長径10mm以上の下部尿管結石に対する体外衝撃波砕石術(ESWL)の治療成績の検討

Abstract

過去10年間に体外衝撃波砕石術(ESWL)を施行した10mm以上の下部尿管結石101症例(103結石)の治療成績を検討した.治療装置はSiemens社製Lithostarを使用した.103結石のうち101結石が1回～12回のESWL単独治療で完全排石できた.排石率は98%であり, 治療開始から3ヵ月時のstone-free rateは95.1%であった.砕石不成功は2例で, 結石と尿管粘膜とに強い癒着を認め, 切石術を施行した.副作用としては, ほぼ全例で肉眼的血尿を認めた.治療時の疼痛は鎮静剤の使用で対応可能であった.他に2例で術後腎盂腎炎を認めたが, 保存的加療で改善した

Optimal treatment for distal ureteral stones remains controversial. During a period of 10 years, from December 1992 to December 2002, 103 distal ureteral stones larger than 10 mm in diameter were treated at our institution with extracorporeal shock wave lithotripsy (ESWL) using the Siemens Lithostar. Only 2 patients had a ureteral stent in place at the time of treatment. The overall stone-free rate was 98% with 1-12 session and 3-month stone-free rate was 95.1%. These data reveal that a high success rate was achieved in multisession ESWL. Therefore, ESWL is considered to be acceptable as first-line therapy for fragmentation of distal ureteral stones larger than 10 mm in diameter.