應用超音波評估體外震波碎石術治療後之併發症

SONOGRAPHY IN THE EVALUATION OF COMPLICATIONS OF RENAL STONES TREATED BY EXTERACORPOREAL SHOCK-WAVE LITHOTRIPSY

程明山(Ming-Shen Cnen) ； 周宜宏(Yi-Hong Chou) ； 許重權(Chung-Chuan Hsu) ； 王萬龍(Wung-Long Wang) ； 黃慶元(Chieng-Yuang Hwang) ； 刁翠美(Chui-Mei Tiu) ； 陳明村(Ming-Tsun Chen) ； 張遵(Tsuen Chang)

《中華放射線醫學雜誌》 13卷2期 (1988/06) Pp. 181-186

摘要

榮民總醫院放射線部自1986年3月至1987年4月間共有50位患者經ESWL治療腎結石後主訴症狀而來作腎臟及／或腹部超音波檢查，男女比例重為31:19，平均年齡為48歲；因病情各異故接受ESWL的總震波數（自500至2650個），平均為1796個。他們超音波發現包括：（A）各種不同程度的腎盂積水為66%。（B）不同形式的腎臟損傷為18%，其中6位患者年齡大於50歲，5位患者有高血壓的病史。（C）有24%患者有腎盂膿腫。（D）有4%有急性腎盂腎炎。超音波檢查無意中發現肝癌2例，膀胱上皮癌1例，對側腎結核1例，腎臟囊腫2例，膽結石1例。參考文獻提出一點經驗報告。

關鍵字

體外震波碎石術(ESWL) ； 超音波(ultrasound) ； 腎融( k idney) ； 併發症(complications)

並列摘要

Extracorporel Shock Wave,Lithotripsy (ESWL) iiad been widely applied as a noninvasive method in the treatment of upper ruinary tract stone: However, complictions may be experienced with this method. Sonography was used to evaluate these complications paying attention to the kidney and its adjacent organs in our hospital. ESWL (Dounter HM -3) had been used in this hospital since August 1985 in the treatment of upper urinary tract stone. From March 1986 to April 1987, there were altogether 50 patients experienced complications post-ESWL. These included 31 males and 19 females. There ages ranged from 21 to 77 years old, with an average of 48 years old. The number of symptoms and signs were the followings: flank pain, hematuria, fever, acute urine retention, renal colic, nausea and vomiting. In most of the patients the Renal and/or Abdominal sonography was performed within one month after the ESWL. Sonography was performed using sector real time scanners. (Diasonics DRF 400 and ATL UM 8 with transducer freqrency of 3. 5/5 .0 MHZ) .The sonographic findings include the followings: 1. hydronephrosis of different grades, 66% (33/50); 2. Tissue injury or hemorrhage inside the kidney or the adjacent area, 18% (9/50): within this group of patients 6 were older than 50 years old and 5 had hypertension: 3. pyonephrosis in 12 patients (24%) and 4. acute pyelonephritis in 2 patients. Accidental findings include hepatoma in 2 cases, epidermoid carcinoma of the ruinary bladder in one case, T. B. in the contralateral kidney in one case. renal cyst in 2 cases, and gall stone in one case. Based on the above results, we concluded that sonography should be performed in patients post-ESWL with clinical syrnpotoms and signs. It could detect the persence of complications and direct correct, suitable adjunctive treatments, For patients being or above 50 years old, or having the history of hypertension should be received regular sonography follow -up, since they might have more tendency of perirenal or subcaplular hematoma. For hepatients, they should receive sonography before ESWL to prevent overlooking the co-existed hepatoma.