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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 簡國龍(Kuo-Liong Chien) | |
dc.contributor.author | Chun-Kai Wang | en |
dc.contributor.author | 王俊凱 | zh_TW |
dc.date.accessioned | 2021-06-15T05:18:55Z | - |
dc.date.available | 2015-09-09 | |
dc.date.copyright | 2010-09-09 | |
dc.date.issued | 2010 | |
dc.date.submitted | 2010-07-21 | |
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Effect of vibration massage therapy after extracorporeal shockwave lithotripsy in patients with lower caliceal stones. J Endourol 1999;13:705-7. 67. Lafrades AR. Percussion after extracorporeal shock wave lithotripsy. Urol Nurs 1992;12:112-4. 68. Brownlee N, Foster M, Griffith DP, Carlton CE, Jr. Controlled inversion therapy: an adjunct to the elimination of gravity-dependent fragments following extracorporeal shock wave lithotripsy. J Urol 1990;143:1096-8. 69. Rodrigues Netto N, Jr., Claro JF, Cortado PL, Lemos GC. Adjunct controlled inversion therapy following extracorporeal shock wave lithotripsy for lower pole caliceal stones. J Urol 1991;146:953-4. 70. D'A Honey RJ, Luymes J, Weir MJ, Kodama R, Tariq N. Mechanical percussion inversion can result in relocation of lower pole stone fragments after shock wave lithotripsy. Urology 2000;55:204-6. 71. Pace KT, Tariq N, Dyer SJ, Weir MJ, RJ DAH. Mechanical percussion, inversion and diuresis for residual lower pole fragments after shock wave lithotripsy: a prospective, single blind, randomized controlled trial. J Urol 2001;166:2065-71. 72. Chiong E, Hwee ST, Kay LM, Liang S, Kamaraj R, Esuvaranathan K. Randomized controlled study of mechanical percussion, diuresis, and inversion therapy to assist passage of lower pole renal calculi after shock wave lithotripsy. Urology 2005;65:1070-4. 73. Proportion Difference Power / Sample Size Calculation 2009. (Accessed at http://statpages.org/proppowr.html.) 74. Youden WJ. Index for rating diagnostic tests. Cancer 1950;3:32-5. 75. Stamatelou KK, Francis ME, Jones CA, Nyberg LM, Curhan GC. Time trends in reported prevalence of kidney stones in the United States: 1976-1994. Kidney Int 2003;63:1817-23. 76. Lee YH, Huang WC, Tsai JY, et al. Epidemiological studies on the prevalence of upper urinary calculi in Taiwan. Urol Int 2002;68:172-7. 77. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157-63. 78. Taylor EN, Stampfer MJ, Curhan GC. Obesity, weight gain, and the risk of kidney stones. JAMA 2005;293:455-62. 79. Parsons JK, Lancini V, Shetye K, Regan F, Potter SR, Jarrett TW. Urinary stone size: comparison of abdominal plain radiography and noncontrast CT measurements. J Endourol 2003;17:725-8. 80. Sabnis RB, Naik K, Patel SH, Desai MR, Bapat SD. Extracorporeal shock wave lithotripsy for lower calyceal stones: can clearance be predicted? Br J Urol 1997;80:853-7. 81. Sampaio FJ, D'Anunciacao AL, Silva EC. Comparative follow-up of patients with acute and obtuse infundibulum-pelvic angle submitted to extracorporeal shockwave lithotripsy for lower caliceal stones: preliminary report and proposed study design. J Endourol 1997;11:157-61. 82. Pace KT, Weir MJ, Harju M, Tariq N, RJ DAH. Individual patient variation and inter-rater reliability of lower calyceal infundibular width on routine intravenous pyelography. BJU Int 2003;92:607-9. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/46615 | - |
dc.description.abstract | 背景與目標:
下端腎結石接受震波碎石後,其結石因重力沈積之故不易排出體外。臨床上有許多治療可以增進結石之廓清;例如倒立、給予利尿以及利用敲擊震動之方式。本研究目標為下端腎結石經過震波碎石術後,給予重力震動排石治療是否可增加其結石之廓清率並減少剩餘結石之面積。同時並找出可能影響結石廓清率之預測因子。 方法: 本研究為回溯性世代研究。114人因下端腎結石而接受體外震波碎石治療。其中58人僅接受震波碎石術,另外56人在震波碎石術後同時接受每週一次,為期一個月(至多4次)的重力震動排石治療。重力震動排石治療過程為:病人飲用500ml清水並接受利尿劑注射。30分鐘後面朝下平躺且上半身向下傾斜45°,並在結石患側綁上震動器實行10分鐘之震動治療。術後一個月及三個月分別接受X光檢查來確認結石廓清率以及剩餘結石之大小。 結果: 兩組患者之年齡、性別、體質比、結石之患側、結石長度、結石面積、腎盞長度、腎盞寬度、腎盞高度、腎盞腎盂夾角、腎盞輸尿管夾角、腎盞脊椎夾角、最大震波強度、震波次數以及震波碎石時間等各變數均無明顯之差異。震動排石治療組與控制組相比,在術後一個月(35.7% vs 19.0%, p=0.045)及術後三個月(46.4% vs 24.1%, p=0.013)之結石廓清率均有顯著增加。另外在結石面積減少之比率方面,震動排石治療組亦明顯大於控制組(術後一個月:68.7% vs 23.4%, p<0.001;術後三個月:82.5% vs 27.9%, p<0.001)。此外除了震動排石治療以外,術後一個月結石廓清之預測因子為結石面積(OR=0.95, 95%CI 0.91-0.99)以及腎盞腎盂夾角(OR=1.07, 95%CI 1.01-1.15)。而術後三個月結石廓清之預測因子為結石面積(OR=0.95, 95%CI 0.92-0.99)、腎盞寬度(OR=2.50, 95%CI 1.32-4.75)以及腎盞腎盂夾角(OR=1.07, 95%CI 1.01-1.13)。 結論: 下端腎結石之患者經震波碎石術後給予重力震動排石治療,可顯著增加術後一個月以及三個月之結石廓清率。 | zh_TW |
dc.description.abstract | Background and Objectives:
Treating lower pole renal stones with shockwave lithotripsy can result in incomplete stone clearance due to poor drainage of residual stone fragments, leading to recurrent stone formation. Clinically we can use the adjunct treatments, such as diuresis, gravity therapy or percussion to facilitate the stone passage. The objectives of this study is to determine whether percussion, diuresis and inversion (PDI) therapy can improve the clearance rate of lower pole renal stone after shockwave lithotripsy. Methods: 114 patients with lower pole renal stone who received shockwave lithotripsy were arranged into two groups. One group (n=58) received shockwave treatment alone, and the other group (n=56) received shockwave lithotripsy followed by weekly PDI therapy (range 1 to 4). PDI therapy was performed as follows. Patient drank 500ml water and received 20mg Furosemide injection. After 30 minutes, they lay in prone position with upper trunk 45°downward to the ground. A vibrator was applied over the flank and subjects received vibration therapy for 10 minutes. Patients received follow up one month and three months after the shockwave lithotripsy. Stone clearance and residual stone characteristics were documented with plain abdominal radiography. Result: There were no significant differences in both groups while comparing demographics, total stone diameter, radiological features (infundibular neck diameter, infundibular length, caliceal height, infundibular-pelvic angles, infundibular-ureteral angles, infundibular-vertebral angles, cortical thickness) and shockwave parameters (shockwave intensity and duration). The radiologically documented complete stone clearance rates were significantly different in one months (control vs PDI: 19.0% vs 35.7%, p=0.045) and three months (control vs PDI: 24.1% vs 48.2%, p=0.006). There was also significant difference in change of stone area between two groups in one month (23.4% v.s. 68.7%, p<0.001) and three months (27.9% v.s. 82.5%, p<0.001). The predictors for one month stone clearance were initial stone area (OR=0.95, 95% CI 0.91-0.99) and infundibular-pelvic angle (OR=1.07, 95% CI 1.01-1.15). The predictors for three month stone clearance were initial stone area (OR=0.95, 95% CI 0.92-0.99), infundibular neck diameter (OR=2.50, 95% CI 1.32-4.75) and infundibular-pelvic angle (OR=1.07, 95% CI 1.01-1.13). Conclusion: Percussion, diuresis and inversion therapy is effective in assisting the clearance of lower pole renal stone after shockwave lithotripsy. | en |
dc.description.provenance | Made available in DSpace on 2021-06-15T05:18:55Z (GMT). No. of bitstreams: 1 ntu-99-R97846013-1.pdf: 3557931 bytes, checksum: bc1f39957865cb2391328f2f82ac8a92 (MD5) Previous issue date: 2010 | en |
dc.description.tableofcontents | 口試委員會審定書 I
致謝 II 摘要 III Abstract V 內容綱要(Table of Contents) VII Tables X Figures XI 第一章 研究背景 1 第一節 體外震波術對於腎結石治療之角色 1 1.1.1 體外震波碎石總論 1 1.1.2 體外震波治療腎結石 3 第二節 影響體外震波術後腎結石廓清之預測因子 4 1.2.1 結石大小 4 1.2.2 結石成分 6 1.2.3 腎臟解剖學構造與結石位置 8 1.2.4 臨床因素:肥胖 9 第三節 下端腎結石之體外震波治療 9 1.3.1 體外震波治療下端腎結石 9 1.3.2 影響下端結石術後廓清之腎下盞解剖學構造 11 1.3.3 震波碎石術後殘餘結石之評估 11 第四節 重力震動排石對下端腎結石碎片排除之效果 13 1.4.1 利尿(Diuresis)治療對於下端碎石排除之影響 13 1.4.2 敲震(Percussion)與倒立(Inversion)對下端碎石排除之影響 14 第五節 重力震動排石(Percussion, diuresis and inversion)之文獻回顧 15 第二章 研究目的 17 第三章 研究材料與方法 18 第一節 研究設計 18 3.1.1 研究對象之選取 18 3.1.2 研究個案資料之收集 18 3.1.3 研究與治療流程細節 19 3.1.4 重力震動排石之治療步驟 19 第二節 研究變數及解剖學構造之測量 19 3.2.1 病人基本資料以及腎臟結構測量 20 3.2.2 結石長度面積之量測 20 3.2.3 震波碎石治療參數 21 第三節 統計學分析 21 3.3.1 研究患者數目之估計 21 3.3.2 患者基本資料以及各變數之比較 21 3.3.3 結石廓清率以及結石長度與面積改變之比較 22 3.3.4 回歸分析模型之探討 22 3.3.5 受試者操作特徵(Receiver operating characteristic)曲線分析 23 第四章 結果 24 第一節 結石病人之人口學資料、X光解剖學以及震波因子之分佈 24 第二節 結石廓清率與結石術後變化之分析 24 第三節 回歸模型之探討 25 4.3.1 重力震動排石治療對於結石廓清率影響之回歸分析探討 25 4.3.2 結石廓清之預測因子分析 26 4.3.3 ROC曲線分析 27 第五章 討論 29 第一節 兩組各測量變數之比較與實驗方法之分析 29 第二節 廓清率與結石長度、面積改變之討論 31 5.2.1 兩組廓清率之分析討論 32 5.2.2 結石長度與面積改變之討論 32 第三節 各干擾因子之分析結果 33 5.3.1 回歸分析之解釋 33 5.3.2 影響廓清率之其他預測因子 33 5.3.3 影響結石廓清之各干擾因子診斷值 34 第四節 研究之限制 35 5.4.1 研究對象之選擇誤差(selection bias) 35 5.4.2 測量方法之可重複性 36 5.4.3 其他可能影響廓清之因子 37 5.4.4 未來之研究方向 38 第五節 結論 38 參考文獻 39 | |
dc.language.iso | zh-TW | |
dc.title | 重力震動排石療法對於下端腎結石經震波碎石術後廓清之影響 | zh_TW |
dc.title | The Role of Precussion, Diuresis and Inversion Therapy in Assisting the Clearance of Lower Pole Renal Stone after Shock Wave Lithotripsy | en |
dc.type | Thesis | |
dc.date.schoolyear | 98-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 季瑋珠(Wei-Chu Chie),李文宗(Wen-Chung Li),謝汝敦(Ju-Ton Hsieh),程蘊菁(Yen-Ching Chen) | |
dc.subject.keyword | 腎結石,震動排石,體外震波,碎石, | zh_TW |
dc.subject.keyword | lithotripsy,percussion,diuresis,kidney,calculi, | en |
dc.relation.page | 60 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2010-07-21 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 預防醫學研究所 | zh_TW |
顯示於系所單位: | 流行病學與預防醫學研究所 |
文件中的檔案:
檔案 | 大小 | 格式 | |
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ntu-99-1.pdf 目前未授權公開取用 | 3.47 MB | Adobe PDF |
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