- 期刊
Comparison of Percutaneous Nephrolithotomy and Ureteroscopic Lithotripsy in the Management of Impacted, Large, Proximal Ureteral Stones
比較以順行性以及逆行性輸尿管鏡碎石術處理大顆並箝閉在上端輸尿管的結石
摘要
對於治療箝閉在上端輸尿管結石的最佳方法，目前仍有爭議。我們在此報告以經皮腎造廔碎石術及輸尿管鏡碎石術處理單顆並箝閉在上端輸尿管結石患者的經驗。從2005年1月至2006年1月，共有53位患者因為上端輸尿管結石超過15公釐，並箝閉在輸尿管內而接受經皮腎造廔碎石術以及輸尿管鏡碎石術處理。患者的平均年齡為48.5±11.8歲。有22位患者接受經皮腎造廔碎石手術；31位患者接受輸尿管鏡碎石術。結石表面積在經皮腎造廔碎石手術患者與輸尿管鏡碎石術患者分別為232.8±113.2平方公厘，與150.3±70.3平方公厘。經皮腎造廔碎石手術與輸尿管鏡碎石術的有效係數(efficiency quotient)分別為0.95與0.67。術後一個月的碎石成功率在經皮腎造廔碎石手術患者與輸尿管鏡碎石術患者分別為95.4%以及58%。經皮腎造廔碎石手術中，有兩位患者因術中出血而須接受輸血治療；輸尿管鏡碎石手術患者則有八位手術中因結石移位至腎臟，而須在手術之後再次接受體外震波碎石或經皮腎造廔碎石手術治療腎臟結石。對於治療大而箝閉在上端輸尿管的結石，經皮腎造廔碎石術提供一個滿意的碎石成功率，並能同時處理合併產生的腎臟結石；而輸尿管鏡碎石手術則具有手術時間較短、術後住院日少以及較輕微的術後併發症等優點。
並列摘要
The optimal treatment for large, impacted, proximal ureteral stones remains controversial. We report our experience and compare treatment outcomes in patients with single, impacted, proximal ureteral stones undergoing percutaneous nephrolithotomy (PCNL) and ureteroscopic lithotripsy (URSL). Between January 2005 and January 2006, a total of 53 consecutive patients with solitary, impacted, proximal ureteral stones＞15 mm in diameter who had undergone PCNL or URSL treatments were enrolled in this study. The mean age was 48.5±11.8 years. PCNL and URSL were performed in 22 and 31 patients. Stone burdens in the PCNL and URSL groups were 232.8±113.2 mm^2 and 150.3±70.3 mm^2, respectively. The efficiency quotient (EQ) for the PCNL and URSL groups was 0.95 and 0.67, respectively. The stone-free rate at the 1 month follow-up was 95.4% in the PCNL group and 58% in the URSL group (p＜0.001). Two patients in the PCNL group had blood loss requiring transfusion. Eight patients had stones showing upward migration during the URSL procedure, and these stones were subsequently treated by extracorporeal shock wave lithotripsy and PCNL. For an impacted, proximal ureteral stone＞15 mm in diameter, PCNL had better stone-free rates and could simultaneously treat coexisting renal stones. However, URSL had the advantages of shorter operative times, shorter postoperative hospital stays, and fewer postoperative complications.
延伸閱讀
- 蘇進明（2020）。下段輸尿管結石以輸尿管鏡碎石與體外震波碎石治療成本效益:傾向分數配對之研究〔碩士論文，高雄醫學大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0011-1407202019023500
- 張麗珍（2011）。輸尿管內視鏡碎石術後泌尿道感染之改善專案。秀傳醫學雜誌，10(1&2)，13-18。https://www.airitilibrary.com/Article/Detail?DocID=15610497-201006-201112130001-201112130001-13-18
- Juan, Y. S., Li, C. C., Shen, J. T., Huang, C. H., Chuang, S. M., Wang, C. J., & Wu, W. J. (2007). 經皮腎造（广婁）管處理大且箝閉在上端輸尿管的結石. The Kaohsiung Journal of Medical Sciences, 23(8), 412-416. https://www.airitilibrary.com/Article/Detail?DocID=02575655-200708-23-8-412-416-a
- 葉進仲、張萬森、陳汶吉、張士三、楊慶鏘、吳錫金（1998）。順行輸尿管腎臟鏡手術於上段輸尿管結石的應用。中華民國泌尿科醫學會雜誌，9(3)，126-131。https://doi.org/10.7024/JUAROC.199809.0126
- 莊光達、黃一勝、葉忠信、鄭以弘、仇光宇、陳宏恩、蔡德甫（2008）。輸尿管鏡碎石術治療輸尿管下段結石治療效果的分析。輔仁醫學期刊，6(2)，69-77。https://www.airitilibrary.com/Article/Detail?DocID=18102093-200806-6-2-69-77-a