上部尿路結石症の検討 第1報 : 腎結石手術および残石に関して

Abstract

Clinical studies were done on 63 patients who had renal stones and who had undergone surgery at the Tsukuba University Hospital from 1977 to 1981. Nearly all patients were residents in the southern part of Ibaraki Prefecture. 1) Sixty-six surgeries were done on 63 patients. Patients' ages ranged from 17 to 74 years old with female to male ratio being 2 to 1. 2) Intraoperative adjuvant techniques recently advocated by some authors were not used in nearly all the surgeries. Modes of surgeries were extended pyelolithotomy (36.4%), partial nephrectomy (21.2%), pyelolithotomy (16.7%), nephrolithotomy (7.6%) and nephrectomy (7.6 %) in order of decreasing frequency. 3) Average blood losses during surgery were 239.1 ml in extended pyelolithotomy, 186.1 ml in partial nephrectomy, 324.0 ml in pyelolithotomy and 454.6 ml in nephrolithotomy. Intraoperative blood replacements were made in 4 patients corresponding to 6.1 % of all surgeries. 4) Components of renal stones frequently seen were CaOx and CaP mixed stones (40.0%), CaOx stones (37.1%), and CaP stones (11.4%) in male patients and CaP stones (35.0%), CaOx and CaP mixed stones (30.0%) and CaOx stones (20.0%) in female patients. 5) Immediate postoperative pseudo-recurrences were seen in II renal units (16.7%). Spontaneous passages of the residual stones were seen in 4 renal units during the followup period. True recurrence was seen in one renal unit (1.5%) one year after surgery. 6) Study of the relationship between the type of pyelogram and the incidence of pseudo-recurrence revealed that the calyceal dilatation with narrowing of calyceal infundibula rather than the dilatation of the renal pelvis was closely related to the frequency of the postoperative pseudo-recurrence. The presence of stones in both the renal pelvis and calyx (or calyces) rather than in the renal pelvis alone was more closely related to the incidence of the postoperative pseudo-recurrence.