Objective To investigate the appropriate management of asymptomatic lower calyceal calculi. Methods A total of 116 patients with asymptomatic lower caliceal calculi were enrolled and divided into mini - percutaneous nephrolithotomy( mPCNL )group, extracorporeal shock wave lithotripsy( ES-WL )group and observation group. To assess the stone status, plain kidney - ureter - bladder( KUB )films were re - examined at 1,3 and 12 months after the intervention. Level of bother was assessed by the times of visit. Renal parenchymal injury was evaluated by renal scintigraphy 12 months after intervention. The clinical efficacy and deleterious effects of different management options were evaluated. Results In mPC-NL group all patients were stone - free and in ESWL group the stone - free rate was 70% at month 3( P < 0. 05 ). Scintigraphy revealed a scar in 1 patient in mPCNL group and 3 patients in ESWL group on month 12 follow - up imaging( P >0. 05 ). In the observation group 7 patients required intervention during 12 -month follow - up. Times of visit in observation group were more than intervention group( P < 0. 05 ). Conclusion Patients with asymptomatic lower caliceal stones should be informed in detail about the necessity and the strategies of treatment. Some patients should receive observation instead of surgical treatment. In all of these treatment options, mPCNL is more effective than ESWL.%目的 总结无症状的肾下盏结石的治疗策略.方法 116例患者分别采取观察、体外冲击波碎石术(ESWL)和经皮肾镜碎石术治疗肾下盏结石.在治疗后第1、3和12个月末复查KUB,在12个月末行核素扫描了解患肾肾小球滤过率和肾实质瘢痕数,并记录3个月内和12个月内就诊次数,评价不同的无症状的肾下盏结石治疗策略.结果 观察组患者3个月末就诊次数和12个月末的就诊次数明显高于治疗组(P<0.05),观察组共7例患者接受进一步治疗.治疗组(ESWL和经皮肾镜碎石术)的净石率高于观察组(P<0.05),其中在3个月末,经皮肾镜治疗组净石率为100%,ESWL治疗组3个月末净石率为70%,经皮肾镜碎石术的疗效优于ESWL(P<0.01),对肾功能和肾实质的影响和ESWL治疗差异无统计学意义(P>0.05),未见严重并发症.结论 对于无症状的肾下盏结石患者,我们应告知治疗结石的必要性和治疗策略.部分结石可以选择观察而不进行治疗,在可选治疗方案中,经皮肾镜碎石术的疗效明显优于ESWL治疗.
展开▼
