Impact of Hydronephrosis on Treatment Outcome of Solitary Proximal Ureteral Stone after Extracorporeal Shock Wave Lithotripsy

腎臟積水對於單一顆近端輸尿管結石病患接受體外震波碎石術治療癒後之影響

蕭錫麟(Hsi-Lin Hsiao) ； 黃書彬(Shu-Pin Huang) ； 吳文正(Wen-Jeng Wu) ； 李永進(Yung-Chin Lee) ； 李威明(Wei-Ming Li) ； 周以和(Yii-Her Chou) ； 張艾文(Ai-Wen Chang) ； 黃俊雄(Chun-Hsiung Huang) ； 孫叔金(Shu-Chin Sun) ； 劉家駒(Chia-Chu Liu)

《The Kaohsiung Journal of Medical Sciences》 24卷10期 (2008/10) Pp. 507-513

摘要

本研究的目的是為了探討腎積水對於用體外震波碎石術來治療近端輸尿管單一顆結石病人癒後之影響。總共182位結石大小位於5至20毫米之間的近端輸尿管單一顆結石的病患在本科接受過體外震波碎石術納入本次的研究。以超音波來定義腎積水的程度。病患人數、結石大小、震波數目及能源也都詳細記錄。在接受過碎石術之後3個月來評估治療的癒後。在多變項分析下，只有結石的最大長度 (OR 0.15, 95% CI 0.03-0.91, p=0.04) 及腎積水的程度(OR 0.40, 95% CI 0.16-0.98, p=0.045)可當作以體外震波碎石術治療3個月之後的結石清除率的預測因子。如果結石的長度小於或等於10毫米的輕度腎積水的病患，結石清除率可達到80%，不過如果腎積水為中度至重度的病患，清除率只能達到56.4%。如果結石的長度超過10毫米的族群中，結石清除率從輕度腎積水的65.2%降至中度至重度腎積水的33.3%。總結來說，在結石長度大於10毫米的單一近端輸尿管結石的病患如果同時合併有中度至重度的腎積水，以體外震波碎石術治療似乎癒後並不如預期。因此選擇一些其他的方式如輸尿管鏡取石術或許可以做為這類結石首次或是經過一次體外震波碎石術後仍失敗的病患的治療方式。

關鍵字

體外震波碎石術 ； 腎臟積水 ； 近端輸尿管 ； 超音波 ； 尿路結石

並列摘要

The purpose of this study was to investigate the impact of hydronephrosis on the treatment outcome of patients with a solitary proximal ureteral stone after extracorporeal shock wave lithotripsy (ESWL). Atotal of 182 consecutive patients who underwent ESWL for a solitary proximal ureteral stone of between 5 and 20 mm in size in our institution were included in this study. The degree of hydronephrosis was defined by renal ultrasonography. Patient data, stone size, shock wave numbers and shock wave energy were also recorded. Treatment outcome was evaluated 3 months after the first session of ESWL. In multivariate analysis, only the maximal stone length (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.03-0.91; p=0.04) and the degree of hydronephrosis (OR, 0.40; 95% CI, 0.16-0.98; p=0.045) were significant predicting factors for stone-free status 3 months after ESWL. For stones ≤ 10 mm, the stone-free rate decreased from 80% in patients with mild hydronephrosis to 56.4% in those with moderate to severe hydronephrosis. For stones ＞10 mm, the stone-free rate decreased further, from 65.2% in patients with mild hydronephrosis to 33.3% in those with moderate to severe hydronephrosis. In summary, patients with a solitary proximal ureteral stone and a stone ＞ 10 mm, the treatment outcome after ESWL was not good if moderate to severe hydronephrosis was noted on ultrasonography. Alternative treatments, such as ureteroscopic lithotripsy, may be appropriate as initial treatment or after failure of one session of ESWL.

並列關鍵字

ESWL ； hydronephrosis ； proximal ureter ； ultrasonography ； urolithiasis