経皮的腎尿管砕石術50例の検討

Abstract

経皮的腎尿管砕石術(PNL)を施行した50症例を検討した.年齢は25～82歳, 平均56.6歳, 男29例, 女21例であった.腎結石は38例, 尿管結石は12例であり, 結石個数は1～10個(平均1.5個, 中央値1個), 結石サイズはDS3が1例, DS4が22例, DS5が17例, DS6が10例であった.腎結石に対するPNL単独治療が19例, 体外衝撃波結石破砕術(ESWL)併用療法19例であった.尿管結石の12例はPNL単独が7例, ESWL併用は5例であった.治療3ヵ月後の評価は結石の完全摘出が45例(90%), 残石を5例(10%)認めた.術後入院期間は10日～86日, 平均30.3日であった.合併症として腎盂穿孔1例と術後38℃以上の発熱を16例に認めたが, 重篤な合併症は認めなかった.これらのことから, PNLは腎尿管結石の治療として, 安全で有効な治療法であると考えられた

Percutaneous nephroureteral lithotripsy (PNL) was conducted in 50 patients with renal or ureteral calculi between March 2000 and August 2002. The mean age of patients was 56.6 years (range 25-82 years) and they included 29 males (58.0%) and 21 females (42.0%). The calculi were renal calculi in 38 patients (76.0%) and ureteral calculi in 12 patients (24.0%). The mean number of calculi was 1.5 (1-10 calculi, median number 1). The mean of the maximum calcule diameter was 30.9 mm (15.0-83.0 mm) for the renal calculi and 17.4 mm (8.0-27.0 mm for the ureteral calculi. The lithotripsy device was an ultrasonic lithotriptor (ALOKA) or Lithoclast (SWISS), as appropriate, and was used with a 24 Fr rigid endoscope (TAKEI). All operations were performed under lumbar spinal anesthesia. Eighteen of the 38 renal calculus patients were treated with PNL alone. In the other 19 PNL was combined with postoperative extracorporeal shock wave lithotripsy (ESWL). Seven of the 12 patients with ureteral calculi were treated with PNL alone, and 5 with PNL combined with postoperative ESWL. After 3 months, the treatment results were Tx(3)-0 in 45 patients (90.0%), and Tx(3)-2 in 5 patients (10.0%). The mean period of postoperative hospitalization was 30.3 days (10-86 days), with a median of 26 days. Complications were renal pelvis perforation in 1 patients and fever of 38.0 degrees C or above in 16 patients, but there was no hemorrhaging that required transfusion or other serious complications. PNL is a safe and reliable treatment method, and should be considered as a treatment option in cases of large calculi when a short treatment period is desired.