手術用軟性腎尿管鏡による腎孟および上部尿管結石の摘出

Abstract

1)尿管結石の摘出など上部尿路病変の内視鏡的手術のため手術用軟性腎尿管鏡を開発した.2) 7症例の上部尿管結石, 2症例の腎盂, 腎杯結石でolive tip dilator, balloon dilator, Teflon dilatorを用い, 尿管を拡張したところ, 全例で手術用軟性尿管鏡を挿入し得, 結石がよく観察された.3)しかし, 結石を摘出し得たのは5例だけであった.4)現段階での本内視鏡の適応は径1.0 cm以下の上部尿管及び腎盂, 腎杯結石といえよう

Two types of operative fiberoptic nephroureteroscopes were developed with the cooperation of the Olympus Optical Company mainly to remove the upper urinary tract calculi. Removal of the renal and upper ureteral stones was attempted in nine cases. The ureter was dilated with olive tip, balloon and Teflon dilators alone or in combination. The combination of balloon and Teflon dilators seemed the most promising. As a result of ureteral dilation, operative fiberoptic nephroureteroscopes, 4.5 mm and 3.5 mm in diameter, could be passed into the ureter in all the cases and the stones could be visualized clearly. Four of the 7 upper ureteral stones and 1 of the 2 pelvic stones could be removed. The success ratio was 56%. The method of stone removal still requires improvement. At present, application of the operative fiberoptic nephroureteroscope is indicated for upper ureteral and renal stones less than 1.0 cm in diameter. With the improved techniques of stone removal using this fiberscope, the indications of extracorporeal shock-wave lithotripsy or percutaneous nephrolithotripsy will probably be greatly reduced in the near future.