評估有無超音波即時追蹤系統體外震波碎石機之碎石成效

Comparison the Results of Extracorporeal Shock Wave Lithotripsy (ESWL) With or Without Real-time Ultrasound Tracking System Treatment for Urinary System Stones

目標：探討有、無超音波即時追蹤系統的體外震波碎石機治療尿路結石的碎石療效差異。
方法：分析 2016 年於中部某區域醫療體系中分別接受有、無超音波即時追蹤系統的體外震波碎石術治療的病人為研究對象，總共有 214 位患者完成治療，並以後續門診追蹤評估碎石結果，其中有 146 位以有超音波即時追蹤系統的體外震波碎石機治療（LiteMed LM-9200 ELMA: LM-9200 ELMA），其餘患者則以不使用超音波追蹤系統的體外震波碎石機治療（Dornier Lithotripter Doli S:DoLiS II），本研究量測內容包含治療完成後立即評估碎石成功率與後續追蹤結石裂解率。
結果：兩組研究族群在年齡、性別與結石位置均無差異。但使用 DoLiS II 之患者族群，其結石大小較大（p=0.02）。使用 LM-9200 治療需要較長的治療時間（p<0.001），較少的震波總數（p<0.001），有較佳的治療完成成功率與結石裂解率（p=0.051）。進一步分析結石的大小與兩種治療方式的相關性，結果顯示兩種方式治療較大的結石（>10 mm）均需要較長的治療時間與較多的震波總數，對於較小結石（0-10 mm）有較高的結石裂解率（p=0.001)，使用LM-9200 對於較小結石（0-10 mm）有較高的治療完成成功率與結石裂解率（p=0.039），同時相較於使用 DoLiS II，不論大、小結石都有較好的結石裂解率。
結論：本研究顯示使用 LM-9200 治療泌尿道系統結石，不論結石大小，相較於使用DoLiS II 都有較好治療完成成功率與結石裂解率。

Study Aim : To evaluate the treatment results for urinary system stones using extracorporeal Shock wave lithotripsy (ESWL) with or without realtime ultrasound tracking.
Method : A total of 214 patients were treated with ESWL in a hospital in central Taiwan. Among them, 146 patients were treated with realtime ultrasound tracking system (LiteMed LM-9200 ELMA) and the other patients were treated with no ultrasound tracking system (Dornier Lithotripter Doli Sue: DoLiS II ESWL). The treatment results, including success and stone fragmentation rates, were analyzed in this study.
Results : There were no differences in age, sex, and stone status in the two groups. However, patients in the DoLiS II group had larger stone size than those in the LM-9200 group (p = 0.02). Patients treated with LM-9200 had longer treated time (P <0.001), less shock waves (p <0.001), and higher success and stone fragmentation rates (p =0.051) than those treated with DoLiS II. The inversed correlation between treatment time, number of shock waves and size of stones were observed in both analyses. Small stones had higher success and stone fragmentation rates than larger stones (p <0.001). Treated with LM-9200 had higher success and stone fragmentation rates for small and larger stones than did the use of DoLiS II
Conclusion : The results of this study demonstrate that using LM-9200 treatment for urinary tract system stones had better success and stone fragmentation rates than using DoLiS II.