Studying the Predictability of the Presence of Ureteral Stones in Patients with Negative Sonographic Findings

Keywords: Renal Colic, Ureteral Stone, Sonography

Background & objectives:

In recent years ،Computed Tomography (CT scan) has become the Gold Standard for detecting urinary stones. This study was conducted to predict the size of possible passage of ureteral stones based on clinical signs, lab data (e.g. Ultrasounds) in patients with small passable stones and to prevent CT scan, which requires high costs and xray exposure. Methods: In this cross-sectional study, fifty consecutive patients from emergency room who had clinical symptoms of renal colic and urinary tract stones were recruited by simple nonrandom sampling. After obtaining the primary data, all of them underwent sonography (US), and in those without sings of stone in US ،CT scan was performed. Based on the CT scan, the patients were divided into two main groups: 1) patients who had no ureteral stones or had ureteral stones <5mm, and 2) patient who had ureteral stones ≥5mm. All gathered data were analyzed by t-test and chi-square test. Results: Among our proposed variables, previous history of urinary stone (p=0.05), irritative urinary symptoms (e.g. dysuria, frequency and urgency) (p=0.001), gross hematuria (p=0.049) and degree of hydronephrosis (p=0.029) had statistically significant relationship with the presence, size and spontaneous expulsive potential of ureteral stones. Conclusion: Based on our results, negative history of urinary stones, absence of irritative urinary symptoms and gross hematuria and absence or mild degree of hydronephrosis in sonography were in favor of small (<5mm) or passable ureteral stones for which CT scan can be omitted. 




  Downloaded from jarums.arums.ac.ir at 6:31 IRDT on Sunday September 1st 2019 [ DOI: 10.29252/jarums.18.2.154 ] Downloaded from jarums.arums.ac.ir at 6:31 IRDT on Sunday September 1st 2019 [ DOI: 10.29252/jarums.18.2.154 ] 


	Downloaded from jarums.arums.ac.ir at 6:31 IRDT on Sunday September 1st 2019 [ DOI: 10.29252/jarums.18.2.154 ]	‫ﻣﻘﺪﻣﻪ‬ ‫ﺳﻨﮓ‬ ‫ﻫﺎي‬ ‫درﻣﺎﻧﮕﺎه‬ ‫و‬ ‫ﺳﯿﺴﺘﻢ‬ ‫اورژاﻧﺲ‬ ‫ادراري‬ ‫ﻣﯽ‬ ‫ﺑﺎﺷﺪ‬ ‫از‬ ‫ﺷﺎﯾﻊ‬ ‫ﺑﻪ‬ ‫ﻋﻔﻮﻧـﺖ‬ ‫ﻫـﺎي‬ ‫دﺳـﺘﮕﺎه‬ ‫ادراري‬ ‫و‬ ‫ﺳﻮﻣﯿﻦ‬ ‫ﺑﯿﻤﺎري‬ ‫ﺷﺎﯾﻊ‬ ‫دﺳﺘﮕﺎه‬ ‫ادراري‬ ‫ﺗﺮﯾﻦ‬ ‫ﮔﻮﻧـﻪ‬ ‫ﻋﻠﻞ‬ ‫اي‬ ‫ﮐـﻪ‬ ‫ﻣﺮاﺟﻌﻪ‬ ‫ﭘـﺲ‬ ‫اﺧـﺘﻼﻻت‬ ‫ﭘﺮوﺳـﺘﺎت،‬ ‫ﺑﻪ‬ ‫از‬ ‫ﺗﻨﺎﺳﻠﯽ‬ ‫را‬ ‫ﺗﺸـﮑﯿﻞ‬ ‫ﻣﯽ‬ ‫دﻫﻨﺪ‬ . ‫ﻻزم‬ ‫ﺑﻪ‬ ‫ذﮐﺮ‬ ‫اﺳـﺖ‬ ‫ﮐـﻪ‬ ‫ﺳـﻨﮓ‬ ‫ﻫـﺎي‬ ‫ﺳﯿﺴـﺘﻢ‬ ‫ﭼﮑﯿﺪه‬ ‫و‬ ‫زﻣﯿﻨﻪ‬ ‫ﻫﺪف:‬ ‫ﻋﻨﻮان‬ ‫ﺑﻪ‬ ‫ﮐﻨﺘﺮاﺳﺖ‬ ‫ﺑﺪون‬ ‫اﺳﮑﻦ‬ ‫ﺗﯽ‬ ‫ﺳﯽ‬ ‫اﺧﯿﺮ‬ ‫ﺳﺎﻟﯿﺎن‬ ‫ﻃﯽ‬ ‫در‬ ‫ادراري‬ ‫در‬ ‫ﮐﻪ‬ ‫از‬ ‫ﻣﻘﺎدﯾﺮ‬ ‫ﺣﻘﯿﻘﺖ‬ ‫ﻣﺘﻐﯿﺮي‬ ‫ﺗﺠﻤﻌﺎت‬ ‫ﮐﺮﯾﺴﺘﺎﻟﻮﺋﯿﺪ‬ ‫ﭘﻠﯽ‬ ‫ﮐﺮﯾﺴﺘﺎﻟﻮﺋﯿﺪ‬ ‫و‬ ‫ﻣﺎﺗﺮﯾﮑﺲ‬ ‫ﻫﺴـﺘﻨﺪ‬ ‫ارﮔﺎﻧﯿﮏ‬ ‫ﺗﺸﮑﯿﻞ‬ ‫ﺷﺪه‬ ‫اﻧﺪ‬ . ‫در‬ ‫اﯾﻦ‬ ‫ﻣﯿﺎن‬ ‫ﺳﻨﮓ‬ ‫ﻫﺎي‬ ‫ﺣﺎﻟﺒﯽ‬ ‫ﺑـﺪﻟﯿﻞ‬ ‫اﯾﺠـﺎد‬ ‫ﻋﻼﺋـﻢ‬ ‫ﺣـﺎد‬ ‫و‬ ‫درد‬ ‫ﺷـﺪﯾﺪ‬ ‫از‬ ‫اﻫﻤﯿـﺖ‬ ‫ﺧﺎﺻـﯽ‬ ‫ﺑﺮﺧﻮردارﻧﺪ‬ ] 1 [ . ‫ﺑﯿﻤﺎرا‬ ‫ن‬ ‫ﻣﺮاﺟﻌﻪ‬ ‫ﮐﻨﻨﺪه‬ ‫ﺑـﻪ‬ ‫اورژاﻧـﺲ‬ ‫ﺑﺪﻟﯿﻞ‬ ‫ﺳﻨﮓ‬ ‫ﺣﺎﻟﺐ‬ ً ‫ﻏﺎﻟﺒﺎ‬ ‫درد‬ ‫ﺷﺪﯾﺪ‬ ‫و‬ ‫ﻏﯿﺮﻗﺎﺑﻞ‬ ‫ﺗﺤﻤـﻞ‬ ‫روش‬ ‫اﺳـﺘﺎﻧﺪارد‬ ‫ﺑـﺮاي‬ ‫ﻃﻼﯾـﯽ‬ ‫ﺗﺸـﺨﯿﺺ‬ ‫ﺳـﻨﮓ‬ ‫ﺑﯿ‬ ‫ﭘﯿﺶ‬ ‫اﻣﮑﺎن‬ ‫ﺑﺮرﺳﯽ‬ ‫ﻣﻄﺎﻟﻌﻪ‬ ‫اﯾﻦ‬ ‫اﻧﺠﺎم‬ ‫از‬ ‫ﻫﺪف‬ ‫اﺳﺖ.‬ ‫ﺷﺪه‬ ‫ﻣﻌﺮﻓﯽ‬ ‫ادراري‬ ‫ﻣﺠﺎري‬ ‫ﺑـﺮ‬ ‫ﺣﺎﻟـﺐ‬ ‫ﺳـﻨﮓ‬ ‫دﻓـﻊ‬ ‫اﺣﺘﻤـﺎل‬ ‫و‬ ‫اﻧﺪازه‬ ‫ﻨﯽ‬ ‫اﺳﺎس‬ ‫وﯾﮋﮔﯽ‬ ‫و‬ ‫ﺑﺎﻟﯿﻨﯽ‬ ‫ﻫﺎي‬ ‫اﻃﻼﻋﺎت‬ ‫ﻣﯽ‬ ‫ﺳﻮﻧﻮﮔﺮاﻓﯽ‬ ‫وﺳﯿﻠﻪ‬ ‫ﺑﺪﯾﻦ‬ ‫ﺗﺎ‬ ‫ﺑﺎﺷﺪ‬ ‫اﻓﺮادي‬ ‫ﮐـﻪ‬ ‫ﺳـﻨﮓ‬ ‫ﻗﺎﺑـﻞ‬ ‫ﺣﺎﻟـﺐ‬ ‫ﮐﻮﭼـﮏ‬ ‫دﻓـﻊ‬ ‫دارﻧـﺪ‬ ‫ﺗﯽ‬ ‫ﺳﯽ‬ ‫اﻧﺠﺎم‬ ‫از‬ ‫و‬ ‫ﺷﺪه‬ ‫ﺷﻨﺎﺳﺎﯾﯽ‬ ‫اﺳﮑﻦ‬ ‫ﮐﻪ‬ ‫ﻣﺴﺘﻠﺰم‬ ‫ﻫﺰﯾﻨﻪ‬ ‫و‬ ‫درﯾﺎﻓﺖ‬ ‫اﺷﻌﻪ‬ ‫اﺳﺖ‬ ‫ﮔﺮدد‬ ‫ﺟﻠﻮﮔﯿﺮي‬ . ‫روش‬ ‫ﮐﺎر:‬ ‫در‬ ‫اﯾﻦ‬ ‫ﻣﻄﺎﻟﻌﻪ‬ ‫ﻣﻘﻄﻌﯽ،‬ ‫ﺗﺤﻠﯿﻠﯽ‬ ‫از‬ ‫ﺑﯿﻦ‬ ‫ﻣﺮاﺟﻌﯿﻦ‬ ‫ﺑﻪ‬ ‫اورژاﻧﺲ‬ ‫ﺑﯿﻤﺎرﺳﺘﺎن‬ ‫ﺷﻬﯿﺪ‬ ‫ﻣـﺪرس‬ ‫داراي‬ ‫ﻋﻼﺋـﻢ‬ ‫ﺑـﺎﻟﯿﻨﯽ‬ ‫رﻧـﺎل‬ ‫و‬ ‫ﮐﻮﻟﯿﮏ‬ ‫ﺳﻨﮓ‬ ‫ﻣﺠﺎري‬ ‫ﺗﻌﺪاد‬ ‫ادراري،‬ 50 ‫ﻧﻔﺮ‬ ‫ﺑﻪ‬ ‫روش‬ ‫ﻏﯿﺮﺗﺼﺎدﻓﯽ‬ ‫ﺳﺎده‬ ‫اﻧﺘﺨﺎب‬ ‫ﮔﺮدﯾﺪﻧﺪ‬ . ‫اﻃﻼﻋﺎت‬ ‫اوﻟﯿﻪ‬ ‫ﺑﯿﻤﺎران‬ ‫آوري‬ ‫ﺟﻤﻊ‬ ‫و‬ ‫از‬ ‫ﺗﻤﺎﻣﯽ‬ ‫ﺑﯿﻤﺎران‬ ‫ﺳﻮﻧﻮﮔﺮاﻓﯽ‬ ‫ﺑﻪ‬ ‫ﻋﻤﻞ‬ ‫آﻣﺪ‬ ‫و‬ ‫در‬ ‫ﺻﻮرت‬ ‫ﻋﺪم‬ ‫ﻣﺸﺎﻫﺪه‬ ‫ﺳﻨﮓ‬ ‫ﺗﺤﺖ‬ ‫ﺗﯽ‬ ‫ﺳﯽ‬ ‫اﺳ‬ ‫ﮑﻦ‬ ‫ﺷﮑﻢ‬ ‫و‬ ‫ﻟﮕﻦ‬ ‫ﻗﺮار‬ ‫ﮔﺮﻓﺘﻨـﺪ.‬ ‫اﺳﺎس‬ ‫ﺑﺮ‬ ‫ﻧﺘﯿﺠﻪ‬ ‫ﺗﯽ‬ ‫ﺳﯽ‬ ‫اﺳﮑﻦ‬ ‫ﺑﯿﻤﺎران‬ ‫ﺑﻪ‬ ‫دو‬ ‫ﮔﺮوه‬ ‫ﺳﻨﮓ‬ ‫اﺻﻠﯽ‬ ‫ﺣﺎﻟﺐ‬ ‫دﻓﻊ‬ ‫ﺷﺪه‬ ‫ﯾﺎ‬ ‫ﺳﻨﮓ‬ ‫زﯾﺮ‬ 5 ‫ﻣﯿﻠﯿﻤﺘﺮ‬ ‫ﺣﺎﻟﺐ‬ ‫ﺳﻨﮓ‬ ‫و‬ ‫ﺑﯿﺸﺘﺮ‬ ‫ﯾـﺎ‬ ‫ﻣﺴﺎوي‬ 5 ‫ﻣﯿﻠﯿﻤﺘﺮ‬ ‫آﻧﺎﻟﯿﺰ‬ ‫ﺑﺎ‬ ‫ﻧﻬﺎﯾﺖ‬ ‫در‬ ‫ﺷﺪﻧﺪ.‬ ‫ﺗﻘﺴﯿﻢ‬ ‫اﻃﻼﻋﺎت‬ ‫اﺧﺬ‬ ‫اﻓﺘﺮاق‬ ‫اﻣﮑﺎن‬ ‫ﺷﺪه،‬ ‫ﺑﯿﻤﺎراﻧﯽ‬ ‫ﮐﻪ‬ ‫ﺳﻨﮓ‬ ‫ﮐﻮﭼﮏ‬ ‫ﻗﺎﺑﻞ‬ ‫دﻓﻊ‬ ‫دارﻧﺪ‬ ‫ﯾﺎ‬ ‫ﺳﻨﮓ‬ ‫ﺧﻮد‬ ‫را‬ ‫دﻓﻊ‬ ‫اﻧﺪ‬ ‫ﮐﺮده‬ ‫و‬ ‫ﮐﺴﺎﻧﯽ‬ ‫ﮐﻪ‬ ‫ﺳﻨﮓ‬ ‫ﺑﺰرگ‬ ‫ﻧﯿﺎزﻣﻨﺪ‬ ‫ﻣﺪاﺧﻠﻪ‬ ‫دارﻧﺪ،‬ ‫اﺳﺎس‬ ‫ﺑﺮ‬ ‫ﺣﺎل‬ ‫ﺷﺮح‬ ‫و‬ ‫ﺷﺪ.‬ ‫ﺑﺮرﺳﯽ‬ ‫ﺳﻮﻧﻮﮔﺮاﻓﯽ‬ ‫ﻫﺎ:‬ ‫ﯾﺎﻓﺘﻪ‬ ‫در‬ ‫ﻣﯿﺎن‬ ‫ﺗﻤﺎﻣﯽ‬ ‫ﻣﺘﻐﯿﺮﻫﺎي‬ ‫ﺑﺮرﺳﯽ‬ ‫ﺷﺪه‬ ‫ﺗﻨﻬﺎ‬ ‫ﭼﻬﺎر‬ ‫ﺧﻮد‬ ‫ﺷﺪن‬ ‫دﻓﻊ‬ ‫اﺣﺘﻤﺎل‬ ‫و‬ ‫ﺣﺎﻟﺐ‬ ‫ﺳﻨﮓ‬ ‫ﺳﺎﯾﺰ‬ ‫و‬ ‫وﺟﻮد‬ ‫ﺑﺎ‬ ‫آﻧﻬﺎ‬ ‫از‬ ‫ﻣﻮرد‬ ‫ﺷـ‬ ‫ﻣﺘﻐﯿﺮﻫـﺎ‬ ‫اﯾـﻦ‬ ‫داﺷـﺘﻨﺪ.‬ ‫ﻗﺒـﻮل‬ ‫ﻗﺎﺑـﻞ‬ ‫ارﺗﺒﺎط‬ ‫ﺧﻮدآن،‬ ‫ﺑﻪ‬ ‫ﺎﻣﻞ‬ ‫ﺳـﺎﺑﻘﻪ‬ ‫ﻗﺒﻠـﯽ‬ ‫ﺳـﻨﮓ‬ ) ‫ادراري‬ 05 / 0 = p ‫ﻋﻼﺋـﻢ‬ ،( ‫ادراري‬ ‫ﺗﺤﺮﯾﮑـﯽ‬ ) 001 / 0 = p ‫وﺟﻮد‬ ،( ) ‫ﻣﺎﮐﺮوﺳﮑﻮﭘﯿﮏ‬ ‫ﻫﻤﺎﭼﻮري‬ 049 / 0 = p ‫ﺷﺪت‬ ‫و‬ ( ‫ﻫﯿﺪروﻧﻔﺮوز‬ ) 029 / 0 = p ( ‫ﻣﯽ‬ ‫ﺑﺎﺷﻨﺪ.‬ ‫ﮔﯿﺮي:‬ ‫ﻧﺘﯿﺠﻪ‬ ‫ادراري،‬ ‫ﺗﺤﺮﯾﮑﯽ‬ ‫ﻋﻼﺋﻢ‬ ‫ﺳﻨﮓ،‬ ‫ﻗﺒﻠﯽ‬ ‫ﺳﺎﺑﻘﻪ‬ ‫ﻫﺎ،‬ ‫ﯾﺎﻓﺘﻪ‬ ‫ﺑﻪ‬ ‫ﺗﻮﺟﻪ‬ ‫ﺑﺎ‬ ‫وﺟـﻮد‬ ‫ﻫﻤـﺎﭼﻮري‬ ‫ﮔـﺮوس‬ ‫آﺷـﮑﺎر(‬ ‫)ﺧـﻮﻧﺮﯾﺰي‬ ‫و‬ ‫ﻫﯿﺪرو‬ ‫وﺟﻮد‬ ‫در‬ ‫ﻧﻔﺮوز‬ ‫ﺳﻮﻧﻮﮔﺮاﻓﯽ،‬ ‫ﺑﺴﯿﺎر‬ ‫ﺑﻪ‬ ‫ﻧﻔﻊ‬ ‫ﺳﻨﮕﻬﺎي‬ ‫ﺣﺎﻟﺐ‬ ‫ﺑﺰرﮔﺘﺮ‬ ‫از‬ 5 ‫ﻣﯿﻠﯿﻤﺘﺮ‬ ‫اﺣﺘﻤـﺎل‬ ‫ﺑـﺎ‬ ‫ﮐـﻢ‬ ‫دﻓـﻊ‬ ‫ﻣـﯽ‬ ‫ﺑﺎﺷـﺪ‬ ‫اﻧﺠـﺎم‬ ‫و‬ ‫ﺳﯽ‬ ‫ﺗﯽ‬ ‫ﻣﯽ‬ ‫ﺗﻮﺻﯿﻪ‬ ‫ﺗﻬﺎﺟﻤﯽ‬ ‫درﻣﺎن‬ ‫ﻧﯿﺎزﺑﻪ‬ ‫ﺑﺮرﺳﯽ‬ ‫ﻫﻢ‬ ‫و‬ ‫ﻣﺤﻞ‬ ‫دﻗﯿﻖ‬ ‫ﺗﻌﯿﯿﻦ‬ ‫ﺟﻬﺖ‬ ‫ﻫﻢ‬ ‫اﺳﮑﻦ‬ ‫ﺷﻮد.‬ ‫ﮐﻠﯿﺪي‬ ‫ﻫﺎي‬ ‫واژه‬ : ‫رﻧﺎل‬ ‫ﮐﻮﻟﯿﮏ،‬ ‫ﺳﻨﮓ‬ ‫ﺣﺎﻟﺐ،‬ ‫ﺳﻮﻧﻮﮔﺮاﻓﯽ‬ ‫داﺷﺘﻪ‬ ‫و‬ ‫ﺑﯿﻘﺮارﻧﺪ‬ . ‫از‬ ‫دﯾﮕـﺮ‬ ‫ﻋﻼﺋـﻢ‬ ‫ﺳـﻨﮓ‬ ‫ﻫـﺎ‬ ‫ي‬ ‫ادراري‬ ‫ﻣﯽ‬ ‫ﺗﻮان‬ ‫ﺑـﻪ‬ ‫ادرار‬ ‫در‬ ‫ﺧـﻮن‬ ‫وﺟـﻮد‬ ، ‫ﺗﮑـﺮر،‬ ‫ﺳـﻮزش‬ ‫و‬ ‫اﺣﺴـﺎس‬ ‫ﻓﻮرﯾـﺖ‬ ‫در‬ ‫ادرار،‬ ‫ﺗﻬـﻮع‬ ‫و‬ ‫اﺳـﺘﻔﺮاغ‬ ‫و‬ ‫ﺳـﺎﯾﺮ‬ ‫ﻋﻼﺋﻢ‬ ‫ﻏﯿﺮاﺧﺘﺼﺎﺻـﯽ‬ ‫اﺷـﺎره‬ ‫ﮐـﺮد‬ ‫ﮐـﻪ‬ ‫ﻧﯿـﺎز‬ ‫ﺑـﻪ‬ ‫ﺗﺎﯾﯿـﺪ‬ ‫ﭘﺎراﮐﻠ‬ ‫ﯿﻨﯿﮏ‬ ‫دارﻧﺪ‬ ] 2 [ . ً ‫ﺳﺎﺑﻘﺎ‬ ‫اﺳﺘﺎﻧﺪارد‬ ‫ﻃﻼﯾـﯽ‬ ‫ﺗﺸـﺨﯿﺺ‬ ‫ﺳـﻨﮓ‬ ‫اﻧﺠـﺎم‬ ‫ﺣﺎﻟـﺐ‬ ‫ورﯾﺪي‬ ‫ﯾﻮرﺗﺮوﮔﺮاﻓﯽ‬ ‫ﺑـﻮده‬ ‫ﮐـﻪ‬ ‫ﺑـﻪ‬ ‫ﻣـﺮور‬ ‫زﻣـﺎن‬ ‫ﺑـﺎ‬ ‫ﮔﺴﺘﺮش‬ ‫و‬ ‫ﮐﺎراﯾﯽ‬ ‫ﺑﺎﻻي‬ ‫اﺳﮑﻦ‬ ‫ﺗﯽ‬ ‫ﺳﯽ‬ ، ‫ﺟﺎﯾﮕﺰﯾﻦ‬ ‫اﻧﺠـﺎم‬ ‫آن‬ ‫ﺷﺪه‬ ‫اﺳﺖ‬ ‫ﮐﻪ‬ ‫ﻣﺤﺪودﯾﺖ‬ ‫ﻫﺎ‬ ‫ي‬ ‫ﺧﺎص‬ ‫ﺧـﻮد‬ ‫را‬ ‫دارد‬ . ‫اﺳﺘﻔﺎده‬ ‫از‬ ‫اﺳﮑﻦ‬ ‫ﺗﯽ‬ ‫ﺳﯽ‬ ‫در‬ ‫ﺧﺎﻧﻢ‬ ‫ﻫـﺎي‬ ‫ﺑـﺎردار‬ ‫ﻣﻤﻨـﻮع‬ ‫ﺑﻮده‬ ‫و‬ ‫در‬ ‫ﮐﻮدﮐﺎن‬ ‫ﺑﺎ‬ ‫ﻣﺤﺪودﯾﺖ‬ ‫ﻣﻮاﺟﻪ‬ ‫اﺳﺖ‬ . ‫ﺑﻌـﻼوه‬ ‫اﻧﺠﺎم‬ ‫آن‬ ‫ﻣﺴﺘﻠﺰم‬ ‫درﯾﺎﻓﺖ‬ ‫اﺷﻌﻪ‬ ‫زﯾﺎد‬ ‫ﺗﻮﺳـﻂ‬ ‫ﺑﯿﻤـﺎر‬ ‫و‬ ‫ﺑﺎر‬ ‫ﻣﺎﻟﯽ‬ ‫زﯾﺎد‬ ‫ﺑﺮاي‬ ‫ﺑﯿﻤﺎر‬ ‫و‬ ‫ﺳﯿﺴـﺘﻢ‬ ‫ﺑﻬﺪاﺷـﺘﯽ‬ ‫ﮐﺸـﻮر‬ ‫ﻣﯽ‬ ‫ﺑﺎﺷﺪ‬ ] 3 [ . ‫ﻃﺒﻖ‬ ‫ﻣﻄﺎﻟﻌﻪ‬ ‫و‬ ‫ﻟـﯽ‬ ‫ﻫﻤﮑـﺎران‬ ‫ﺑﺴـﯿﺎري‬ ‫از‬ ‫ﭘﺰﺷﮑﺎن‬ ‫دﭘﺎرﺗﻤﺎن‬ ‫اورژاﻧﺲ‬ ‫ﺗﺨﻤﯿﻦ‬ ‫ﻧﺎدرﺳﺘﯽ‬ ‫از‬ ‫ﻣﯿـﺰان‬ ‫اﺷـﻌﻪ‬ ‫درﯾـﺎﻓﺘﯽ‬ ‫ﺑﯿﻤـﺎران‬ ‫از‬ ‫اﺳـﮑﻦ‬ ‫ﺗـﯽ‬ ‫ﺳـﯽ‬ ‫را‬ ‫دا‬ ‫رﻧـﺪ‬ . ‫ﺑﺴﯿﺎري‬ ‫از‬ ‫اﯾﻦ‬ ‫ﭘﺰﺷﮑﺎن‬ ‫ﻣﻌﺘﻘﺪ‬ ‫ﺑﻪ‬ ‫اﻓﺰاﯾﺶ‬ ‫ﺧﻄﺮ‬ ‫ﺳﺮﻃﺎن‬ ‫در‬ ‫ﻃﻮل‬ ‫زﻧﺪﮔﯽ‬ ‫ﺑﯿﻤﺎران‬ ‫ﻧﯿﺴﺘﻨﺪ‬ ‫و‬ ‫ﯾﺎ‬ ‫ﺑﺮاي‬ ‫آن‬ ‫اﻫﻤﯿﺖ‬ ‫ﻗﺎﺋﻞ‬ ‫ﻧﻤﯽ‬ ‫ﺷﻮﻧﺪ‬ . ‫ﺳﻨﮓ‬ ‫ادراري‬ ‫ﯾﮏ‬ ‫ﺑﯿﻤﺎري‬ ‫ﺧﻮش‬ ‫ﺧﯿﻢ‬ ‫و‬ ‫راﺟﻌﻪ‬ ‫ﻣﯽ‬ ‫ﺑﺎﺷﺪ‬ ‫ﮐﻪ‬ ‫ﺑﻌﻠﺖ‬ ‫ﻣﺎﻫﯿﺖ‬ ‫راﺟﻌﻪ‬ ‫ﺑﻮدن‬ ‫ﺑﺎﯾﺪ‬ ‫ﺑـﻪ‬ ‫ﻣﯿﺰان‬ ‫اﺷﻌﻪ‬ ‫درﯾﺎﻓﺘﯽ‬ ‫ﺑﯿﻤﺎران‬ ‫در‬ ‫ﻃﻮل‬ ‫زﻧـﺪﮔﯽ‬ ‫اﯾﺸـﺎن‬ ‫ﻧﺎﺷﯽ‬ ‫از‬ ‫اﺳﮑﻦ‬ ‫ﺗﯽ‬ ‫ﺳﯽ‬ ‫ﺗﻮﺟﻪ‬ ‫ﺧﺎص‬ ‫داﺷﺖ‬ ] 4 [ . ‫ﻣﻮارد‬ ‫اﯾﻦ‬ ‫ﺑﻪ‬ ‫ﺗﻮﺟﻪ‬ ‫ﺑﺎ‬ ‫ﺑﻨﻈﺮ‬ ‫ﻣﯽ‬ ‫رﺳﺪ‬ ‫اﻧﺠﺎم‬ ‫روش‬ ‫ﻫـﺎي‬ ‫ﺟﺎﯾﮕﺰﯾﻦ‬ ‫ﺑﺮاي‬ ‫ﺗﺸﺨﯿﺺ‬ ‫ﺳﻨﮓ‬ ‫ﻫﺎ‬ ‫ي‬ ‫ﺣﺎﻟﺐ‬ ‫ﺣﺎﺋﺰ‬ ‫اﻫﻤﯿـﺖ‬ ‫اﺳـﺖ‬ . ‫در‬ ‫اﯾـﻦ‬ ‫ﻣﻄﺎﻟﻌـﻪ‬ ‫ﻋﻮاﻣـﻞ‬ ‫ﻓـﺮدي‬ ‫و‬ ‫ﺑـﺎﻟﯿﻨﯽ‬ ‫و‬ ‫ﺗﺼﻮﯾﺮﺑﺮداري‬ ‫ﺑﯿﻨﯽ‬ ‫ﭘﯿﺶ‬ ‫ﮐﻨﻨﺪه‬ ‫وﺟﻮد‬ ‫و‬ ‫اﻧﺪازه‬ ‫ﺳـﻨﮓ‬ ‫ﺣﺎﻟﺐ‬ ‫ﺑﺮرﺳﯽ‬ ‫ﮔﺮدﯾﺪ‬ . ‫در‬ ‫اﯾـﻦ‬ ‫ﺻـﻮرت‬ ‫ﻣـﯽ‬ ‫ﺗـﻮان‬ ‫ﺑـﻪ‬ ‫ﻣﻌﯿﺎرﻫﺎﯾﯽ‬ ‫در‬ ‫ﺣـ‬ ‫ﺷﺮح‬ ‫و‬ ‫ﺎل‬ ‫ﺳـﻮﻧﻮﮔﺮاﻓﯽ‬ ‫دﺳـﺖ‬ ‫ﭘﯿـﺪا‬ ‫ﮐﺮد‬ ‫ﮐﻪ‬ ‫ﺑﺎ‬ ‫ﺗﻮﺟﻪ‬ ‫ﺑﻪ‬ ‫آن‬ ‫ﻣﻌﯿﺎرﻫﺎ‬ ‫ﺑﯿﻤﺎران‬ ‫ﺑﺎ‬ ‫ﺳـﻨﮓ‬ ‫ﻗﺎﺑـﻞ‬ ‫دﻓﻊ‬ ‫ﺣﺎﻟﺐ‬ ‫را‬ ‫از‬ ‫اﻧﺠﺎم‬ ‫ﺑﺮرﺳﯽ‬ ‫ﺑﯿﺸﺘﺮ‬ ‫ﻣﺜﻞ‬ ‫ﺗﯽ‬ ‫ﺳﯽ‬ ‫اﺳﮑﻦ‬ ‫ﻣﻌﺎف‬ ‫ﻧﻤﻮد‬ . ‫ﭘﯿﺶ‬ ‫اﻣﮑﺎن‬ ‫ﺑﺮرﺳﯽ‬ ‫ﻣﻄﺎﻟﻌﻪ‬ ‫اﯾﻦ‬ ‫اﻧﺠﺎم‬ ‫از‬ ‫ﻫﺪف‬ ‫ﺑﺮ‬ ‫ﺣﺎﻟﺐ‬ ‫ﺳﻨﮓ‬ ‫دﻓﻊ‬ ‫اﺣﺘﻤﺎل‬ ‫و‬ ‫اﻧﺪازه‬ ‫ﺑﯿﻨﯽ‬ ‫اﺳﺎس‬ ‫وﯾﮋﮔﯽ‬ ‫ﻫـﺎي‬ ‫و‬ ‫ﺑﺎﻟﯿﻨﯽ‬ ‫اﻃﻼﻋﺎت‬ ‫ﻣـﯽ‬ ‫ﺳـﻮﻧﻮﮔﺮاﻓﯽ‬ ‫ﺑﺎ‬ ‫وﺳـﯿﻠﻪ‬ ‫ﺑـﺪﯾﻦ‬ ‫ﺗـﺎ‬ ‫ﺷـﺪ‬ ‫اﻓﺮادي‬ ‫ﮐﻪ‬ ‫ﺳﻨﮓ‬ ‫ﻗﺎﺑـﻞ‬ ‫ﺣﺎﻟﺐ‬ ‫ﮐﻮﭼﮏ‬ ‫دﻓـﻊ‬ ‫ﺷﻨﺎﺳـﺎﯾﯽ‬ ‫دارﻧـﺪ‬ ‫از‬ ‫و‬ ‫ﺷﺪه‬ ‫اﻧﺠﺎم‬ ‫ﺗﯽ‬ ‫ﺳﯽ‬ ‫اﺳﮑﻦ‬ ‫ﮐﻪ‬ ‫ﻣﺴﺘﻠﺰم‬ ‫ﻫﺰﯾﻨﻪ‬ ‫و‬ ‫درﯾﺎﻓﺖ‬ ‫اﺷﻌﻪ‬ ‫اﺳﺖ‬ ‫ﮔﺮدد‬ ‫ﺟﻠﻮﮔﯿﺮي‬ . ‫ﮐﺎر‬ ‫روش‬ ‫ﺗﺤﻘﯿﻖ‬ ‫اﯾﻦ‬ ‫در‬ ‫ﺻﻮرت‬ ‫ﺑﻪ‬ ‫ﮐﻪ‬ ‫ﺗﺤﻠﯿﻠﯽ‬ ‫ﻣﻘﻄﻌـﯽ‬ 1 ‫ﻃﺮاﺣـﯽ‬ ‫ﮔﺮدﯾﺪ‬ ، 50 ‫ﺑﺎﻻي‬ ‫ﺑﯿﻤﺎر‬ 18 ‫ﮐـﻪ‬ ‫ﺳـﺎل‬ ‫ﺑـﺎ‬ ‫ﺷـﮑﺎﯾﺖ‬ ‫رﻧـﺎل‬ ‫ﺑـﻪ‬ ‫ﮐﻮﻟﯿـﮏ‬ ‫اورژاﻧـﺲ‬ ‫او‬ ‫روﻟـﻮژي‬ ‫ﺑﯿﻤﺎرﺳـﺘﺎن‬ ‫ﺷـﻬﯿﺪ‬ ‫ﻣﺪرس‬ ‫در‬ ‫ﺑﻬﺎر‬ ‫و‬ ‫ﺗﺎﺑﺴﺘﺎن‬ 96 ‫ﻣﺮاﺟﻌﻪ‬ ‫ﮐﺮدﻧﺪ‬ ‫از‬ ‫ﺑﻌﺪ‬ ‫و‬ ‫رﺿﺎﯾﺖ‬ ‫ﮐﺴﺐ‬ ‫ﺳـﺎده‬ ‫ﺗﺼـﺎدﻓﯽ‬ ‫ﻏﯿـﺮ‬ ‫ﺻـﻮرت‬ ‫ﺑـﻪ‬ 2 ‫وارد‬ ‫ﺷﺪﻧﺪ‬ ‫ﻣﻄﺎﻟﻌﻪ‬ . ‫ﺑﺎ‬ ‫ﺗﻮﺟﻪ‬ ‫ﺑﻪ‬ ‫اﻧﺠﺎم‬ ‫ﻣﻄﺎﻟﻌﻪ‬ ‫ﻣﺸـﺎﺑﻪ‬ ‫در‬ ‫اﯾـﻦ‬ ‫زﻣﯿﻨـﻪ‬ ‫و‬ ‫ﻧﯿـﺰ‬ ‫اﺳـــﺘﻔﺎده‬ ‫از‬ ‫ﻓﺮﻣـــﻮل‬ ‫ﺑـــﺮاي‬ ‫ﻧﻤﻮﻧﻪ‬ ‫ﺣﺠﻢ‬ ‫ﻣﺤﺎﺳﺒﻪ‬ ، ‫ﺑﺎ‬ ‫در‬ ‫ﻧﻈﺮ‬ ‫ﮔﺮﻓﺘﻦ‬ α ‫)ﺧﻄﺎي‬ ‫ﻧـﻮع‬ ‫ا‬ ‫ول:‬ 5 (% ، Z ‫اﻃﻤﯿﻨـﺎن:‬ ‫)ﺣـﺪود‬ 95 (% ، p ‫ﻣﯿـﺰان‬ ‫دﻗـﺖ‬ ‫ﺑﺮآورد‬ ‫ﺷﺪه‬ ‫آﻧﺎﻟﯿﺰ‬ ‫ﺳـﻨﮓ‬ ‫ﺑـﻪ‬ ‫روش‬ ‫ﻫـﺎي‬ ‫اﺳـﺘﺎﻧﺪارد‬ ‫ﻣﻮﺟﻮد:‬ 25 (% ، Z 1-α/2 ‫ﺟﺪاول‬ ‫و‬ ‫آﻣﺎري‬ ‫ﻣﺤﺎﺳﺒﺎت‬ ‫)ﺑﺮاي‬ ‫ﻣﻮﺟﻮد:‬ 96 / 1 ‫در‬ ‫و‬ ( ‫ﻧﻬﺎﯾﺖ‬ d ) ‫ﺣﺪاﮐﺜﺮ‬ ‫ﺧﻄﺎ‬ ‫در‬ ‫ﺑﺮآورد‬ ‫دﻗﺖ:‬ 12 / 0 ‫ﻧﻤﻮﻧﻪ‬ ‫ﺗﻌﺪاد‬ ( 50 ‫ﮔﺮدﯾﺪ‬ ‫ﻣﺤﺎﺳﺒﻪ‬ ‫ﺑﯿﻤﺎر‬ . ‫اﻃﻼﻋﺎت‬ ‫اوﻟﯿﻪ‬ ‫ﺷـﺎﻣ‬ ‫ﺑﯿﻤـﺎران‬ ‫دﻣﻮﮔﺮاﻓﯿـﮏ‬ ‫اﻃﻼﻋـﺎت‬ ‫ﻞ‬ ، ‫ﻣﺮاﺟﻌﻪ‬ ‫زﻣﺎن‬ ‫ﻋﻼﺋﻢ‬ ، ‫ﻗﺒﻠﯽ‬ ‫ﺳﺎﺑﻘﻪ‬ ، ‫ﻏﺬاﯾﯽ‬ ‫رژﯾﻢ‬ ، ‫اﻃﻼﻋﺎت‬ ‫ـﻪ‬ ‫ﯾﺎﻓﺘـ‬ ‫و‬ ‫ـﮕﺎﻫﯽ‬ ‫آزﻣﺎﯾﺸـ‬ ‫ـﻮﻧﻮﮔﺮاﻓﯽ‬ ‫ﺳـ‬ ‫ـﺎي‬ ‫ﻫـ‬ ‫از‬ ‫ـﻖ‬ ‫ﻃﺮﯾـ‬ ‫ﭘﺮﺳﺸﻨﺎﻣﻪ‬ ) ‫آوري‬ ‫ﺟﻤـﻊ‬ ‫ﻣﻘﺎﻟﻪ(‬ ‫ﺿﻤﯿﻤﻪ‬ ‫ﺷـﺪ‬ . ‫ﺑﯿﻤـﺎران‬ ‫ﻧﺎﭘﺎﯾﺪار‬ ‫از‬ ‫ﻟﺤﺎظ‬ ‫ﻫﻤﻮدﯾﻨﺎﻣﯿﮏ‬ ، ‫ﺑـﺎردار‬ ‫و‬ ‫ﻏﯿﺮ‬ ‫از‬ ‫ﻫﻤﮑـﺎر‬ ‫ﺟﻬﺖ‬ ‫اﻧﺠﺎم‬ ‫ﺳﻮﻧﻮﮔﺮاﻓﯽ‬ ‫و‬ ‫ﯾﺎ‬ ‫اﺳـﮑﻦ‬ ‫ﺗﯽ‬ ‫ﺳﯽ‬ ‫ﻣﻄﺎﻟﻌـﻪ‬ ‫از‬ ‫ﺣﺬف‬ ‫ﺷﺪﻧﺪ‬ . ‫از‬ ‫ﺗﻤﺎﻣﯽ‬ ‫ﺑﯿﻤﺎران‬ ‫ﺳﻮﻧﻮﮔﺮاﻓﯽ‬ ‫ﺑـﻪ‬ ‫ﻋﻤـﻞ‬ ‫آﻣﺪ‬ ‫و‬ ‫در‬ ‫ﺻﻮرت‬ ‫ﻋﺪم‬ ‫ﻣﺸﺎﻫﺪه‬ ‫ﺳـﻨﮓ‬ ‫ﺣﺎﻟـﺐ‬ ‫ﺗﺤـﺖ‬ ‫ﺗﯽ‬ ‫ﺳﯽ‬ ‫اﺳﮑﻦ‬ ‫ﺷﮑﻢ‬ ‫و‬ ‫ﻟﮕـﻦ‬ ) Brilliance 64 ، Phillips Medical System ( ‫ﻗﺮار‬ ‫ﮔﺮﻓﺘﻨﺪ‬ . ‫ﺳﻮﻧﻮﮔﺮاﻓﯽ‬ ‫دﺳﺘﮕﺎه‬ ‫ـﺪل‬ ‫ﻣــ‬ ‫ـﺘﻔﺎده‬ ‫اﺳــ‬ ‫ﻣــﻮرد‬ Phillips IU22 ‫ـﻂ‬ ‫ﺗﻮﺳــ‬ ‫و‬ ‫رزﯾﺪﻧﺖ‬ ‫ﻫﺎ‬ ‫رادﯾﻮﻟﻮژي‬ ‫ﮐﺸﯿﮏ‬ ‫ي‬ ) ‫ﺳﺎل‬ 2 ‫ﺷﺪ‬ ‫اﻧﺠﺎم‬ ( . ‫در‬ ‫ﻧﻬﺎﯾﺖ‬ ‫ﺑﺮاﺳﺎس‬ ‫ﻧﺘﯿﺠﻪ‬ ‫ﺗـﯽ‬ ‫ﺳﯽ‬ ‫اﺳـﮑﻦ‬ ‫ﺑﯿﻤـﺎران‬ ‫ﺑـﻪ‬ ‫دو‬ ‫ﮔﺮوه‬ ‫اﺻﻠﯽ‬ ‫ﺗﻘﺴﯿﻢ‬ ‫ﺷﺪﻧﺪ‬ : ‫ﮔﺮوه‬ ‫اول‬ ‫اﻓﺮادي‬ ‫ﺑﻮدﻧﺪ‬ ‫ﮐﻪ‬ ‫ﺳﻨﮓ‬ ‫ﺣﺎﻟـﺐ‬ ‫آﻧﻬـﺎ‬ ‫دﻓـﻊ‬ ‫ﺷـﺪه‬ ‫ﯾـﺎ‬ ‫ﺳـﻨﮓ‬ ‫ﺣﺎﻟـﺐ‬ ‫زﯾـﺮ‬ 5 ‫ﻣﯿﻠﯿﻤﺘﺮ‬ ‫داﺷﺘﻪ‬ ‫اﻟﻒ(‬ ‫)ﮔﺮوه‬ ‫اﻧﺪ‬ ‫و‬ ‫ﮔﺮوه‬ ‫دوم‬ ‫ﻧﯿﺰ‬ ‫ﺷﺎﻣﻞ‬ ‫اﻓﺮادي‬ ‫ﺑﻮدﻧﺪ‬ ‫ﮐﻪ‬ ‫ﺳﻨﮓ‬ ‫ﺣﺎﻟﺒﺸﺎن‬ ‫ﺑﺰرﮔﺘﺮ‬ ‫ﯾﺎ‬ ‫ﻣﺴـﺎوي‬ 5 ‫ﻣﯿﻠﯿﻤﺘﺮ‬ ‫ﺑﻮده‬ ‫ب(‬ ‫)ﮔﺮوه‬ ‫اﺳﺖ‬ ‫ﺟﺪول‬ 1 . ‫اﻧﺪازه‬ ‫ﺣﺴﺐ‬ ‫ﺑﺮ‬ ‫ﺑﯿﻤﺎران‬ ‫دﻣﻮﮔﺮاﻓﯿﮏ‬ ‫اﻃﻼﻋﺎت‬ ‫ﺑﻨﺪي‬ ‫ﺗﻘﺴﯿﻢ‬ ‫اﺳﮑﻦ‬ ‫ﺗﯽ‬ ‫ﺳﯽ‬ ‫در‬ ‫ﺳﻨﮓ‬ . ‫د‬ ‫ر‬ ‫راﺑﻄﻪ‬ ‫ﺑﺎ‬ ‫ﻣﺪت‬ ‫زﻣﺎن‬ ‫ﺷﺮوع‬ ‫درد،‬ ‫ﺑﯿﻤـﺎران‬ ‫از‬ mm 5 < mm 5 ≥ ‫ﻧﻈـﺮ‬ ‫زﻣﺎن‬ ‫ﺷﺮوع‬ ‫درد‬ ‫رﻧﺎل‬ ‫ﮐﻮﻟﯿـﮏ‬ ‫ﺑـﻪ‬ ‫دو‬ ‫دﺳـﺘﻪ‬ ‫ﺗﻘﺴـﯿﻢ‬ ‫ﺷﺪﻧﺪ‬ . ‫دﺳﺘﻪ‬ ‫اول‬ ‫ﺑﯿﻤﺎراﻧﯽ‬ ‫ﮐﻪ‬ ‫ﮐﻮﻟﯿﮏ‬ ‫ﮐﻠﯿـﻮي‬ ‫آﻧﻬـﺎ‬ ‫در‬ ‫ﮐﻤﺘﺮ‬ ‫از‬ 48 ‫ﺳﺎﻋﺖ‬ ‫ﮔﺬﺷﺘﻪ‬ ‫ﺷﺮوع‬ ‫ﺷﺪه‬ ‫ﺑـﻮد‬ ‫و‬ ‫ﺗﻌﺪاد‬ ‫ﻣﺮد‬ ‫ﺑﯿﻤﺎر‬ %) 65 ( 17 %) 71 ( 17 ‫زن‬ ‫ﺑﯿﻤﺎر‬ ‫ﺗﻌﺪاد‬ %) 35 ( 9 %) 29 ( 7 ‫)ﺳﺎل(‬ ‫ﺑﯿﻤﺎران‬ ‫ﺳﻦ‬ ‫ﻣﺘﻮﺳﻂ‬ 49 / 16 ± 81 / 43 84 / 14 ± 17 / 47 ‫ﻣﺘﻮﺳﻂ‬ BMI ) kg/m 2 ( 02 / 4 ± 78 / 25 82 / 4 ± 13 / 27 ‫دﺳـﺘﻪ‬ ‫دوم‬ ‫ﺑﯿﻤﺎراﻧﯽ‬ ‫ﮐﻪ‬ ‫از‬ ‫ﺷﺮوع‬ ‫ﮐﻮﻟﯿﮏ‬ ‫ﮐﻠﯿﻮﯾﺸـﺎن‬ ‫ﺣـﺪاﻗﻞ‬ 48 ‫ﺳﺎﻋﺖ‬ ‫ﮔﺬﺷﺘﻪ‬ ‫ﺑﻮد‬ . ‫ﺳﭙﺲ‬ ‫دو‬ ‫ﮔﺮوه‬ ‫اﺻﻠﯽ‬ ‫ﺑﺎ‬ ‫ﺟﺪول‬ 2 . ‫ﺑﻨﺪي‬ ‫ﺗﻘﺴﯿﻢ‬ ‫ادراري‬ ‫ﺳﻨﮓ‬ ‫ﻟﺤﺎظ‬ ‫از‬ ‫ﺑﯿﻤﺎران‬ ‫ﺳﺎﺑﻘﻪ‬ ‫و‬ ‫ﻋﻼﺋﻢ‬ ‫ﺑﺮ‬ ‫اﺳﮑﻦ‬ ‫ﺗﯽ‬ ‫ﺳﯽ‬ ‫در‬ ‫ﺳﻨﮓ‬ ‫اﻧﺪازه‬ ‫ﺣﺴﺐ‬ ‫ﻣﺪت‬ ‫زﻣﺎن‬ ‫ﺷﺮوع‬ ‫ﮐﻮﻟﯿﮏ‬ ‫ﮐﻠﯿﻮي‬ ‫ﺑﯿﻤﺎران‬ ‫ﻣﻘﺎﯾﺴﻪ‬ ‫ﮔﺮدﯾﺪ‬ mm 5 < mm 5 ≥ . ‫ﺟﻬـﺖ‬ ‫ﺗﺤﻠﯿـﻞ‬ ‫داده‬ ‫ﻫـﺎ‬ ‫از‬ ‫ﺑﺮﻧﺎﻣـﻪ‬ SPSS-22 ‫اﺳـﺘﻔﺎده‬ ‫ﮔﺮدﯾﺪ‬ . ‫داده‬ ‫ﺗﺤﻠﯿﻞ‬ ‫و‬ ‫ﺗﺠﺰﯾﻪ‬ ‫ﺟﻬﺖ‬ ‫ﻫـﺎ‬ ‫آزﻣـﻮن‬ ‫از‬ ‫ﻫـﺎ‬ ‫ي‬ ‫آﻣﺎري‬ ‫ﮐﺎي‬ ‫ﻣﺠﺬور‬ ‫و‬ ‫ﺗﯽ‬ ‫ﺷﺪ.‬ ‫اﺳﺘﻔﺎده‬ ‫اﺳﺮار‬ ‫ﺑﯿﻤﺎران‬ ً ‫ﮐﺎﻣﻼ‬ ‫ﻣﺤﻔﻮظ‬ ‫و‬ ‫ﺑﻮده‬ ‫ﺑﺠﺰ‬ ‫ﻣﺤﻘﻖ‬ ‫اﺻﻠﯽ‬ ‫ﮐﺴﯽ‬ ‫ﺑﻪ‬ ‫اﻃﻼﻋﺎت‬ ‫ﺟﺰﺋﯽ‬ ‫ﺑﯿﻤـﺎران‬ ‫دﺳﺘﺮﺳـ‬ ‫ﯽ‬ ‫و‬ ‫ﻧﺪاﺷـﺖ‬ ‫ﻣﻄﺎﻟﻌـﻪ‬ ‫اﯾـﻦ‬ ‫ﺟﻬـﺖ‬ ‫ﻣـﺎﻟﯽ‬ ‫ﮐﻨﻨـﺪه‬ ‫ﺣﻤﺎﯾـﺖ‬ ‫ﻧﻮﯾﺴﻨﺪﮔﺎن‬ ‫اﻧﺪ.‬ ‫ﻧﺪاﺷﺘﻪ‬ ‫ﯾ‬ ‫ﺎﻓﺘﻪ‬ ‫ﻫﺎ‬ ‫در‬ ‫ﻣﻄﺎﻟﻌﻪ‬ ‫ﺣﺎﺿﺮ،‬ ‫در‬ ‫ﻣﺠﻤﻮع‬ ‫ﺗﻌﺪاد‬ 50 ‫ﻧﻔﺮ‬ ‫ﺑﯿﻤﺎر‬ ‫ﮐـﻪ‬ ‫ﺑﺎ‬ ‫ﺷﮑﺎﯾﺖ‬ ‫رﻧﺎل‬ ‫ﮐﻮﻟﯿﮏ‬ ‫ﺑـﻪ‬ ‫ﺑﯿﻤﺎرﺳـﺘﺎن‬ ‫ﺷـﻬﯿﺪ‬ ‫ﻣـﺪرس‬ ‫ﻣﺮاﺟﻌـﻪ‬ ‫ﺗﻬـﺮان‬ ‫ﮐـﺮده‬ ‫ﺑﻮدﻧـﺪ‬ ‫ﻣـﻮرد‬ ‫ارزﯾـﺎﺑﯽ‬ ‫ﺳﻨﮓ‬ ‫ﻣﺜﺒﺖ‬ ‫ﺳﺎﺑﻘﻪ‬ %) 31 ( 8 %) 58 ( 14 ‫ﺳﻨﮓ‬ ‫ﻣﻨﻔﯽ‬ ‫ﺳﺎﺑﻘﻪ‬ %) 69 ( 18 %) 42 ( 10 ‫ﻣﺜﺒﺖ‬ ‫ﺳﺎﺑﻘﻪ‬ ‫دﻓﻊ‬ ‫ﺧﻮدﺑﺨﻮدي‬ ‫ﺳﻨﮓ‬ %) 27 ( 7 %) 46 ( 11 ‫ﻣﻨﻔﯽ‬ ‫ﺳﺎﺑﻘﻪ‬ ‫دﻓﻊ‬ ‫ﺧﻮدﺑﺨ‬ ‫ﻮدي‬ ‫ﺳﻨﮓ‬ %) 73 ( 19 %) 54 ( 13 ‫در‬ ‫درد‬ ‫ﺷﺮوع‬ 48 ‫اﺧﯿﺮ‬ ‫ﺳﺎﻋﺖ‬ %) 57 ( 15 %) 33 ( 8 ‫از‬ ‫ﺑﯿﺶ‬ ‫درد‬ ‫ﺷﺮوع‬ 48 ‫ﺳﺎﻋﺖ‬ %) 42 ( 11 %) 67 ( 16 ‫راﺳﺖ‬ ‫ﭘﻬﻠﻮي‬ ‫درد‬ %) 53 ( 14 %) 67 ( 16 ‫ﭼﭗ‬ ‫ﭘﻬﻠﻮي‬ ‫درد‬ %) 46 ( 12 %) 33 ( 8 ‫ادرار‬ ‫ﺗﺤﺮﯾﮑﯽ‬ ‫ﻋﻼﺋﻢ‬ ‫وﺟﻮد‬ %) 31 ( 8 %) 79 ( 19 ‫ﺗﺤﺮﯾﮑﯽ‬ ‫ﻋﻼﺋﻢ‬ ‫ﻧﺒﻮد‬ %) 69 ( 18 %) 20 ( 5 ‫وﺟ‬ ‫ﻫﻤﺎﭼﻮري‬ ‫ﻮد‬ %) 35 ( 9 %) 62 ( 15 ‫ﻫﻤﺎﭼﻮري‬ ‫ﻧﺒﻮد‬ %) 65 ( 17 %) 38 ( 9 ‫ﻫﯿﺪروﻧﻔﺮوز‬ ‫ﻧﺒﻮد‬ %) 50 ( 13 %) 21 ( 5 ‫ﺧﻔﯿﻒ‬ ‫ﻫﯿﺪروﻧﻔﺮوز‬ %) 42 ( 11 %) 46 ( 11 ‫ﺷﺪﯾﺪ‬ ‫ﺗﺎ‬ ‫ﻣﺘﻮﺳﻂ‬ ‫ﻫﯿﺪروﻧﻔﺮوز‬ %) 8 ( 2 %) 33 ( 8 ‫ﻗـﺮار‬ ‫ﮔﺮﻓﺘﻨﺪ‬ . ‫ﺗﻌﺪاد‬ 26 ‫ﻧﻔﺮ‬ ‫در‬ ‫ﮔـﺮوه‬ » ‫اﻟـﻒ‬ « ‫و‬ 24 ‫ﻧﻔـﺮ‬ ‫در‬ ‫ﮔﺮوه‬ » ‫ب‬ « ‫ﺟﺎي‬ ‫ﮔﺮﻓﺘﻨﺪ‬ . ‫در‬ ‫اﯾﻦ‬ ‫ﻣﯿﺎن‬ 34 ‫ﻣﻮرد‬ ) 68 % ( ‫را‬ ‫ﻣﺮدان‬ ‫و‬ 16 ‫ﻣﻮرد‬ ) 32 (% ‫را‬ ‫زﻧﺎن‬ ‫ﺗﺸﮑﯿﻞ‬ ‫ﻣﯽ‬ ‫دادﻧـﺪ‬ . ‫ﻣﯿﺎﻧﮕﯿﻦ‬ ‫ﺳﻨﯽ‬ ‫ﻫﻤـﻪ‬ ‫ﺑﯿﻤـﺎران‬ ‫ﺑﺮاﺑـﺮ‬ ‫ﺑـﺎ‬ 65 / 15 ± 42 / 45 ‫ﺑﻮد‬ ‫ﺳﺎل‬ . ‫ﻣﯿﺎﻧﮕﯿﻦ‬ ‫ﺳﻨﯽ‬ ‫ﻣﺮدان‬ ‫ﺑﺮاﺑﺮ‬ ‫ﺑﺎ‬ 82 / 13 ± 74 / 43 ‫ﺑﺎ‬ ‫ﺑﺮاﺑﺮ‬ ‫زﻧﺎن‬ ‫در‬ ‫و‬ ‫ﺳﺎل‬ 98 / 18 ± 49 ‫ﮐﻪ‬ ‫ﺑﻮد‬ ‫ﺳﺎل‬ ‫ﺗﻔﺎوت‬ ‫ﻣﻌﻨﯽ‬ ‫داري‬ ‫ﺑـﯿﻦ‬ ‫دو‬ ‫ﮔـﺮوه‬ ‫ﺑﺮﻗـﺮار‬ ‫ﻧﺒـﻮد‬ ) 075 / 0 = p ( . ‫اﻧـﺪازه‬ ‫ﻧﺴﺒﺖ‬ ‫ﺑﻪ‬ ‫ﺑﯿﻤﺎران‬ ‫دﻣﻮﮔﺮاﻓﯿﮏ‬ ‫اﻃﻼﻋﺎت‬ ‫ﺗﻮﺻﯿﻒ‬ ‫ﺟﺪول‬ ‫در‬ ‫ﺳﻨﮓ‬ 1 ‫اﺳﺖ‬ ‫ﺷﺪه‬ ‫ذﮐﺮ‬ . ‫ﺷﺪه‬ ‫اﻧﺠﺎم‬ ‫ﺑﺮرﺳﯽ‬ ‫ﻫﯿﭻ‬ ‫ارﺗﺒﺎﻃﯽ‬ ‫ﺑـﯿﻦ‬ ‫ﺟـﻨﺲ‬ ‫اﻓـﺮاد‬ ) 085 / 0 = p ( ، ‫ﻣﯿﺎﻧﮕﯿﻦ‬ ) ‫ﺳﻨﯽ‬ 095 / 0 = p ‫ﺗـﻮده‬ ‫ﺷﺎﺧﺺ‬ ‫و‬ ( ) ‫ﺑﺪﻧﯽ‬ 085 / 0 p= ( ‫ﺑﺎ‬ ‫وﺟﻮد‬ ‫و‬ ‫ﺳﺎﯾﺰ‬ ‫ﺳﻨﮓ‬ ‫ﺣﺎﻟـﺐ‬ ‫آﻧﻬـﺎ‬ ‫و‬ ‫ﻧﯿﺰ‬ ‫اﺣﺘﻤﺎل‬ ‫دﻓﻊ‬ ‫ﺷﺪن‬ ‫ﺧﻮد‬ ‫ﻧﺸﺪ‬ ‫ﻣﺸﺎﻫﺪه‬ ‫ﺳﻨﮓ‬ ‫ﺑﺨﻮدي‬ . ‫ﺟﺪول‬ ‫در‬ ‫ﺑﯿﻤﺎران‬ ‫ﺳﺎﺑﻘﻪ‬ ‫و‬ ‫ﻋﻼﺋﻢ‬ ‫ﺑﻪ‬ ‫ﻣﺮﺑﻮط‬ ‫اﻃﻼﻋﺎت‬ 2 ‫اﺳﺖ‬ ‫ﺷﺪه‬ ‫ذﮐﺮ‬ . ‫ﻣﻌﯿﺎر‬ ‫از‬ ‫ﻫﺎ‬ ‫ﻓﻮق‬ ‫ﺟﺪول‬ ‫ي‬ ‫ﻗﺒﻠـﯽ‬ ‫ﺳـﺎﺑﻘﻪ‬ ) ‫ادراري‬ ‫ﺳﻨﮓ‬ 05 / 0 p= ( ‫ﻣﻌﻨﯽ‬ ‫ﺗﻔﺎوت‬ ‫ﮔـﺮوه‬ ‫دو‬ ‫در‬ ‫دار‬ ‫داد‬ ‫ﻧﺸﺎن‬ ‫ﮐﻪ‬ ‫ﻧﺸﺎن‬ ‫دﻫﻨﺪه‬ ‫آن‬ ‫اﺳﺖ‬ ‫ﮐﻪ‬ ‫ﻋﻤﺪه‬ ‫ﺑﯿﻤﺎران‬ ‫رﻧﺎل‬ ‫ﮐﻮﻟﯿﮑﯽ‬ ‫ﮐﻪ‬ ‫ﺳﺎﺑﻘﻪ‬ ‫داﺷﺘﻦ‬ ‫ﺳﻨﮓ‬ ‫را‬ ‫ذﮐﺮ‬ ‫اﻧﺪ‬ ‫ﮐﺮده‬ ، ً ‫ﻣﻌﻤﻮﻻ‬ ‫ﺳﻨﮓ‬ ‫ﺑﺰرﮔﺘـﺮ‬ ‫از‬ 5 ‫ﻣﯿﻠﯿﻤﺘـﺮ‬ ‫و‬ ‫ﻏﯿﺮﻗﺎﺑـﻞ‬ ‫دﻓـﻊ‬ ‫دارﻧﺪ‬ . ‫ﭘﺲ‬ ‫ﻣﯽ‬ ‫ﺗﻮان‬ ‫ﻧﺘﯿﺠﻪ‬ ‫ﮔﺮﻓـﺖ‬ ‫ﮐـﻪ‬ ‫داﺷـﺘﻦ‬ ‫ﺳـﺎﺑﻘﻪ‬ ‫ﺳﻨﮓ‬ ‫ﺑﯿﺸﺘﺮ‬ ‫ﺑﻪ‬ ‫ﻧﻔ‬ ‫ﻊ‬ ‫داﺷﺘﻦ‬ ‫ﺳـﻨﮓ‬ ‫ﻫـﺎ‬ ‫ي‬ ‫ﺣﺎﻟـﺐ‬ ‫ﺑﺰرﮔﺘـﺮ‬ ‫ﺑﻮده،‬ ‫و‬ ‫ﻧﺪاﺷﺘﻦ‬ ‫ﺳﺎﺑﻘﻪ‬ ‫ﻗﺒﻠﯽ‬ ‫از‬ ‫ﺳﻨﮓ‬ ‫ﻫـﺎ‬ ‫ي‬ ‫ادراري‬ ‫ﻧﯿـﺰ‬ ‫ﺑﯿﺸﺘﺮ‬ ‫ﺑﻪ‬ ‫ﻧﻔﻊ‬ ‫ﺳﻨﮓ‬ ‫ﻫﺎ‬ ‫ي‬ ‫ﺣﺎﻟﺐ‬ ‫ﮐﻮﭼﮑﺘﺮ‬ ‫از‬ 5 ‫ﻣﯿﻠﯿﻤﺘـﺮ‬ ‫و‬ ‫ﻗﺎﺑﻞ‬ ‫دﻓﻊ‬ ‫ﻣﯽ‬ ‫ﺑﺎﺷﺪ‬ . ‫در‬ ‫راﺑﻄﻪ‬ ‫ﺑﺎ‬ ‫ﻣﺪت‬ ‫زﻣﺎن‬ ‫ﺷـﺮوع‬ ‫درد،‬ ‫اﺧـﺘﻼف‬ ‫ﻋﻠﯿـﺮﻏﻢ‬ ‫ﻧﺸﺎن‬ ‫ﮐﻪ‬ ‫اﻋﺪاد‬ ‫در‬ ‫ﻇﺎﻫﺮي‬ ‫ﻣﯽ‬ ‫دﻫﺪ‬ ‫ﻋﻤﺪه‬ ‫ﺑﯿﻤﺎراﻧﯽ‬ ‫ﮐﻪ‬

1Cross Sectional Study 2 Sequential
Alireza Lashay, Navid Masoumi, Mahdi Dehghani, Mobin Nakhaie
Studying the Predictability of the Presence of Ureteral Stones in Patients with Negative Sonographic Findings