臺灣博碩士論文加值系統

研究背景：近年來，國人尿路結石的發生率有逐年增加的趨勢，根據衛生福利部2009年至2013年統計資料顯示，台灣地區因尿路結石住院手術，每年平均有4萬多件。治療輸尿管下段結石的首要選擇為輸尿管鏡碎石術，治療後部份病患放置輸尿管內雙J導管幫助碎石的排空，而雙J導管管徑雖然不大，但對病患而言仍屬異物，易造成腰痠、頻尿、疼痛及血尿等症狀，本研究目的旨在探討輸尿管鏡碎石手術治療後，有無放置輸尿管內雙J導管，對於手術後病患疼痛及解尿情形之影響。
研究方法：本研究為橫斷式研究，研究對象為中部某區域教學醫院，接受輸尿管鏡碎石之手術病患，以病歷查閱及結構式問卷收集資料，由研究者進行病歷查閱，內容為性別、出生年月及雙J導管相關資訊等；問卷內容包括有無慢性病、輸尿管鏡碎石手術及放置雙J導管經驗，並以疼痛量表及膀胱過動症評估表（OABSS），收集手術後疼痛及解尿情形。統計分析方法包含敘述性統計、獨立樣本t檢定、單因子變異數分析(ANOVA)，並以線性複迴歸模式，探討有無放置雙J導管，對手術後腰痛及解尿疼痛之影響。
研究結果：本研究共收集139位輸尿管鏡碎石手術病患，其中男性比女性多(91人; 65.5％ vs. 48人; 34.5％)，平均年齡為52.6歲，83名(59.7％)有放置輸尿管內雙J導管。在解尿情形方面，有血尿者100人(71.9％)最多、頻尿情形以8-14次為多，計有109人(78.4％)、夜尿情形一次者較多有46人(33.1％)。依據線性複迴歸模式結果發現，有放置雙J導管較無放置者，平均腰痛分數多0.718分；膀胱過動症症狀中度者比輕微者，其平均腰痛分數多0.318，症狀嚴重者比輕微者，其平均腰痛分數多0.609分。在解尿疼痛方面，有放置雙J導管較無放置者，平均解尿疼痛分數多1.273分；膀胱過動症症狀嚴重者，比輕微者平均解尿疼痛分數多0.62分。
研究結論與建議：影響手術後腰痛及解尿疼痛之主要因素為「有無放置雙J導管」及「膀胱過動症症狀」，與雙J導管廠牌、長度及管徑粗細等並無顯著差異。本研究之建議如下：(1)接受輸尿管鏡碎石術之病患，可建議主治醫師評估，是否有放置輸尿管內雙J導管之必要性，以減輕手術後腰痛及解尿疼痛情形；(2)在臨床上若病患膀胱過動症情形較嚴重者，可建議醫師考慮先治療膀胱過動症症狀。

Background:In recent years, the occurrence rate of urolithiasis has grown gradually. According to the statistical data from the Ministry of Health and Welfare, it shows that there were around 40,000 people in the hospital due to urolithiasis in Taiwan from 2009 to 2013. Ureteroscopic lithotripsy is the primary treatment when it comes to treating lower ureteral stones. Some patients will be placed the double-J ureteral stent inside their ureter after the operation to empty the stones. Even with a small size, the double-J Stent is still considered a foreign material inside the patient’s body and can result in a number of symptoms, such as a sore waist, frequent urination, pain, and hematuria (Chen-Hsun Ho et al., 2010). This paper aims at exploring the impact of placing the double-J Stent on the patient’s pain and voiding symptoms after the ureteroscopic lithotripsy.
Methods:This paper is a cross-sectional study and uses patients who did uretero scopic lithotripsy in one of the regional teaching hospitals in central Taiwan as its research objects. The research data is collected through checking patients’ medical records and structured questionnaires in order to comprehend whether these patients have done the ureteroscopic lithotripsy as well as the placement of double-J Stent. The questionnaires investigate chronic disease history, and ureteroscopic lithotripsy experiences. Moreover, the pain scale and overactive bladder symptom score questionnaire are also applied to comprehend patients’ pain and voiding symptoms after the operation. Descriptive statistics, independent-sample T test, one-way ANOVA, and linear multiple regression model are used in this study to discuss the impact of placing the double-J Stent on patient’s pain and voiding symptoms after the ureteroscopic lithotripsy.
Results: This paper collects the information from a total of 139 patients who did the ureteroscopic lithotripsy. There are more males than females (91 males versus 48 females) with an average age of 52.6. Among these patients, there are 83 patients who had the double-J Stent inside their ureter. Regarding patients’ voiding symptomss, there are 100 patients with hematuria (71.9%), 109 patients with frequent urination between 8 to 14 times (78.4%), and 46 patients with nocturia (33.1%). According to the results from the linear multiple regression model, patients with the double-J Stent have a 0.718 higher lumbago point than patients without the double-J Stent. Patients with moderate overactive bladder have a 0.318 higher lumbago point than patients with mild overactive bladder. Patients with severe overactive bladder receive a 0.609 higher lumbago point than patients with mild overactive bladder. As for the dysuria, patients with the double-J Stent have a 1.273 higher dysuria point than patients without the double-J Stent. Patients with severe overactive bladder also have a 0.62 higher dysuria point than patients with mild overactive bladder.
Conclusion and suggestions:The placement of the double-J Stent and symptom of the overactive bladder are the main causes for lumbago and dysuria after the operation. The research results demonstrate that the brand, length, and size of the double-J Stent have an insignificant impact on lumbago and dysuria. There are a few suggestions drawn from this paper as below. First of all, the attending physician should evaluate whether it is necessary to place the double-J Stent inside the patient’s ureter to ease the lumbago and dysuria after the ureteroscopic lithotripsy. Secondly, for patients with severe overactive bladder, doctors may consider treating the symptoms first.

第一章緒論
第一節研究動機1
第二節研究目的3
第二章文獻探討
第一節 尿路結石之定義、特性及現況4
第二節 輸尿管鏡碎石術6
第三節 雙J導管之介紹7
第四節 疼痛與解尿情形評估方法8
第五節 放置雙J導管對疼痛及解尿情形之相關研究10
第六節 文獻小結11
第三章研究方法
第一節 研究對象及資料來源12
第二節 研究工具及材料12
第三節 研究架構13
第四節 變項名稱與操作定義14
第五節 資料處理與分析方法15
第四章研究結果17
第五章討論27
第六章結論與建議31
參考文獻33
附錄
附錄一 膀胱過動症症狀問卷38
附錄二 研究計畫審查通過證明書39
附錄三 問卷內容40
附錄四 專家名單44

表 目 錄
表4-1 研究對象基本資料20
表4-2 雙J導管相關資訊21
表4-3 解尿情形統計22
表4-4 手術後腰痛及解尿疼痛之比較23
表4-5 放置雙J導管者手術後腰痛及解尿疼痛之比較24
表4-6 輸尿管鏡碎石術後腰痛及解尿疼痛迴歸分析26

圖 目 錄
圖2-1 尿結石醫療費用統計圖5
圖2-2 尿結石人次統計圖5
圖2-3 尿結石性別比較圖6

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