- 期刊
靜脈注射尿路攝影術與腹部X光素片於體外震波碎石術前之評估
Evaluation of Intravenous Urography and Plain Kidney-ureter-bladder Radiograph before Extracorporeal Shock Wave Lithotripsy
摘要
目的：體外震波碎石術(Extracorporeal Shock Wave Lithotripsy, ESWL)為目前治療尿路結石的主流之一。而在碎石治療前的結石影像診斷，亦功不可沒。此文章在評估於ESWL前，施行腹部X光片(plain KUB)與靜脈注射尿路攝影術(intravenous urography, IVU)，個別診斷結石位置及評估；此有助於泌尿科醫師施行ESWL前的精準定位依據，降低第二次ESWL施行，提升結石清除率。方法：本院主要是於2003年元月份至2003年二月份，由泌尿科門診轉至放射科，安排施行IVU之病患，共34例，皆為施行腎臟超音波檢查後，符合左或右側腰痛及血尿的研究標準；我們將34例病患於門診施行之plain KUB與IVU分別預作為ESWL前之結石定位依據，藉以評估兩者於結石位置定位之優劣。本研究所使用之X光機為SIEMENS，機型為Polydoros LX50。結果：本次研究有34例符合研究標準，將plain KUB與IVU互相比較及評估，其中plain KUB有結石，但IVU判定無結石，有12例，結果顯示plain KUB有腸氣、糞石、骨陰影及靜脈結石等各種因素，容易造成誤判；另一組plain KUB無結石，但IVU判定有結石，有4例，皆配合超音波檢查，結果顯示為plain KUB所無法看到的透明石(radiolucent stone)。藉由研究結果得知，使用IVU來確定結石，可使病人於ESWL前之定位透視輻射劑量降低，以符合游離輻射防護法中之合理抑低(as low as reasonable achievable, ALARA)原則。結論：在ESWL前之影像定位，可以有多種選擇，但以現今國內健保給付制度下，為病患尋求最精準的定位及最少的負擔，仍以IVU來作為ESWL前之影像定位依據為首選。
並列摘要
Background & Purpose: Extracorporeal Shock Wave Lithotripsy (ESWL) is currently the primary treatment for most urinary calculi. It is necessary to assess the location of stones by radiography before ESWL treatment. The aim of this study was to evaluate the accuracy of intravenous urography (IVU) and plain kidney-ureter-bladder radiograph (KUB), which can precisely determine the location of urinary stones. Methods: From January 2003 to February 2003, 34 patients with acute flank pain and hematuria who were referred to the Radiological Department for ESWL treatment were primarily assessed by kidney ultrasound in the Urological Department. The average age of the patients was 46.4 years. In this study, we used SIEMENS generator model Polydoros LX50. We performed an IVU and plain KUB on the 34 patients and evaluated which method was more effective at indicating the location of stones. Results: The data showed that, in 12 cases, urinary stones were visible on the plain KUB but not visible by IVU. Further, plain KUB might cause misdiagnosis of intestinal gas, phleboliths or bone shadows in the abdomen as the images of urinary calculi. Four patients were determined to have urinary stones by IVU, which were not detected by plain KUB, as plain KUB was not sensitive to the radiolucent stones. There was a 40% misdiagnosis rate if plain KUB was used instead of IVU. Conclusion: Nowadays, plain KUB, IVU, ultrasound and spiral computed tomography (CT) are techniques used to detect the location and size of stones before ESWL treatment. In order to show the most precise localization of stones, and the least physical and financial burden to the patient, our data suggests that IVU is a more practical method for use before ESWL treatment.
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
- 王俊皓（2020）。利用田口動態分析與自製塊規評量靜脈注射尿路攝影之X-ray影像品質的最小可分辨差異〔碩士論文，中臺科技大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0099-0702202315060797
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- Lin, T. H., Chang, C. H., Yeh, C. C., Chen, W. N., Chang, S. S., Lu, H. F., Chen, C. C., Yang, C. C., Wu, H. C., & Chen, W. C. (2005). Efficacy of Extracorporeal Shock Wave Lithotripsy on the Treatment of Upper Urinary Tract Stones. Mid-Taiwan Journal of Medicine, 10(1), 38-42. https://doi.org/10.6558/MTJM.2005.10(1).6