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    L4横突以下输尿管上段结石两种治疗方法的前瞻性随机研究

    A prospective randomized study of two treatments for upper ureteral calculi below transverse process of L4

      摘要
    • 摘要:
      目的比较多尼尔体外冲击波碎石术（ESWL）和输尿管镜碎石术（URS）治疗L4横突以下输尿管上段结石的疗效和安全性。
      方法收集L4横突以下输尿管上段结石（结石长径1.0~ < 2.0cm）病人158例，按随机数字表法分入ESWL组（80例）和URS组（78例），再根据结石长径分为 < 1.3cm和≥1.3cm 2个亚组，分析各组一次碎石成功率、最终碎石成功率、医疗费用及并发症等。
      结果ESWL组的一次碎石成功率和医疗费用明显低于URS组，重复治疗率明显高于URS组（P < 0.01），2组最终碎石成功率和并发症发生率差异无统计学意义（P>0.05）。在ESWL组，结石长径≥1.3 cm亚组一次碎石成功率和最终碎石成功率低于长径 < 1.3cm（P < 0.01）；在URS组的2个亚组内碎石成功率差异无统计学意义（P>0.05）。结石长径≥1.3cm，行URS一次碎石成功率和最终碎石成功率高于ESWL，差异有统计学意义（P < 0.01和P < 0.05）；结石长径 < 1.3cm，行ESWL与URS疗效差异无统计学意义（P>0.05）。各亚组内和亚组间比较，并发症发生率差异无统计学意义（P>0.05）。
      结论位于L4横突以下输尿管上段结石的治疗，若结石长径1.3~ < 2.0 cm，首选URS；若结石长径1.0~ < 1.3 cm，适合行ESWL。

       

      Abstract:
      ObjectiveTo compare the efficacy and safety between extracorporeal shock wave lithotripsy(ESWL) and ureteroscopy(URS) in the treatment of upper ureteral calculi below the transverse process of L4.
      MethodsA total of 158 patients with upper ureteral calculi(length diameter 1.0- < 2.0 cm) below the transverse process of L4 were randomly divided into the ESWL group(80 cases) and URS group(78 cases), Two groups were subdivided into the < 1.3 cm group and ≥1.3 cm group according to the length diameter of calculi.The one-time lithotripsy success rate, final lithotripsy success rate, costs stone calculi and complications were compared between two groups.
      ResultsThe one-time lithotripsy success rate and medical expenses in ESWL group were lower than those in URS group, and the repeated treatment rate in ESWL group was higher than that in URS group(P < 0.01).There was no statistical significance in the final lithotripsy success rate and incidence rate of complications between two groups(P>0.05).In ESWL group, the one-time lithotripsy success rate and final lithotripsy success rate in patients with calculi diameter ≥1.3 cm were lower than those in patients with calculi diameter < 1.3 cm(P < 0.01).In URS group, the difference of the lithotripsy success rate between two subgroups was not statistically significant(P>0.05).For the calculi with diameter ≥1.3 cm, the one-time lithotripsy success rate and final lithotripsy success rate of URS were higher than those of ESEWL(P < 0.01 and P < 0.05).For the calculi with diameter < 1.3 cm, the difference of the curative effect between ESWL and URS was not statistically significant(P>0.05).There was no statistical significance in the incidence rate of complications within and between subgroups(P>0.05).
      ConclusionsFor the management of upper ureteral calculi below the transverse process of L4, URS can be preferred for patients with calculi diameter 1.3- < 2.0 cm, and ESWL can be suited for patients with calculi diameter 1.0 < 1.3 cm.

       

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