- 期刊
使用體外震波碎石術及輸尿管鏡治療下段輸尿管結石之經驗
Extracorporeal Shock Wave Lithotripsy (ESWL) Vs Ureteroscopic Lithotripsy (URSL) in the Treatment of Distal Ureteral Calculi
摘要
目的：我們分別從結石廓清率(stone free rate)、併發症、手術時問、醫療費用及治療效益(effectiveness quotient, EQ)來比較使用體外震波碎石術及輸尿管鏡碎石術治療下段輸尿管結石的差異。 方法：從1994年l月至1997年9月，總共治療954位下段輸尿管結石的患者，依照醫師個人之臨床判斷，採行任一方法。其中524位病患接受體外震波碎石術(ESWL Group)，另外430位病患則接受輸尿管鏡碎石術(URSL Group)的治療。我們統計並比較兩組之三個月各項的差別。 結果：在體外震波碎石術這一組：三個月結石廓清率為86.7%、再治療率為13.7%、併發症為0%、平均操作時間為42.6分鐘、治療效益為68.7%、平均醫療費用為新台幣31,900元；在輸尿管鏡碎石術這一組：三個月結石廓清率為96.0%、併發症為4.2%、平均操作時間為38.9分鐘、治療效益為92.1%、平均醫療費用為新台幣29,630元。 結論：本研究顯示，輸尿管鏡碎石術對下段輸尿管結石的治療，不論是在結石廓清率、醫療費用及治療效益上，均優於體外震波碎石術。但它卻存在著一定比率的手術併發症，而且需住院觀察。
並列摘要
Objective: To compare ESWL with URSL in the treatment of distal ureteral calculi from the 3-month stone free rate, major complication rate, efficacy, operation time and cost. Methods: From Jan 1994 to Sep. 1997, 954 cases of distal ureteral stones treated in our hospital. There were 524 patients treated with ESWL (Siemens Lithostar) and the other 430 patients treated with URSL (Wolf 8.0 Fr ureteroscope + Swiss lithoclast). Results: In the ESWL group, the 3-month stone free rate is 86.7% with a major complication rate of zero, effectiveness quotient of 68.7%, mean operation time of 42.6 mm, and mean hospital cost of NT 31,900 dollars. In URSL group, the 3-month stone free rate is 96.0% with a major complication rate of 4.2%, effectiveness quotient of 92.1%, mean operation time of 38.9 mm, and mean hospital cost of NT 29,630 dollars. Conclusion: ESWL is the first line therapy when stone size is smaller than 1 cm. Compared with URSL, ESWL is less invasive procedure with no adverse side effect in the management of distal ureteral stone. The outpatient basis treatment course is also the merit of ESWL. In the other hand, the improvement of technique and equipment of ureteroscopy will improve the efficacy and decrease the complication rate. So, we suggest that URSL is of best choice in patients who are symptomatic with a lager (more than 1cm.) impacted stone. When patients are asymptomatic, at high risk for anesthesia, suffer from small stones (less than 1cm.), or refuse for URSL, ESWL is preferable.