- 學位論文
輸尿管鏡碎石術和體外震波碎石術對於近端輸尿管結石治療之探討
Study of Ureteroscopic Lithotripsy and Extracorporeal Shock Wave Lithotripsy for Treating Proximal Ureteral Stone
摘要
探討治療困難的近端輸尿管結石的實際臨床和效益，本研究比較治療輸尿管結石需要多個手術的病人，先用輸尿管鏡碎石術( Ureteroscopic Lithotripsy, URSL )或先用體外震波碎石術( Extracorporeal Shock Wave Lithotripsy, ESWL )臨床治療療效和總費用。 本研究納入213例至少接受一次URSL和ESWL，治療同一近端輸尿管結石的患者。審查了2011年1月至2015年9月在某區域醫院的所有近端輸尿管結石患者的病歷、診斷影像和治療花費帳目。81名患者先使用URSL和132名患者先使用ESWL，先使用URSL病人有更高的總費用；更長的住院天數；更長的雙丁型輸尿導管放置天數；更大的結石；更多的手術前泌尿道感染引起的敗血症；更多慢性腎臟疾病；和手術前急性腎損傷。對於一公分或更大的結石，65例先使用URSL與64例先使用ESWL，先使用URSL的總費用統計高於先使用ESWL，先使用URSL有更長的住院天數；有更多的慢性腎臟病患者；更多手術前急性腎損傷和手術前泌尿道感染引起的敗血症。對於小於一公分的結石，16例患者在先使用URSL，68例患者在先使用ESWL。先使用URSL組的總費用在統計學上是相似的。但是先用URSL有比較多的腎臟疾病、術前急性腎損傷和結石病史。 治療困難近端輸尿管的結石，建議先用URSL於具有較大結石和複雜狀況( 如：慢性腎臟病、急性腎損傷、泌尿敗血症、需要經皮腎造口術 )的病人，複雜狀況的原因會導致URSL組的總費用較高和住院時間較長，若是結石小於一公分的近端輸尿管結石，先用ESWL或先用URSL都有相似療效和醫療費用。
並列摘要
To investigate the clinical and economical feature of dealing with difficult Proximal ureteral stones, we compared the total cost and clinical outcome in treating Proximal ureteral stones requiring multiple procedures with initial Ureteroscopic Lithotripsy ( URSL ) or initial Extracorporeal Shock Wave Lithotripsy ( ESWL ). In this study, 213 patients undergoing both URSL and ESWL for the same Proximal ureteral stone were included. The medical records, images, and billing statements of all patients for Proximal ureteral stones between January 2011 and September 2015 at a regional hospital were reviewed. Two groups were compared according to the initial treatment URSL or ESWL. We divided these patients in different stone size groups ( ≥1 cm and <1 cm ). A total of 81 patients were in the URSL first group and 112 patient in the ESWL first group. The URSL first group had higher total cost, longer hospital days, longer DBJ placement days, larger stone sizes, more Pre-operative Urosepsis, Chronic Kidney Disease, and Pre-OP Acute Kidney Injury compared with the ESWL first group. For stone smaller than 1 cm , 16 patients were in URSL first group and 68 patients were in ESWL group. The total cost of URSL first was statistically comparable. For stone in 1 cm or larger, 65 patients were in URSL first group and 64 patients were in ESWL first group. The total cost of URSL first was statistical higher than ESWL first group and hospital days of URSL first were longer. Initial URSL for treating patients with difficult Proximal ureteral stone and complex conditions. These complex conditions resulted in higher cost and longer hospitalization days. For patients with Proximal ureteral stone sized less than 1 cm, URSL or ESWL had similar treatment benefit and medical cost.