Treatment Options for Upper Ureteral Calculi: A Comparison between Ureteroscopy and Extracorporeal Shock Wave Lithotripsy

上段輸尿管結石之治療選擇：輸尿管鏡和體外震波碎石術之比較

張世忠(Shi-Chung Chang) ； 許悌(Tsi Hsu) ； 郭漢崇(Hann-Chorng Kuo)

《慈濟醫學雜誌》 5卷1期 (1993/03) Pp. 15-21

https://doi.org/10.6440/TZUCMJ.199303.0015

摘要

在總計210例上段輸尿管結石病患之分析中，結石體積較大的病患(大於10×6厘米)若使用體外震波碎石術來治療，其結石清除率僅66.2%，遠低於結石體積較小的患者(82.9%)。雖然以往的經驗認為使用輸尿管鏡處理上段輸尿管結石並不如理想，但本研究發現其結石清除率可達65%。超過百分之九十之患者若成功地以體外震波碎石治療，其碎裂之結石均在一個月內排出。總計仍有17例(7.7%)接受傳統截石術以治療結石。
作者們認為，結石若不太大，使用體外震波碎石極為理想，因其成功率可達90%以上。儘管輸尿管鏡碎石處直的效果並不差，尤其對體積較大者，但我認對此仍法仍持保留的態度，並建議將其保留運用在無法有效使用體外震波碎石來治療之病患。

關鍵字

輸尿管鏡取石術 ； 體外震波碎石術 ； 經皮腎臟造癭碎石術 ； 上段輸尿管結石

並列摘要

In a series of 210 patients with upper ureteral calculi stratified into 3 groups, each having a specific merit and treatment option, were subjected to analyses. For larger calculi (10 mm × 6 mm) treated with ESWL, the stone free rate (66.2) was apparently inferior to the group having smaller stones (82.9). Ureteroscopic manipulation (URS) previously thought to be inappropriate for proximal ureteral calculi were successful in 64.9% of cases undertaken this procedure. Ninety percent of cases finally rendered the stone free after ESWL has passed out the fragments within 28 days. Open ureterolithotomy was performed in 17 patients (7.7%) as a final solution who were refractory to both nonsurgical procedures.
We conclude from the study that smaller proximal ureteral calculi are ideal cases for ESWL and a rate free of stone over 90% is anticipated with only one session of treatment. Larger stones, although much more difficult to achieve satisfactory disintegration solely by in situ ESWL, are best treated primarily with ESWL after retrograde manipulation of the stones into the kidney. URS should be reserved for a second-line consideration and applied as an alternative only after a failing ESWL.

並列關鍵字

ureteroscopy ； URS ； extracorporeal shock wave lithotripsy ； ESWL ； percutaneous nephrolithotripsy ； PCNL ； upper ureteral calculus