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中華民國泌尿科醫學會雜誌

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篇名 The Management of Staghorn Renal Calculi ─Analysis of 100 Cases
卷期 1:4
並列篇名 腎臟鹿角形結石之治療─100個病例之分析
作者 楊志東周固張奐光林文州羅景易
頁次 303-308
關鍵字 Staghorn renal calculiESWLPCNLNephrectomyTSCI
出刊日期 199012

中文摘要

馬偕紀念醫院從1988年3月至1989年3月共治療了100例(103個腎單位)之腎臟鹿角形結石,治療之方法包括了:1.體外震波碎石術單一療法 ─ 28例(29個腎單位) 2.經皮腎造瘻腎結石截石術單一療法 ─ 44例 (45個腎單位) 4.腎臟切除術 ─ 4例。結石全清除率在體外震波碎石術單一療法者為83%,在經皮腎造瘻腎結石截石術療法者為75%,在合併療法者為85%鄉力術後有9例發生了菌血症,7例發生了輸尿管結石成排阻塞,其中有5例以輸尿管鏡將結石夾出,兩例以體外震波碎石術處理。在體外震波碎石術單一療法中為了避免結石碎片造成輸尿管阻塞,治療前先放置雙丁形導管於輸尿管。鹿角形結石之治療一般均須多次才可達療效。對於較不複雜之鹿角形結石可以體外震波碎石術併用雙丁形導管來作為初期之治療而可得不錯之療效及較少之併發症,經皮腎造瘻腎結石截石術可用來治療較複雜的鹿角形結石及當體外震波碎石術無法達到療效時使用之,腎臟切除術則只限用於無腎功能之鹿角形結石。

英文摘要

From May 1988 to May 1989, there were 100 cases (103 kidney units) of staghorn re-nal calculi treated in Mackay Memorial Hospital. The treatment modalities in this series included a. Extracorporeal shock wave lithotripsy (ESWL) monotherapy - 28 cases (29 Kidney units) b. Percutaneous nephrolithotomy (PCNL) monotherapy - 24 cases (25 Kid-ney units) c. Percutaneous nephrolithotomy debulking and Extracorporeal shock wave lithotripsy combined therapy - 44 cases (45 Kidney units) d. Nephrectomy - 4 cases. The stone free rate for ESWL monotherapy was 83%, for PCNL monotherapy was 75%, for combined method was 85%. In the postoperative period, 9 cases suffered from sepsis, 7 cases suffered from Steinstrasse formation that necessitated secondary procedure - either ureterorenoscopic manipulation (5 cases) or ESWL (2 cases). In the ESWL monotherapy group, we inserted double J catheter as the ureteral stent to prevent ureteral obstruction caused by stone fragments. Multiple treatment sessions are usually needed in the management of staghorn renal calculi. ESWL monotheraphy can be used along with double J catheter as the initial treat-ment for uncomplicated staghorn renal calculi with less complication and promissing result. PNCL still has its role in the treatment of complex stone and in place where there is no facilities of extracorporeal shock wave lithotripter. Nephrectomy is restricted in cases of staghorn renal calculi with non-functioning kidney. (J Urol R.O.C., 1:303-308, 1990)

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