腎盂尿管移行部狭窄症に対するエンドパイロトミー施行前腎機能と術後腎機能の回復

Abstract

腎機能とその予後を患側が低腎機能である症例を対象として検討した.症例が少なくはっきりとは言えないが, 分腎のクレアチニンクリアランスで20ml/min以下の腎臓では水腎の改善がみられない可能性が高いと示唆された

Between July 1988 and February 1998, we treated 132 patients with 133 procedures of endopyeloureterotomy via the transpelvic extraureteral approach and followed them up for more than one year. Of 9 unsuccessful cases, 4 were confirmed to have the patency of the stenotic segment on retrograde pyeloureterograms. We compared these 4 cases with another 4 cases which were subsequently treated successfully despite poor renal function. Pre- and post-operative changes in renal function in 8 cases with unilateral hydronephrosis due to ureteropelvic junction obstruction were studied based on 99mTc-DMSA renal uptake rate and creatinine clearance. In successful cases, DMSA renal uptake rates compared with the healthy side were 9% to 59%. Unilateral creatinine clearance was 6 to 34 ml/min. All cases were improved slightly in renal function. In unsuccessful cases, DMSA the renal uptake rate was 2% to 89% and creatinine clearance 10 to 16 ml/min. No improvement in renal function was noted. Patients with differential renal function of less than 20 ml/min would thus appear to have little chance of postoperative improvement of differential function.