成人急性泌尿道結石的診斷與處置

Diagnosis and Acute Management of Urolithiasis in Adults

王彥驊(Yann-Hwa Wang) ； 徐永建(Yung-Chien Hsu) ； 林俊良(Chun-Liang Lin)

《腎臟與透析》 33卷1期 (2021/03) Pp. 6-12

https://doi.org/10.6340/KD.202103_33(1).0002

摘要

泌尿道結石為臨床上常見的問題，約八成左右的病人其結石為含鈣結石。其典型症狀包括血尿、腎絞痛，並可能伴隨嘔心嘔吐等症狀。臨床上須與上泌尿感染、肝膽腸胃道及一些女性生殖系統疾患做鑑別。在確認診斷的部分，主要是依靠影像學檢查，常用的有腹部X光檢查、腹部和骨盆腔電腦斷層及腎臟及膀胱超音波。治療部分，急性期需給予病人適當疼痛控制，使用解痙孿劑（如鈣離子阻斷劑、α交感神經阻斷劑），指導病人出力解尿，並評估是否須轉介或照會泌尿科醫師做進一步適當處置。

關鍵字

泌尿道結石 ； 血尿 ； 腎絞痛 ； 電腦斷層 ； 超音波

並列摘要

Urolithiasis is a common problem encountered in primary care practice. Around 80% of patients with urolithiasis form calcium stones, most of which are constituted primarily by calcium oxalate. Typical symptoms and signs include hematuria, renal colic, and may be accompanied by nausea and vomiting. Differential diagnosis includes upper urinary tract infection, some diseases of the gastrointestinal and hepatobiliary system, and problems from the female reproductive system. The diagnosis of urolithiasis is confirmed with imaging studies, and kidney, ureter, bladder radiography, computed tomography of the abdomen and pelvis, and ultrasound of kidneys and bladder are frequently used. As to the management of urolithiasis, patients should receive adequate pain control, antispasmodic agents, such as calcium channel blockers, α-adrenergic blockers, and be instructed to strain their urine in the acute phase. Also, the need for urology consultation or referral for further appropriate management should be evaluated.

並列關鍵字

urolithiasis ； hematuria ； renal colic ； computed tomography ； ultrasonography