臺灣博碩士論文加值系統

研究背景及目的：尿路結石是泌尿系統最常見的疾病之一，體外震波碎石術（ESWL）是最常被利用的治療方法，而我國健保制度自開辦以來，一直是以論病例計酬方式支付醫療費用，體外震波碎石術的支付點數在門診各項診療項目中為單次給付之冠，結石治療情形及復發與否皆是影響ESWL 醫療費用的主要原因之一。本研究除瞭解以體外震波碎石術治療泌尿道結石的廓清情形，並分析影響結石復發之相關因素。
方法：本研究以中部某區域醫院自2000 年7 月至2001 年6 月間，接受ESWL 治療之結石患者為對象，共計706 人，以病例回顧的方式，追蹤其結石是否完全廓清及五年內復發情形，並進一步以羅吉斯迴歸分析，來瞭解影響結石廓清率的相關因素，同時利用存活分析來探討結石病患在接受ESWL 治療且完治後，影響其再次復發的顯著相關因素。
結果：在接受ESWL 治療之病患中，男性有506 人，女性200 人。年齡最大86 歲，最小16 歲，平均年齡為47.23 歲。本研究以腎臟為觀察單位(renal unit)，在接受治療的763 個單位中，未完全廓清有324個單位，完全廓清的為439 個單位，廓清率為7.54％，完全廓清者中再復發的比率為28%。影響結石廓清的顯著相關因素為結石大小、結石數目及結石位置，結石愈大、數目愈多，則愈不容易廓清，而「上端輸尿管結石」及「上腎盞結石」廓清機率顯著高於「下腎盞結石」。影響結石治療復發之顯著相關因素為病患年齡及結石位置，隨著年齡增加結石復發機率降低，「上端輸尿管結石」患者復發機率顯著低於
「下腎盞結石」患者。
結論：對泌尿道結石而言，體外震波碎石術是一項有效的治療方式，然而結石的低廓清率及高復發率都會提高體外震波碎石治療之次數，進而增加醫療成本之耗用。依據病患的疾病狀態，選擇做合適的治療方法，有助於提高結石的廓清率。此外，除病患年齡及結石位置，
經由適當的衛教將有助於降低結石復發的可能。

Objective: Since the implementation of National Health Insurance, the method for payment is fee-for-service. The highest payment unit in medical equipment usage is per outpatient treatment in ESWL. This study is to understand the stone-free rate after ESWL and analysis the factors that affect the recurrence rate.Materials and Methods: Between Jul. 2000 to Jun 2001, total 706 patients underwent ESWL in Cheng-Ching general hospital. We retrospectively reviewed the stone-free rate and recurrence rate after ESWL. Furthermore,we investigated the factors that contributed the stone-free rate and recurrence rate with Logistic regression analysis.
Results: There are 506 males and 200 females in this study. Mean age was 47.23 y/o (range from 16 to 86 y/o). Totally 763 renal units were enrolled. In these 763 renal units, 439 were stone-free after ESWL and the other 324 were not. The stone-free rate is 57.53%. Stone recurred in 123 of 439 renal units (28%). The stone size, number and location are significant factors that affect the stone-free rate. The stone free rate of upper ureteral and upper renal calyceal stones are higher than lower calyceal stone. Patients with an early onset of stone formation had the higher recurrence rate. In addition, lower calyceal stone is easier recurred than upper ureteral stone.
Conclusion: ESWL is a less invasive and effective method for urolithiasis.However, lower stone-free rate and higher recurrence rate resulted in higher utilization of ESWL. Complete image study and a proper management will increase the stone free rate. In additional to age and stone location, education on changing in diet habit and life style is important.

第一章 緒論-1
第一節 研究背景與動機 -1
第二節 研究目的 -3
第二章 文獻探討 -5
第一節 泌尿道結石的致病機轉及成因 -5
第二節 泌尿道結石的發生率及盛行率 -8
第三節 泌尿道結石的治療 -9
第四節 以體外震波碎石術來治療結石的廓清率 -15
第五節 結石的復發率 -16
第六節 體外震波碎石術的治療成本與醫療耗用 -17
第三章 研究方法 -19
第一節 研究對象及資料來源 -19
第二節 研究架構 -20
第三節 研究變項及名詞解釋 -21
第四節 資料處理與統計分析 -23
第四章 研究結果 -25
第一節 描述性統計分析結果 -25
第二節 推論性統計分析結果 -29
第三節 存活分析結果 -33
第五章 討論 -34
第六章 結論與建議 -41
第一節 建議 -41
第二節 研究限制 -42
參考文獻 -45

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