目的 體外震波碎石術治療腎臓及上泌尿道結石是一種有效和非侵入性的治療方法，但治療大於20毫米的上泌尿道石仍有爭議。我們的主旨在研究體外震波碎石術對上泌尿道結石的治療效果與預後是否與結石的大小有關。方法 從1999年12月到2000年7月共有703例上泌尿道結石的病人在我們醫院接受體外震波碎石術治療，包括470例腎臓結石和233例上輸尿管結石。175例因資料遺失或末繼續追蹤而排除，在這次研究中總共有528。我們將所有案例結石大小分爲3組並分析各組間的差異：A組小於10毫米有274例，B組小於20毫米有204例，C組大於20毫米有50例。結果 三個月追蹤後全部結石排空率爲69.7百分比(結石碎片小於3毫米)。術後接受輔助性治療的比率，三組有明顯的不同(p<0.001)。C組接受輔助性治療的比率(24%)高於其他兩組，而結石排空率低於其他兩組。術後並沒有與體外震波碎石術有關的嚴重併發症發生。結論 體外震波碎石術治療腎臟及上輸尿管結石是有效且安全的，當結石大於20亳米時體外震波碎石術不建議作第一線的治療選擇，因較低的結石排空率與術後接受輔助性治療的比率較高。
Objectives. Extracorporeal Shock wave Lithotripsy (ESWL) is an effective and non-invasive treatment for renal and upper ureteral stones. However, appropriate treatment for larger stones (>2 cm) is still controversial. We aimed to investigate the efficacy of ESWL for larger upper urinary tract stones and the factors that influence outcome. Methods. From December 1999 to July 2000, a total of 703 patients with upper urinary tract stones (470 patients with renal stones and 233 patients with upper ureteral stones) were treated by ESWL at the China Medical University Hospital. One hundred seventy-five cases were excluded from this study because of missing data or because they were lost to follow up. A total of 528 patients were enrolled in this study. We analyzed the difference in outcome by dividing patients into 3 groups according to stone size: Group A<10 mm (274 cases), Group B<20 mm but>10 mm (204 cases), Group C>20 mm (50 cases). Auxiliary treatment for the complications in the 3 groups included either uretero-renoscopic lithotripsy (URSL) or percutaneous nephro-lithotripsy (PCNL). Results. An overall stone free rate of 69.7% (stone fragment< mm) was achieved during 3- month follow-up. The auxiliary treatment rate differed among the 3 groups (p<0.001). Group C required a higher auxiliary treatment rate (24.0%) and had a lower stone free rate (32.0%) than the other two groups. No serious complications related to ESWL were observed. Conclusions. In conclusion, the ESWL is a safe and effective method for treating renal and upper ureteral stones. However, ESWL is not recommended for treating stones greater than 20 mm because of the higher auxiliary treatment rate and lower stone free rate.
