉的使用，治疗次数，辅助措施和并发症。对患者进行静脉输尿管造影或肾脏，输尿管和膀胱的平片检查，并在无结石或临床上显着的残留碎片状态（包括4毫米无阻塞和非传染性的微小碎片）进行超声检查时进行评估。在最后一次疗程后2至4周，在荧光镜下观察到小于或等于0。在最后一届会议后的10到12周做出了最终的临床上有意义的残留碎片最终决定。如果在第3节后未发现碎裂，则认为体外冲击波碎石术是失败的，如果发现碎裂则继续进行。比较了有关钙质定位的结果。结果：共有591个肾单位的完整数据。治疗前以81（14％）个单位使用辅助程序。 101例（17％）患者接受了麻醉。平均冲击波数和能量消耗分别为2022 kV和17.4 kV。仅在传递给上下牙的能量上，三个Calice位置之间的冲击波，能量和治疗率的差异才达到统计显着性。体外冲击波碎石术对下，中，上极结石疾病的有效商分别为36％，46％和41％（p = 0.4）。无结石率和再处理率与结石负荷之间存在高度显着的相关性。下部，中部和上部钙质结石的总无结石率分别为66％，63％，73％和71％（p = 0.1）。对于结石大于2 cm.2的组，总的无结石率分别下降到49％，在下部，中部和上部钙质位置分别为53％，60％和23％。总体而言，体外冲击波碎石术单药治疗在46个肾单位（7.7％）中失败。 Steinstrasse在39名（6.5％）患者中发展，然后接受重复碎石术治疗。结论：体外冲击波碎石术似乎是成功的孤立钙化石疾病的管理。在下，中，上极的结石之间，治疗效果无明显差异。我们建议将其作为所有钙质部位小于2.0 cm.2的结石的首选主要治疗方法。应对大于2.0 cm.2的钙结石进行治疗应个体化，直到获得比较冲击波碎石术和经皮肾镜取石术的大型前瞻性随机试验为止。

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