Impact of Lower Pole Anatomy on Stone Clearance after Shock Wave Lithotripsy

腎臟下端的構造對於體外震波碎石術後結石清除之影響

阮雍順(Yung-Shun Juan) ； 莊淑棉(Shu-Mien Chuang) ； 吳文正(Wen-Jeng Wu) ； 沈榮宗(Jung-Tsung Shen) ； 王起傑(Chii-Jye Wang) ； 黃俊雄(Chun-Hsiung Huang)

《The Kaohsiung Journal of Medical Sciences》 21卷8期 (2005/08) Pp. 358-364

摘要

本研究回溯性的分析腎臟下端的構造是否可以預測因腎臟下端結石接受體外震波治療患者的術後碎石排出率。從2002年6月至2004年3月，我們共分析59位小於二公分的下端腎結石而接受體外震波治療患者的靜脈腎盂攝影。其中包括44位男性，15位女性，年齡從23歲至78歲。將患者分為結石清除組與結石剩餘組。在經過體外震波碎石治療之後，全部的碎石成功率為57.6%，對於小於一公分腎結石的結石清除率為64.5%，而一至二公分的結石清除率則降為50%。靜脈腎盂攝影上的腎臟內部的構造，包括腎盞寬度、腎盞腎盂輸尿管角度1、腎盞腎盂輸尿管角度2，對於結石清除組與結石剩餘組並沒有顯著差異，但腎盞長度、結石的大小與結石負荷，則對結石清除率則有顯著意義(P=0.005, 0.024, 0.017)。體外震波碎石術對於小於10公厘的腎臟下端結石可以提供一個低併發症且可接受的成功率的治療方法。

關鍵字

腎臟 ； 構造 ； 尿路攝影 ； 震波碎石

並列摘要

This study retrospectively analyzed patients treated with shock wave ithotripsy (SWL) for lower calyceal stones, to determine the influence of the lower pole anatomy and stone size in predicting the clearance of fragments. Between June 2000 and March 2002, we reviewed excretory urography (IVU) of 59 patients with isolated lower pole stones treated with SWL. A total of 44 men and 15 women, with an age ranging between 23 and 78 years (mean, 55 years), were included in the study. The patients were divided into two groups, either a stone-free group or residual-stone group. After SWL, overall stone rate was 57.6%, and clearance for stones less than 10 mm in diameter was 64.5%, whereas clearance was 50% for stones between 10 and 20 mm in diameter. Intrarenal anatomy on IVU, such as infundibular width and infundibulopelvi-ureteric angle showed no significant difference between the stone-free and residual-stone groups. Our analysis showed that three significant variables were relevant to stone clearance: infundibular length, stone size and stone burden. We conclude that SWL is the best treatment for lower pole kidney stones 10 mm or less in diameter, showing lower complication and acceptable stone-free rates.

並列關鍵字

stone ； kidney ； anatomy ； excretory urography