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上泌尿道結石體外電震波碎石術後經皮腎造瘻術之應用

Application of Percutaneous Nephrostomy in Stones of Upper Urinary Tract after Extracorporeal Shock Wave Lithotripsy

摘要


泌尿道結石為國人常見之一種疾病。本院從1985年開始採用體外電震波碎石術來治療泌尿道結石。不過泌尿道結石在體外電震波碎石術治療後,經擊碎之碎石仍需經由尿路排出體外。而在碎石排出體外之過程中,可能因某些因素,導致延遲排出而引起尿路阻塞;甚而引起腎功能變壞或膿腎。也有些結石經體外電震波碎石術治療後,結石並未擊碎或擊碎之碎石長期殘留在尿路中。因此從1989年7月至1990年3月,我們嘗試以經皮腎造瘻術來治療泌尿道結石經體外電震波碎石術治療後引起之尿路阻塞或膿腎有12個病例;或以經皮腎造瘻截石術將未擊碎之上端輸尿管結石或長期殘留於上泌尿道中之碎石取出有18個病例。30例病人出院後均在本院體外電震波碎石特別門診追蹤。接受經皮腎造痙術之12病例;體外電震波碎石術後產生膿腎之8例均治癒;結石完全消失有4例;產生輸尿管結石路之8例,其輸尿管結石路亦全部排出體外;但殘留碎石於腎臟有8例。經皮腎造瘻術後腎功能有2例變好,1例變壞,1例無變化,8例無追蹤。接受經皮腎造瘻截石術之18病例,術後有10例結石完全消失,殘留小碎石或砂樣碎石於腎臟有8例。術後腎功能6例變好,2例變壞,2例無變化,8例無追蹤。總之,在經體外電震波碎石術治療後之上泌尿道結石的病人應至門診定期追蹤。而對於產生膿腎或腎功能變壞,或對於碎石有一段期間存留於上泌尿道,或對於未擊碎之上端輸尿管結石之病例,應速給予適當之療法他如經皮腎造瘻術或經皮腎造瘻截石術。

並列摘要


Since 1980, extracorporeal shock wave lithotripsy (ESWL) has been widely used in the treatment of stones in the upper urinary tract, and our hospital began to use ESWL in 1985. After ESWL of stones in the upper urinary tract, fragments have to pass out of the human body through the natural course of urinary tract. During the passage of stone fragments, stasis may occur in some cases which may cause pyonephrosis or impairment of the renal function. In other cases, the stones could not be broken by ESWL or the fragments might lodge in the upper urinary tract for a period of time. We therefore tried percutaneous nephrostomy (PCN) in 12 cases of patients who developed stone street in the ureter without or with pyonephrosis after ESWL (group 1); and percutaneous nephrolithotomy (PCNL) in 18 cases who developed lodgement of the stone fragments in the upper urinary tract for a period time or whose ESWL treatment was ineffective (group 2)。In group 1,8 cases of pyonephrosis disappeared after PCN, and complete disappearance of stones occurred in 4 cases. Complete disappearance of stone street in the ureter after PCN was noted in all 8 cases who developed stone street in the ureter after ESWL, but residual small stone fragments in the kidneys were noted in 8 cases. In group 2, complete disappearance of stones occurred in 10 cases after PCNL, but residual sandy or small st. one fragments in the kidneys were noted in 8 cases. The change of the renal function after PCN or PCNL could not be evaluated, because 16 cases did not have follow-up renal function study after PCN or PCNL。 In conclusion, periodic follow-up in out-patient department is necessary in patients with stones in the upper urinary tract who received ESWL. If stone street in the ureter and/or pyonephrosis occurs, PCN should be applied immediately; and PCNL should also be applied to those patients with stone fragments lodged in the upper urinary tract for a period of time or those patients with ineffective treatment of ESWL.

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