CAJ | 학술논문

目的评价以结石直径×停留时间系数为标准选择ESWL治疗输尿管上段结石适应证的效果.方法回顾性分析2009年1月至2011年5月收治的180例输尿管上段结石患者的临床资料,男109例,女71例.年龄21 ～ 65岁,平均39岁.结石直径0.5 ～1.6 cm,平均(0.9±0.2)cm.结石在同一部位停留时间1d～5个月,平均(12.6±9.7)d.X线检查均为阳性结石,左侧93例,右侧87例.以结石直径为标准分为≥1 cm组75例和＜1 cm组105例.以结石直径×停留时间系数为新标准分为≥1组101例和＜1组79例.停留时间系数以1周为基准单位,结石停留时间每增加1周,系数增加0.1.比较同一标准不同分组间和不同标准对应分组间ESWL后碎石排净率.结果新标准＜1组排净率为96.2％ (76/79),结石直径＜1 cm组排净率为81.9％(86/105),两组比较差异有统计学意义(P＜0.05).新标准≥1组排净率为60.4％(61/101),结石直径≥1 cm组排净率为68.0％ (51/75),两组比较差异无统计学意义(P＞0.05).结石直径＜1 cm组中26例因结石停留时间长依照新标准进入≥1组,结石排净率为38.5％(10/26),显著低于结石直径≥1 cm组排净率,两组比较差异有统计学意义(P＜0.05).结论结石直径×停留时间系数作为新标准选择输尿管上段结石ESWL的适应证,综合考虑了结石直径和结石停留时间两项因素,新标准＜1组ESWL碎石效果显著高于结石直径＜1 cm组.
목적 평개이결석직경×정류시간계수위표준선택ESWL치료수뇨관상단결석괄응증적효과.방법 회고성분석2009년1월지2011년5월수치적180례수뇨관상단결석환자적림상자료,남109례,녀71례.년령21 ～ 65세,평균39세.결석직경0.5 ～1.6 cm,평균(0.9±0.2)cm.결석재동일부위정류시간1d～5개월,평균(12.6±9.7)d.X선검사균위양성결석,좌측93례,우측87례.이결석직경위표준분위≥1 cm조75례화＜1 cm조105례.이결석직경×정류시간계수위신표준분위≥1조101례화＜1조79례.정류시간계수이1주위기준단위,결석정류시간매증가1주,계수증가0.1.비교동일표준불동분조간화불동표준대응분조간ESWL후쇄석배정솔.결과 신표준＜1조배정솔위96.2％ (76/79),결석직경＜1 cm조배정솔위81.9％(86/105),량조비교차이유통계학의의(P＜0.05).신표준≥1조배정솔위60.4％(61/101),결석직경≥1 cm조배정솔위68.0％ (51/75),량조비교차이무통계학의의(P＞0.05).결석직경＜1 cm조중26례인결석정류시간장의조신표준진입≥1조,결석배정솔위38.5％(10/26),현저저우결석직경≥1 cm조배정솔,량조비교차이유통계학의의(P＜0.05).결론 결석직경×정류시간계수작위신표준선택수뇨관상단결석ESWL적괄응증,종합고필료결석직경화결석정류시간량항인소,신표준＜1조ESWL쇄석효과현저고우결석직경＜1 cm조.
Objective To evaluate stone retention time coefficient (RTC) times stone size value (RTC × S) as the indication of extracorporeal shockwave lithotripsy (ESWL) efficacy in the treatment of upper ureteral calculi.Methods From January 2009 to May 2011,180 consecutive patients including 109males and 71 females who underwent ESWL for a single radiopaque upper ureteral stone with the mean stone size (0.9 ± 0.2) cm and the mean stone retention time (12.6 ± 9.7) d were retrospectively analyzed.The mean patient age was 39 years (range from 21 to 65 years).The base of RTC was set as 1 and each 0.1 was added on it if the stone stayed one more week in upper ureter.Patients were classified into 2 groups by stone size.105 patients were in group ＜ 1 cm and 75 patients were in group≥ 1 cm.According to RTC × S value,79 patients were in group ＜ 1 and 101 patients were in group≥ 1.Stone-free rate between these two groups in the same grouping indication and between two matched groups in the different grouping indication were compared respectively.The chi-square test compared categorical variables between the two groups and all statistical analyses were 2-sided with P ＜ 0.05 defined as statistically significant.Results The overall stone-free rate of group ＜ 1 cm was significantly higher than that of group≥ 1 cm (81.9％ vs.68.0％,P ＜0.05).The overall stone-free rate of group RTC × S value ＜ 1 was significantly higher than that of group RTC × S value ≥1 (96.2 ％ vs.60.4％,P ＜ 0.05).Comparison between two matched groups showed that the stone-free rate of group RTC S value ＜ 1 was significantly higher than that of group ＜ 1 cm (96.2％ vs.81.9 ％,P＜0.05),but group RTC×Svalue≥1 was comparable to group≥l cm (60.4％ vs.68.0％,P ＞ 0.05).26 patients with ＜ 1 cm stones were enrolled in group ≥ 1 for long stone retention time and larger RTC × S value.The overall stone-free rate of them was 38.5％ (10/26) which was significantly lower than that of group≥ 1 cm (P ＜ 0.05).Conclusions The stone retention time is an important factor in efficacy of ESWL for upper ureteral calculi.Use RTC × S as a new indication of ESWL,not only the stone size but stone retention time is taken into account as well.ESWL is highly efficacious in patients with RTC × S values ＜ 1.