輸尿管鏡碎石術治療輸尿管下段結石治療效果的分析

Outcome Analysis of Ureteroscopic Treatment for Patients with a Distal Ureteral Stone

莊光達(Guang-Dar Juang) ； 黃一勝(Thomas I-Sheng Hwang) ； 葉忠信(Chung-Hsin Yeh) ； 鄭以弘(Yi-Hong Cheng) ； 仇光宇(Kuang-Yu Chou) ； 陳宏恩(Hung-En Chen) ； 蔡德甫(Te-Fu Tsai)

《輔仁醫學期刊》 6卷2期 (2008/06) Pp. 69-77

摘要

Purpose: To retrospectively estimate objective outcomes of ureteroscopic lithotripsy for distal ureteral stones. Methods and Results: From January 2004 to December 2006, 750 distal ureteral calculi were treated using ureteroscopy. All treatments were performed with the patient under spinal or general anesthesia and on an inpatient basis. The overall stone-free rates were 86.5% (96/111) for stones of ＞ 1 cm and 94.5% (604/639) for stones of ＜ 1 cm. Retreatment was required in 5 (5.2%) and 6 cases (1.5%), respectively. The causes of failed attempts at ureteroscopic stone treatment in 61 patients included an inability to gain access to the stone in 40 (65.6%), ureteral injury during the procedure in 15 (24.6%), and failure to adequately dilate the orifice in 6 (9.8%). Extracorporeal shock wave lithotripsy and secondary ureteroscopy were used after failed initial treatment, and the success rateswere 75%and 100%for smaller stones and 83.3%and 78.6% for large stones, respectively. Complications occurred in 29 patients (3.86%), including urinary tract infection (in 14), massive hematuria (in 10), and ureteral stenosis (in 1). Conclusions: Ureteroscopy can be a treatment of choice for lower ureteral stones. Repeat ESWL was useful as an adjuvant treatment modality after failure of the initial ureteroscopic attempt.

關鍵字

治療效果分析 ； 輸尿管下段結石 ； 輸尿管鏡碎石術

並列摘要

Purpose: To retrospectively estimate objective outcomes of ureteroscopic lithotripsy for distal ureteral stones. Methods and Results: From January 2004 to December 2006, 750 distal ureteral calculi were treated using ureteroscopy. All treatments were performed with the patient under spinal or general anesthesia and on an inpatient basis. The overall stone-free rates were 86.5% (96/111) for stones of ＞ 1 cm and 94.5% (604/639) for stones of ＜ 1 cm. Retreatment was required in 5 (5.2%) and 6 cases (1.5%), respectively. The causes of failed attempts at ureteroscopic stone treatment in 61 patients included an inability to gain access to the stone in 40 (65.6%), ureteral injury during the procedure in 15 (24.6%), and failure to adequately dilate the orifice in 6 (9.8%). Extracorporeal shock wave lithotripsy and secondary ureteroscopy were used after failed initial treatment, and the success rateswere 75%and 100%for smaller stones and 83.3%and 78.6% for large stones, respectively. Complications occurred in 29 patients (3.86%), including urinary tract infection (in 14), massive hematuria (in 10), and ureteral stenosis (in 1). Conclusions: Ureteroscopy can be a treatment of choice for lower ureteral stones. Repeat ESWL was useful as an adjuvant treatment modality after failure of the initial ureteroscopic attempt.

並列關鍵字

cost analysis ； treatment outcome ； distal ureteral stone ； extracorporeal shock wave lithotripsy ESWL