Dornier MFL5000を用いた上部尿路結石に対する体外衝撃波結石破砕術単独療法

Abstract

上部尿路結石345例(腎結石188例, 尿管結石157例)にESWL単独療法を施行した。治療終了から3ヵ月後の完全排石率は腎結石60.5%, 尿管結石89.4%で, 完全排石と4mm以下の残石を合わせた有効率は腎結石86.4%, 尿管結石93.6%であった。全体では, 完全排石率74.7%, 有効率89.9%となった。サンゴ状結石では, 治療回数, 総衝撃波数ともに多くなり, 全治療期間は長くなるが, ESWL単独療法で良好な成績がえられた。尿管嵌頓結石もESWL単独で満足できる砕石効果がえられるが, 破砕片が尿管粘膜に包埋されている症例ではTULや尿管切石術が必要であった

A total of 345 cases of upper urinary tract stones (188 renal and 157 ureteral stones) were treated by extracorporeal shock wave lithotripsy (ESWL) monotherapy using the Dornier lithotriptor MFL5000. Of these cases 294 (85.2%) had stones less than 20 mm in length. A double-J ureteral stent was placed in 40 cases of renal stones and 8 ureteral stones due to large stone burden or failure of in situ ESWL for impacted stones. Epidural or spinal anesthesia was necessary in 32 cases to maximize the generator voltage or to prevent intractable pain. The number of ESWL sessions and shock waves increased in accordance with the stone size, with an average of 1.6 and 4442, respectively. Multiple sessions were required in 68 cases of renal stones (36.2%) and 59 of ureteral stones (37.6%). With a 3-month follow-up, the stone-free rate was 60.5% for renal stones and 89.4% for ureteral stones, with the overall stone-free rate of 74.7%. Including the cases with residual fragments less than 4 mm, ESWL monotherapy was successful for 86.4% of renal stones and 93.6% of ureteral stones, achieving the overall success rate of 89.9%. No serious complications related to ESWL were observed. Four cases of impacted ureteral stones underwent ureteroscopic extraction or open ureterolithotomy for fragment removal. ESWL monotherapy using the Dornier MFL5000 is an effective and noninvasive method of treating upper urinary tract stones. Satisfactory fragmentation and clearance can be achieved with multiple sessions even for large or impacted stones, but alternative procedures may be necessary to salvage fragments of impacted stones.