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題 名 | 輸尿管鏡碎石術治療輸尿管下段結石治療效果的分析=Outcome Analysis of Ureteroscopic Treatment for Patients with a Distal Ureteral Stone |
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作 者 | 莊光達; 黃一勝; 葉忠信; 鄭以弘; 仇光宇; 陳宏恩; 蔡德甫; | 書刊名 | 輔仁醫學期刊 |
卷 期 | 6:2 2008.06[民97.06] |
頁 次 | 頁69-77 |
分類號 | 416.274 |
關鍵詞 | 治療效果分析; 輸尿管下段結石; 輸尿管鏡碎石術; Cost analysis; Treatment outcome; Distal ureteral stone; Extracorporeal shock wave lithotripsy; ESWL; |
語 文 | 中文(Chinese) |
中文摘要 | 目的:統計輸尿管下段結石採用輸尿管鏡碎石術治療的效果。方法與結果:從西元2004 至2006 年於新光吳火獅紀念醫院的回溯性研究,輸尿管下段結石接受輸尿管鏡碎石術治療的病患中,結石<1 公分有639 位,而結石 1 公分有111 位。治療的成功率方面,結石< 1 公分和結石 1 公分這二組分別為94.5% 和86.5% 統計學上有明顯的差異(p < 0.001) 。第一次輸尿管鏡碎石治療失敗的61 位病患,分析失敗的原因有三:輸尿管鏡無法前進至結石的部位有40 位(65.6%) ,碎石過程造成輸尿管的傷害導致手術無法進行繼續有15 位(24.6%) ,輸尿管口擴張不夠有6 位。第一次輸尿管鏡碎石治療失敗的病患,採用第二次輸尿管鏡碎石的成功率依結石的大小分別為75% 和83.3 %,而採用體外電震波碎石術當作後續的治療,仍有 100% 至 78.6% 的機會成功。在治療後門診追蹤的次數方面,當結石 <1 公分是1.09 次而在結石 1 公分是1.19 次,由此可見,輸尿管鏡碎石術碎石之後碎石排清的速度快。但是全部的750 位病患中,有29 位(3.86%) 於接受輸尿管鏡碎石術治療後有併發症發生,大部份是輕微的併發症如泌尿道感染合併發燒有14 位(48.3%) 、血尿有10 位(34.5%) ,而重大的併發症如輸尿管狹窄僅有1 位,但是有併發症發生的這些病患中有8 位(32%) 再次住院接受治療。結論:輸尿管鏡的手術可作為輸尿管下段結石的首要選擇之一。在初步輸尿管鏡碎石手術失敗之病例,後續輔助治療採用體外電震波碎石術治療也是有效的治療方法。 |
英文摘要 | Purpose: To retrospectively estimate objective outcomes of ureteroscopic lithotripsy for distal ureteral stones. Methods and Results: From January 2004 to December 2006, 750 distal ureteral calculi were treated using ureteroscopy. All treatments were performed with the patient under spinal or general anesthesia and on an inpatient basis. The overall stone-free rates were 86.5% (96/111) for stones of > 1 cm and 94.5% (604/639) for stones of < 1 cm. Retreatment was required in 5 (5.2%) and 6 cases (1.5%), respectively. The causes of failed attempts at ureteroscopic stone treatment in 61 patients included an inability to gain access to the stone in 40 (65.6%), ureteral injury during the procedure in 15 (24.6%), and failure to adequately dilate the orifice in 6 (9.8%). Extracorporeal shock wave lithotripsy and secondary ureteroscopy were used after failed initial treatment, and the success rates were 75% and 100% for smaller stones and 83.3% and 78.6% for large stones, respectively. Complications occurred in 29 patients (3.86%), including urinary tract infection (in 14), massive hematuria (in 10), and ureteral stenosis (in 1). Conclusions: Ureteroscopy can be a treatment of choice for lower ureteral stones. Repeat ESWL was useful as an adjuvant treatment modality after failure of the initial ureteroscopic attempt. |
本系統中英文摘要資訊取自各篇刊載內容。