- 學位論文
軟式輸尿管腎臟鏡與經皮腎臟鏡碎石療效之比較
Comparision of retrograde intrarenal surgery and percutaneous nephrolithotripsy for the treatment of urolithiasis
摘要
研究目的： 尿路結石症是泌尿生殖系統好發的疾病之一。尿路結石症的發生率為12 ％，尿路結石症的復發率可高達50 ％。因此，尿路結石是非常重要，值得高度關注的疾病。台灣泌尿科醫學會所制定的尿路結石的治療指引主要是依據美國或歐洲泌尿醫學協會的治療準則。在這此項研究中，我們主旨是探討台灣本土中部區域醫院軟式輸尿管腎臟鏡碎石手術和經皮腎臟鏡碎石取石手術療效的比較。 從民國106年1月到109年12月止，收集台灣中部某一區域醫院52例接受軟式輸尿管腎臟碎石鏡手術和139例接受經皮腎臟鏡碎石取石手術的患者。我們根據結石大小將病患分為：小於2公分，2至5公分和大於5公分結石的三組，分析兩種治療尿路結石的結石清除率的差異。進而分析兩種治療方式在住院天數，術後住院天數，併發症發生率，血紅素下降數，手術時間長短和輸血率的差異。 研究方法： 本研究採用回朔性世代研究，比較不同治療方法 ( PCNL, RIRS ) 對於結石治療療效的差異 (結石清除率)。以及不同治療方法 ( PCNL, RIRS ) 對於結石治療照護結果的差異 ( 併發症、輸血率、住院天數、再治療率 )。 研究結果： 經皮腎臟鏡碎石取石手術的整體結石清除率是51.3 ％，軟式輸尿管腎臟鏡碎石手術的整體結石清除率是59.0 ％。在小於2公分的結石治療上，經皮腎臟鏡碎石取石手術的結石清除率為93.3 ％，軟式輸尿管腎臟鏡碎石手術的結石清除率為79.2 ％。在2至5公分的結石治療上，經皮腎臟鏡碎石取石手術的結石清除率是55.9 ％，軟式輸尿管腎臟鏡碎石手術的結石清除率是70.8 ％。在大於5公分的結石治療上，經皮腎臟鏡碎石取石手術的結石清除率是36.4 ％，軟式輸尿管腎臟碎石鏡手術的結石清除率是0 ％。經皮腎臟鏡碎石取石手術的併發症發生率較高 （ 11.5 ％ ） 同時有較高的輸血率 （ 18.7 ％ ），但這兩個結果是無統計學顯著意義。經皮腎臟鏡碎石取石手術的血紅素下降平均為1.7 gm / dl。經皮腎臟鏡碎石取石手術的住院天數和術後住院天數較長 （ p < 0.001 ）。 結論： 此研究證實，軟式輸尿管腎臟鏡碎石手術對於直徑小於2公分的尿路結石是一安全有效的治療方法，且手術併發症較低，住院天數亦較短。軟式輸尿管腎臟鏡碎石手術對於2至5公分的尿路結石也有不錯的治療預後。根據回歸分析，經皮腎臟鏡碎石取石手術仍然是治療大於2公分的尿路結石之黃金標準。
並列摘要
Purpose： Urolithiasis is one of the most prevalent disease of the genitourinary system worldwide. The incidence of urolithiasis is 12 %, and the recurrence rate of urolithiasis is as high as 50 %. As a result, urolithiasis is very important and deserves attention. The treatment guidelines of urolithiasis set by the Taiwan Urology Association are mostly based on the guidelines of the American or European Urology Association. In the study, we aimed to investigate at comparing at the efficacy of retrograde intrarenal surgery ( RIRS ) and percutaneous nephrolithotripsy ( PCNL ) in middle Taiwan. From January 2017 to December 2020, there were 52 patients received RIRS and 139 patients received PCNL at one hospital in middle Taiwan. We analyzed the difference in stone free rate by dividing patients into 3 groups according to stone size: < 2cm, 2~5cm and > 5cm of two approaches for treating urolithiasis. The days of hospital stay, the days of post-operative stay, the rate of complication, the decrease of hemoglobin ( Hgb ) levels, the operative time and the rate of blood transfusion are included to be analyzed. Method： In this cohort study, the stone-free rate and the results ( complications, blood transfusion rate, length of stay in hospital, re-treatment rate) were analyzed in the different procedure of RIRS and PCNL. Result： An overall stone free rate is 51.3 % in the group of PCNL and 59.0 % in the group of RIRS. The stone free rate is 93.3 % in the group of PCNL and 79.2 % in the group of RIRS for treating the stone < 2 cm in size. The stone free rate is 55.9 % in the group of PCNL and 70.8 % in the group of RIRS for treating the stone 2~5 cm in size. The stone free rate is 36.4 % in the group of PCNL and 0 % in the group of RIRS for treating the stone > 5 cm in size. The procedure of PCNL is associated higher complication rate ( 11.5 % ) and higher blood transfusion ( 18.7 % ), but the result were not statistically significant. The dropped Hgb is average 1.7 gm/dl. The days of hospital and post-operative stay are longer in the group of PCNL ( p < 0.001 ). Conclusion： This study confirms that RIRS is a safe and effective method for treating less 2cm in diameter of urinary stone with lower surgical complications and shorter hospital stays. RIRS is also a good prognosis for treating 2~5 cm stones. According the analysis of univariable logistic regression model, the PCNL is still the gold standard procedure for treating stones greater 2 cm.