尿管結石に対する体外衝撃波結石破砕術不成功例の検討

Abstract

1997年1月から2年間に尿管結石に対してin situ ESWLで治療を開始した388例を対象にESWL不成功についての予測因子を検討した.ESWL有効群(317例)と無効群(71例)にロジスティック回帰分析による多変量解析を行ったところ, 1)中下部尿管結石, 2)結石の大きさ9mm以上, 3)中等度以上の水腎症及び 4)初回ESWL無効が予測因子として有意であった.1)～4)の全ての予測因子を満たす場合, 85.0%と高い確率でESWL不成功が見込まれた.これらの予測因子は, 治療方針についての患者の意思決定のための臨床的根拠として有用になると考えられた

In this study, we attempted to determine which patients with ureteral calculi are likely to have an unsuccessful outcome for extracorporeal shock wave lithotripsy (ESWL). The records of 388 patients with ureteral calculi treated with ESWL at Ijinkai Takeda General Hospital between January 1997 and December 1998 were retrospectively reviewed. Three hundred seventeen patients had been treated with ESWL alone (single session 156, multiple sessions 161) and 71 with transurethral ureterolithotripsy (TUL) due to failure of ESWL. We compared these two groups by multivariate logistic regression analysis, which revealed that (1) middle and lower ureteral calculi, (2) stones > 8 mm, (3) moderate to severe hydronephrosis and (4) failure of the first session ESWL were factors associated with poor outcome of ESWL. Although each predictive value of these factors was relatively low (29.6-38.6%), the rate of failure of ESWL was 85.0% when patients had all four factors. We therefore recommend an early change in treatment modality to TUL for patients with ureteral calculi when all four risk factors listed above are present.