Efficacy of extracorporeal shock wave lithotripsy for isolated lower caliceal stones in children compared with stones in other renal locations
Efficacy of extracorporeal shock wave lithotripsy for isolated lower caliceal stones in children compared with stones in other renal locations
复制标题
DOI：
10.1016/j.urology.2005.07.061
复制
发表时间：
2006-01-01
期刊：
影响因子：
2.1
通讯作者：
Öner, A
中科院分区：
文献类型：
--
作者：
Demirkesen, O;Önal, B;Öner, A
目标.评价体外冲击波碎石术（ESWL）单一疗法治疗小儿年龄组孤立性肾盏下段结石的疗效，并与孤立性肾盏中/上段结石和肾盂结石进行比较。我们回顾性分析了1992年3月至2004年2月间，126名接受ESWL治疗的儿童的151个肾单位的资料。结石分别位于下、中/上肾盏和肾盂中50、26和75个肾单位。比较两组患者的肾脏位置和结石负荷。患者的中位年龄为8岁（范围1 - 16岁）。下肾盏组和中/上肾盏组的中位结石负荷分别为0.6、0.6和1 cm（2），显著低于肾盂组（P = 0.002）。下肾盏结石总排净率为62%，中/上肾盏结石总排净率为65.3%，肾盂结石总排净率为80%。对于结石尺寸大于2 cm（2）的组，下盏和中/上盏的结石清除率均降至33%;然而，肾盂的结石清除率几乎相同（81.8%）。结石负荷与治疗次数有显著相关性（P < 0.001），与结石清除率无显著相关性。在我们的研究中，ESWL对所有部位的结石同样有效。我们推荐ESWL作为肾盏结石小于2.0 cm（2）的首选治疗方法。对于大于2.0 cm的肾盏结石的治疗，比较ESWL和经皮肾镜取石术的前瞻性随机试验是必要的。
Objectives. To evaluate the efficacy of extracorporeal shock wave lithotripsy (ESWL) monotherapy for isolated lower caliceal calculi in a pediatric age group and compare it with that for isolated middle/upper caliceal and renal pelvic calculi.Methods. We retrospectively reviewed the data of 151 renal units in 126 children treated with ESWL for isolated caliceal and renal pelvic stones from March 1992 to February 2004. The stones were localized in the lower, middle/upper calices, and renal pelvis in 50, 26, and 75 renal units, respectively. The results were compared with respect to renal location and stone burden.Results. The median patient age was 8 years (range 1 to 16). The median stone burden in the lower and middle/upper caliceal groups was significantly lower than in the renal pelvis group at 0.6, 0.6, and 1 cm(2), respectively (P = 0.002). The overall stone-free rate was 62% for lower calices, 65.3% for middle/upper calices, and 80% for renal pelvis stones. For the group with a stone size greater than 2 cm(2), the stone-free rate decreased to 33% in both lower and middle/upper calices; however, it was almost the same in the renal pelvis (81.8%). A highly significant relation was found between the stone burden and number of sessions (P < 0.001), but none between the stone burden and stone-free rate.Conclusions. In our study, ESWL was equally effective for stones in all locations. We recommend ESWL as the primary treatment of choice for stones less than 2.0 cm(2) in all caliceal locations. For the management of caliceal stones greater than 2.0 cm(2), prospective randomized trials comparing ESWL and percutaneous nephrolithotomy are necessary.