経皮的腎尿管結石摘出(PNL)の成績

Abstract

1984年9月より1987年10月までに金沢大学医学部附属病院泌尿器科を受診した腎, 尿管結石患者104例にPNLを施行した.方法はKorthに直接指導を受けた方法に準じ, より簡便に, より低コストにてPNLを施行することを目標にした.104例中内視鏡的にもX線学的にも結石が完全に摘出しえた症例は52例(50%)であり, X線学的に直径5 mm以下までの結石破片の残石が認められたものの水腎症や疼痛が改善された症例は44例(42.3%)と臨床的には96例(92.3%)に成功であった.8例には結石を摘出できずに切石術を施行した.副作用として発熱は12例(11.5%)に, 出血は5例に認められ, 2例に輸血を必要とした.1例には胸水が認められ胸水穿刺を必要とした

One hundred and four consecutive patients with renal and/or ureteral calculi, 66 males and 38 females with an average age of 44.3 years ranging from 17 to 83, were treated by a percutaneous procedure between September, 1984 and October, 1987. In an early series of 6 patients, a two-stage procedure consisting of temporary renal drainage and the introduction of an endoscope a few days later was employed. The remaining 98 patients received a so-called one-stage procedure. The stone was removed successfully in 96 patients with an average operation time of 140 minutes. In 2 of the 96 patients, renal stones recurred 7 months and 20 months later. The most common cause for failure in stone removal was the difficulty of engaging calyceal stones and ureteral stones using a basket and/or 3-prong grasper, because of inflammatory mucosa adhering to the stones. Out of 8 failures, 7 and 1 required an open operation and trans-urethral intervention, respectively. There were 40 complications in 33 patients. Of 11 patients in whom renal pelvic perforation occurred, 2 required open surgical repair. Of 5 patients complaining of renal bleeding, 1 required renal artery embolization. With increasing experience and improving procedure, most renal, and upper and mid ureteral stones have been safely and successfully removed percutaneously.