【摘要翻译】肾下极结石经体外冲击波碎石术后的结石清除率－争论依然存在

肾下极结石经体外冲击波碎石术后的结石清除率－争论依然存在
(Stone clearance in lower pole nephrolithiasis after extra corporeal shock wave lithotripsy - the controversy continues.)

M Hammad Ather , Fuad Abid , Sobia Akhtar and Karim Khawaja
Dept of Surgery, The Aga Khan University, Karachi, Pakistan

BMC Urol. 2003 Jan 21;3(1):1.
PMID: 12546707

Abstract

Background

To determine factors influencing the clearance of fragments after extra-corporeal shock wave lithotripsy (ESWL) for lower pole calyceal (LPC) stones.

Methods

In the period between July 1998 and Oct 2001, 100 patients with isolated lower polar calyceal calculi ≤ 20 mm, in patients aged ≥ 14 years, were included in the study. Intravenous urograms (I
VU) were reviewed to define the LPC anatomy (width of the infundibulum and pelvicalyceal angle). Study end points i.e. stone free status; number of shock waves used and number of sessions were correlated with variables like LPC anatomy, body mass index and stone size.

Results

At three months follow up the clearance for stone size ≤ 10 mm, 11–15 mm and 16–20 mm were 95, 96 and 90% respectively. Patients with acute LPC (<90°) and obtuse angle (>90°) had stone clearance of 94 and 100% respectively. For the infundibular width of < 4 mm, the stone clearance was 93% were as for > 4 mm, it was 100%. For body mass index (BMI) less than and > 30 , the stone clearance was 92 and 95% respectively.

Conclusions

There is a trend towards more ESWL sessions and shock wave requirement in patients with acute pelvi-calyceal angle and narrow infundibulum but it is not statistically significant. Size (≤ 20 mm) and BMI has no relation with stone clearance. With modern lithotripter, stones up to 20 mm could primarily be treated by ESWL, irrespective of an un-favorable lower polar calyceal anatomy and body habitus.

摘要

背景：

为明确肾下盏结石（LPC)经体外冲击波碎石术(ESWL)后的结石碎块清除率的影响因素。

方法：

从1998年7月到2001年10月，共研究了100例孤立性肾下极结石患者（结石≤20mm，年龄≥14岁）。通过复习静脉尿路造影片（IVU）明确LPC的解剖结构（肾盏的宽度和肾盂肾盏角度）。研究的终点即结石的清除状况、冲击波应用的次数及同某些变量如LPC解剖、体重指数和结石大小相关的进程数目。

结果：

对于结石≤10mm、11－15mm及16－20mm的病例经3个月的随访后结石清除率分别为95％、96％和90％。LPC为锐角( <90°)和钝角( >90°)的结石清除率分别为94％和100％。肾盏宽度< 4 mm的结石清除率为93％，而> 4 mm的为100％。对体重指数（BMI）小于和大于30 kg/m2 的病例，结石清除率分别为92％和95％。

结论：

对于肾盂肾盏角为锐角和肾盏窄的病例倾向于更多的ESWL次数和冲击波需求，但在统计学上无显著性。结石尺寸 (≤ 20 mm) 和BMI同结石清除率没有关系。应用新式碎石器后，大至20mm的结石应当首先考虑ESWL，即使肾下盏解剖和身体条件不利。