【摘要】 目的评估体外冲击波碎石(ESWL)和输尿管软镜(RIRS)在治疗2cm以下肾下盏结石的安全性和有效性。方法将2013年1月至2015年1月间在本院治疗的195例<2cm、X线不透光肾下盏结石患者纳入研究。将所有患者随机分为两组:体外冲击波碎石治疗组(ESWL组,参数设置为120kV、240mA)97例;输尿管软镜钬激光碎石取石治疗组(RIRS组,奥林巴斯电子输尿管软镜)98例。分别对患者的基本信息、结石清除率、重复治疗率、辅助治疗方法以及并发症发生率进行分析统计。结果结石平均大小ESWL组为(12.1±1.2)mm,RIRS组为(12.3±1.1)mm(P=0.52)。术后3个月结石清除率:ESWL组为82.2%(74/90),RIRS组为86.6%(78/90),两组差异无统计学意义(P=0.34)。3个月清除率:对于<10mm结石,ESWL组为84.9%(43/51),RIRS组为87.7%(43/51),差异无显著性统计学意义(P>0.05);对于10~20 mm结石,ESWL组为78.4%(29/35),RIRS组为85.4%(35/39),差异有显著性统计学意义(P<0.05)。重复治疗率ESWL组显著大于RIRS组(61.1%vs.1.1%,P<0.001)。辅助治疗(21.1%vs.17.7%)及并发症发生率(6.6%vs.11.1%),两组差异均无显著性统计学意义(P均>0.05)。结论 ESWL和RIRS均为治疗2cm以下肾下盏结石的安全有效的方法。对于<1cm结石,ESWL治疗创伤小,安全性更高;对于1~2cm肾下盏结石,RIRS治疗效果更好,且重复治疗率更低。更多还原

【Abstract】 Objective To evaluate the efficacy and safety of shock wave lithotripsy(ESWL)and flexible ureteroscopy(RIRS)for lower caliceal calculus<2 cm.Methods A total of 195 patients with single radio-opaque lower caliceal calculi<2 cm treated during Jan.2013 and Jan.2015 were enrolled in the study.The patients were randomized into group A(n=97)and group B(n=98).In Group A,ESWL was performed as an outpatient procedure using the electromagnetic lithotripter(Dornier compact delta),while in Group B,RIRS was performed using the F6/F7.5 flexible ureteroscope(Richard Wolf)with holumium laser intracorporeal lithotripsy.Demographic characteristics,success,retreatment and auxiliary procedure rates and complications were analyzed statistically.Results The mean stone size was 12.1 mm in group A and 12.3 mm in group B(P=0.52).The overall 3-month stone-free rate was 82.2%(74/90)for group A vs.86.6%(78/90)for group B(P=0.34);for stones<10 cm,it was 84.9%(45/55)for group Avs.85.4%(35/39)for group B(P=0.12).Retreatment rate was significantly greater in group A compared with group B(61.1% vs.11.1%;P<0.001).Auxiliary procedure rate was comparable(21.1% vs.17.7%;P=0.45).The complication rate was 6.6%in group Avs.11.1%in group B(P=0.21).Conclusions Both ESWL and RIRS are safe and efficacious for lower caliceal calculi<20 mm.For stones<10 mm,ESWL is safer and less invasive than RIRS with efficacy comparable to it.However,for 10-20 mm stones,RIRS is more effective,with lesser retreatment rate.更多还原