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題 名 | Calculi Occurrence in Patients with Urinary Diversion=尿路改道後病患發生結石之再探 |
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作 者 | 于大雄; 馬正平; 張聖原; | 書刊名 | 醫學研究 |
卷 期 | 20:3 1999.12[民88.12] |
頁 次 | 頁164-170 |
分類號 | 416.274 |
關鍵詞 | 尿路改道; 尿路結石; 感染性結石; 體外震波碎石術; Urinary diversion; Urinary calculi; Struvite stone; ESWL; |
語 文 | 英文(English) |
中文摘要 | 為了分析尿路分流與結石形成之間的關係,我們以回溯性的方法來探討本院做過尿道分流後病人發生結石之情形。這個研究總數為90個病人,男女比例為60:30,平均年齡62.6歲(28歲~82歲)。結石形成的盛行率為16.7%(15/90),而所有結石病人中除一人外均無結石病史,尿路改道的原因包括了12例膀胱移行上皮癌以及3例神經性膀胱;迴腸尿路改道為最常見之手術方法,泌尿道感染(9/15)以及菌血症也常在這些病人發生,尿液培養發現了8例綠膿桿菌。總共治療了15個病人24處結石,結石平均大小為1.8 cm (0.5~5.5 cm),24處結石中14處位於腎臟內,2處在輸尿管腎盂交界處,5處在輸尿管,而3處則發生於尿液儲存囊內。其中6個病人接受了經皮腎穿刺插管引流以緩解急性阻塞及敗血症的症狀,而較大的複雜性結石,如合併輸尿管狹窄者,則以開放性手術行之,但併發症機率較高且住院天數較常。其他之3處尿液儲存囊結石則以內視鏡移除。體外震波碎石為針對大多數小結石而能達到高清除率的首選方式,但後續追蹤發現體外震波碎石後也有較高的復發率。適度補充水分及有效利用抗生素在尿液分流病人之結石復發預防上扮演著相當重要之角色。 |
英文摘要 | To analyze the relationship between urinary diversion and calculi formation, retrospective review of the patients who had calculi formation after urinary diversion in our hospital was performed. Totally, 90 patients were enrolled in this study with a male to female ratio of 60:30 and mean age of 62.6 years (ranged from 28 to 82). The incidence of calculi formation was 16.7% (15/90) in all patients with diversion and 14.9% (11/74) among those patients having an ileal conduit. All of these stone patients with the exception of one (12 men and 3 women) had no history of urinary stone prior to diversion. A stone usually occurred at 1.3 years postoperatively (ranging from 6 months to 5 years). The causes of diversion included 12 cases of transitional cell carcinoma (TCC) of the bladder and 3 cases of neurogenic bladder. Ileal conduit remained the most popular method of diversion (11/15). Urinary tract infection (9/15) and bacteremia were also common in these patients. Urine culture was positive in 8 cases with Psudomonas aerugionosa the most prevalent. Totally, 24 units of calculi were treated in these 15 patients according to the size and location of the calculi. The mean size of calculi was 1.8 cm (0.5-5.5 cm). Fourteen units were in the kidney, 2 at the UP junction, 5 in the ureter and 3 in the diversion pouch. Six patients received emergency PCN tube drainage for acute obstruction and signs of urosepsis. Larger and complicated stones such as ureteral strictures were managed with open surgery in 4, but the complication rate was higher and hospitalization days longer. Three units of pouch stones were removed by endoscopic manipulation. Extracorporeal shock wave lithotripsy (ESWL) became the first choice in the majority of simple stone units to achieve a high stone free rate (14/16 units, 88%), but the follow-up found a high recurrent rate after ESWL (6/10 patients, 60%). The incidence of urinary calculi in patients with urinary diversion was 16.7% in our series. Adequate hydration and effective antibiotics play an important role in the prevention of calculi recurrence in urinary diversion patients. |
本系統中英文摘要資訊取自各篇刊載內容。