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体外冲击波碎石术治疗经皮肾镜或输尿管镜碎石术后上尿路残余结石的效果

ESWL in the treatment of residual upper urinary tract stones after percutaneous nephrolithotomy or ureteroscopic lithotripsy

    摘要
  • 摘要:
    目的 探讨体外冲击波碎石术（extracorporeal shock wave lithotripsy, ESWL）治疗经皮肾镜取石术(percutaneous nephrolithotomy, PNL)或经尿道输尿管镜碎石术(ureteroscopic lithotripsy, URL)后上尿路残余结石的疗效和安全性。
    方法 回顾性分析2018年8月至2020年6月于复旦大学附属中山医院行PNL（86例）或URL（149例）术后存在上尿路残余结石，并接受术后ESWL的235例患者的临床资料，分析残余结石形状，ESWL疗效及术后并发症。
    结果 86例PNL术后患者中有55例行ESWL 1次、21例行ESWL 2次后未发现临床有意义残石(significant residual fragments，SIRF)；10例行ESWL 2次后仍有大于0.4 cm残余结石，其中8例结石形状改变、2例结石形状无明显变化。149例URL后患者中有96例行ESWL 1次、28例行ESWL 2次后未发现SIRF；25例行ESWL 2次后仍有大于0.4 cm残余结石，其中18例结石形状改变、7例结石形状无明显变化。ESWL结石总碎石率为96.2%（226/235），总清除率85.1%（200/235）。肉眼血尿发生率为17.9%（42/235），肉眼血尿症状在患者增加饮水量1~3 d后均消失；疼痛发生率为10.6%（25/235），患者均可忍受，无需特殊治疗；泌尿系感染发生率为0.9%（2/235），予以抗炎治疗3 d后均痊愈。
    结论 ESWL对PNL或URL后的上尿路残余结石有明显疗效，安全性高，可行性强，且创伤小、痛苦少。

     

    Abstract:
    Objective To investigate the efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) for residual upper urinary tract stones after percutaneous nephrolithotomy (PNL) or ureteroscopic lithotripsy (URL).
    Method Clinical data of 235 patients with residual upper urinary tract stones after PNL (n=86) or URL (n=149) and underwent ESWL in Zhongshan Hospital, Fudan University from August 2018 to June 2020 were retrospectively analyzed. The shape of residual stones, ESWL efficacy, and postoperative complications were analyzed.
    Result Among the 86 patients after PNL, 55 underwent ESWL once and 21 underwent ESWL twice and had no clinically significant residual fragment (SIRF); 10 patients still had residual stones larger than 0.4 cm after ESWL for 2 times, among which the shape of the stones changed in 8 patients, while that of the stones did not change significantly in 2 patients. Among the 149 patients after URL, 96 nderwent ESWL once and 28 underwent ESWL twice and had no SIRF; There were still residual stones larger than 0.4 cm in 25 patients after ESWL for 2 times, and the shape of the stones changed in 18 cases, while that of the stones did not change significantly in 7 patients. The total lithotripsy success rate was 96.2% (226/235), total clearance rate was 85.1% (200/235). The incidence of gross hematuria was 17.9% (42/235), which disappeared after 1-3 d of large amount of water intake. The incidence of pain was 10.6% (25/235), which was tolerable and required no special treatment. The incidence of urinary tract infection was 0.9% (2/235), and both patients recovered after 3 d of anti-inflammatory therapy.
    Conclusion ESWL is effective in treating residual upper urinary tract stones after PNL or URL and it is safe and feasible.

     

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