以電腦斷層掃描評估腹部脂肪分佈預判體外震波碎石術對輸尿管結石的廓清率

Abdominal fat distribution on computed tomography predicts ureteric calculus fragmentation by shock wave lithotripsy

阮序承(Hsu-Cheng Juan)

指導教授 ： 黃俊雄

高雄醫學大學/醫學院/醫學研究所/碩士(2012年)

https://doi.org/10.6832/KMU.2012.00088

摘要

研究背景與目的
為了客觀評估腹部脂肪對於體外震波碎石廓清率的影響，本篇研究試著探討以非顯影性電腦斷層掃描(Unenhanced computed tomography)來評估身體腹部的脂肪分佈及結石的特性。藉此探討腹部脂肪分佈對於評估體外震波碎石對於輸尿管結石的廓清率。

研究方法
本研究採病歷回溯的方式，從民國97年8月到民國98年8月，收集於高雄醫學大學附設醫院185位接受體外震波碎石的輸尿管結石病人進行整理分析。每位病人都在接受體外震波碎石之前一個月內進行非顯影性的電腦斷層掃描檢查，並且在一個月之後，利用腎-輸尿管-膀胱攝影(Kidney-Ureter-Bladder 簡稱KUB)的X光檢查評估體外震波碎石處理輸尿管結石的成效。從非顯影性電腦斷層掃描獲取包括結石的表面積，Hounsfield unit(HU)密度，腹部脂肪面積以及結石到皮膚距離等參數進行整理與分析。

研究結果
本研究一共收集了185位接受體外震波碎石的病人進行整理分析。一個月後接受KUB X光檢查，結果顯示其中有128位患者輸尿管結石已經完全排除。以多變項邏輯回歸分析顯示，Hounsfield unit(HU)密度、總脂肪面積、內臟脂肪面積以及結石到皮膚距離，統計上均有顯著的差異。以receiver-operating characteristic(ROC)統計方法分析顯示，總脂肪面積、腎周圍/腎旁脂肪面積和內臟脂肪面積等因子均可有效預測體外震波碎石廓清率。

研究結論
研究中我們發現，病人腹部脂肪含量，尤其是內臟脂肪含量，與體外震波碎石治療結石的廓清率呈反比關係。在台灣，利用非顯影性電腦斷層掃描的技術來診斷泌尿系統結石愈來愈方便的情形之下，利用此種影像學檢查評估腹腔內脂肪的分布，是可以做為體外震波碎石處理輸尿管結石廓清率的預測因子。

關鍵字

電腦斷層 ； 輸尿管結石 ； 體外震波碎石術 ； 內臟脂肪面積 ； 皮下脂肪面積

並列摘要

Objectives
To assess the effects of abdominal fat on shock wave lithotripsy (SWL). We used pre-SWL unenhanced computed tomography (CT) to evaluate the impact of abdominal fat distribution and calculus characteristics on the outcome of SWL.

Methods
One hundred and eighty-five patients with a solitary ureteric calculus treated with SWL were retrospectively reviewed. Each patient underwent unenhanced CT within 1 month before SWL treatment. Treatment outcomes were evaluated 1 month later. Unenhanced CT parameters, including calculus surface area, Hounsfield unit (HU) density, abdominal fat area and skin to calculus distance (SSD) were analyzed.

Results
One hundred and twenty-eight of the 185 patients were found to be calculus-free following treatment. HU density, total fat area, visceral fat area, and SSD were identified as significant variables on multivariate

並列關鍵字

computed tomography ； ureteric calculus ； shock wave lithotripsy ； visceral fat area ； subcutaneous fat area

參考文獻

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