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研究生:顏溫榕
論文名稱:電磁式體外震波碎石機對於治療尿路結石效果的評估
論文名稱(外文):The efficacy of extracorporeal shock wave lithotripsy with a electromagnetic for urolithiasis
指導教授:陳鴻震 老師
學位類別:碩士
校院名稱:國立中興大學
系所名稱:生命科學院碩士在職專班
學門:生命科學學門
學類:生物學類
論文種類:學術論文
論文出版年:2003
畢業學年度:91
語文別:中文
論文頁數:52
中文關鍵詞:體外震波碎石尿路結石
外文關鍵詞:ESWLurolithiasis
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中文摘要
體外震波碎石術已成為治療尿路結石最受歡迎的治療方法,然而碎石的成功與否取決於許多因素,本文研究的目的是針對這些因素如:結石的大小、數目、位置、震波頻率與結石的排除率對於治療結果的影響。首先收集了292位(男213位,女79 位)因尿路結石而來署立台中醫院接受體外震波碎石治療的病患,使用德國Dornier 公司所生產的Compact Delta機型作為治療設備;其震波的產生是屬於電磁式。碎石成功的標準以術後三個月結石完全排清或者殘餘碎石<4mm稱之。結果顯示其三個月後結石的排除率為88.4%,再治療率是10.6﹪,碎石前、後額外處置占11.6%,用來做為機器效能評估的有效商為75.5。另外,以下腎盞、中段輸尿管結石、低的震波頻率及單顆結石的治療效果最好;不論腎結石或輸尿管結石其結石越大再治療率及所需的額外處置也就相對的較多。總括來看,以輸尿管的效果較腎臟來的好並且也打破了第一代碎石機HM-3的療效是最好的迷思。
ABSTRACT
Extracorporeal shock wave lithotripsy ( ESWL ) has become the favored treatment.The success of ESWL therapy depends on many factors. The purpose of this study is to compare the influence of different factors ( including stone size, location, number, shockwave frequency and stone free rate ) to treatment outcome. We treated 292 patients ( male:213 female:79 ) with urolithiasis, using a Dornier Compact Delta with electromagnetic shochwave generators. Successful treatment is measured as being stone clearance or clinically significant residual fragments 4 mm or less after three months of treatment.The results showed: stone free rate was 88.4%, retreatment rate was 10.6%, auxiliary procedures were performed in 11.6% ( pre- and post- ESWL ), the effectiveness quotient of lithotripsy was 75.5.The efficacy of stone location in the lower pole of renal and the middle ureteral, low shockwave frequency and single stone is better, either renal or ureteral stone that retreatment and auxiliary procedures were increases as stone burden increases. The overall the efficacy of ureteral was better than renal and contradicting the myth that a spark gap source ( HM-3) is by definition superior to an generator.
目 錄
頁數
中文摘要…………………………………………………… Ⅰ
英文摘要…………………………………………………… Π
目錄………………………………………………………… Ⅲ
第一章 緒論
1-1 前言…………………………………………….1
1-2 研究動機及目的……………………………….1
第二章 文獻回顧
2-1 流行病學……………………………………….3
2-2 形成機轉……………………………………….4
2-3 治療方法的演進……………………………….5
2-4 震波原理的產生……………………………….7
2-5 碎石術所引起的後遺症……………………….9
2-6 殘餘結石………………………………………10
2-7 預防結石的復發………………………………11
2-8 各地區碎石機的使用情況……………………12
第三章 材料與方法
3-1 實驗設備………………………………………15
3-2 實驗材料與方法........................15
3-3 資料分析………………………………………17
第四章 結果
4-1 臨床資料………………………………………19
4-2 結石大小………………………………………20
4-3 結石數目………………………………………21
4-4 結石的位置……………………………………21
4-5 震波頻率………………………………………23
第五章 討論 ………………………………………………25
第六章 結論 ………………………………………………31
第七章 表格與圖 …………………………………………34
第八章 參考文獻 …………………………………………53
表&圖目 錄
頁數
表 1. 震波數和能階的關係 …………………………… 34
表 2. Overall Results ......................... 34
表 3. 碎石前、後病人額外的處置 …………………… 35
表 4. 腎臟、輸尿管結石的大小與有效商EQ 的關係. 36
表 5. 單顆 & 多顆結石的清除率及有效商 ......... 37
表 6. 結石的位置與清除率的關係 …………………… 38
表 7. 結石的位置與再治療率的關係 ………………… 39
表 8. 結石位置的有效商EQ …………………………… 40
表 9. 頻 率 & 清除率 的關係 ……………………… 41
表10 頻 率 & 額外處置的關係 …………………… 41
表11. 頻率的有效商 …………………………………… 42
表12. 體外震波碎石機的比較 ………………………… 43
圖 1. 病人年齡分布圖 ……………………………… 44
附 錄
附表 1. 八十一年至九十年底台灣各區碎石機的數目.45
附表 2. 90年度體外震波碎石機的設備數及使用人數 46
附表 3. 90年度碎石機再各等級醫院所佔的比例…… 47
附表 4. 各國具有體外震波碎石設備的數目.........48
附表 5. Parameters for clinical comparison of
lithotripters..........................49
附圖1. 結石粉碎的機制.........................50
附圖2. Dornier Compact Delta..................51
附圖3. 體外震波碎石術後幫助排出石頭的姿勢 ……52
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