探討超音波影像結石定位體外震波碎石的療效

Exploration of the Curative Effect of ultrasound-based real-time Lithotripsy

10.6288/TJPH2009-28-02-05

陳志榮(Chih-Jung Chen)；鐘威昇(Wei-Sheng Chung)；李麗花(Li-Hua Lee)

尿路結石 ； 超音波碎石術 ； 結石碎裂率 ； 結石廓清率 ； 有效商 ； urinary calculi ； ultrasound lithotripsy ； stone fragmentation rate ； stone free rate ； efficiency quotient

台灣公共衛生雜誌

28卷2期（2009 / 04 / 01）

124 - 131

繁體中文

目標：探討體外震波碎石治療泌尿系統結石的療效和安全性。方法：2004-2007年於花東某區域醫院門診接受體外震波碎石術的病人為研究對象，總共1542位完成治療前和治療後一週、兩週、四週、三個月的相關資料收集，內容包含測量血壓、腹部X光攝影和腎臟超音波、小便分析及併發症的監測等。結果：腎結石者佔86.3%、輸尿管結石佔13.7%，治療平均花費22.7分鐘，過程未使用任何麻醉藥或止痛劑。震波治療後結石碎裂率為93.6%、廓清率78%，再次接受體外震波碎石者佔9.21%，接受輔助治療者佔2.39%，且與結石位置及大小有統計上明顯的差異(p≦.05)，治療有效商0.67。治療後和兩週後血壓有明顯下降；術後四週的尿液分析，血尿者完全改善且無感染發生，亦未發生皮下瘀青或腎臟血腫等傳統合併症，完成三個月之追蹤為86.7%。結論：本研究顯示體外震波碎石術有不錯的療效及很少的併發症，可能是自動雙定位結石追蹤系統提高碎石機對結石命中的機率，而將腎臟組織傷害降至最低，進而減少併發症的發生。

Objectives: To explore the curative effect and safety of extracorporeal shock wave lithotripsy (ESWL) in the treatment of urinary calculi. Methods: From 2004-2007, 1542 patients received ESWL in a clinic of an Eastern Taiwan regional hospital. Blood pressure determination, abdominal x-ray, renal ultrasound, urinalysis, and assessment of complications were conducted prior to treatment and 1-, 2-, and 4-weeks, and 3-months post-treatment. Results: Urinary calculi were predominantly renal calculi (86.3%), with the remainder (13.7%) being ureteral calculi. Treatment averaged 22.7 minutes and never involved any anesthetic or analgesic. The fragmentation rate was 93.6% and stone free rate was 78%. ESWL re-treatment and auxillary treatment was necessary in 9.21% and 2.39% of cases, respectively. A statistically significant difference (p≤0.05) was evident in the position and size of calculi. The efficiency quotient was 0.67. Blood pressure was significantly lower 2-weeks after treatment. Postoperative urinalysis 4-weeks post-treatment revealed total resolution of hematuria. Infection did not recur. Traditional complications such as subcutaneous bruises or renal hematuria never occurred. The 3-month tracking rate was 86.7%. Conclusions: ESWL is curative with fewer complications. These attributes reflect the enhanced targeting of calculi and lessened renal tissue damage.

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