リソスターを用いたESWL単独療法の経験 : 衝撃波ヘッド(Standard-tubeとC-tube)による治療成績の比較

Abstract

ESWL単独療法を行った症例を対象としてstandard-tubeとC-tubeの臨床成績を比較検討した. 1)全ての結石の大きさと位置で完全排石率と臨床的成功率ともC-tubeがstandard-tubeに比し良好な成績を示した. 2)長径30mmを超える大きな結石に対しては, ESWLのみでいたずらに衝撃波数を増すことなく, 内視鏡的処置を積極的に併用する必要がある. 3)砕石強度決定のおもなlimited factorは疼痛であり, ESWL装置の能力を十分に発揮させるためには確実な疼痛対策が必要である

Between October 1990 and April 1996, we treated 892 upper urinary tract stones with ESWL therapy using Lithostar (Siemens Medizinische Technik, Erlangen, Germany). In March 1993, the coupling head of lithotriptor was upgraded from "standard-tube" to "C-tube". The C-tube has approximately two times or more destructive energy and intensity than the standard-tube. In this study, we analyzed the clinical results according to type of coupling head in 713 cases treated by ESWL monotherapy and evaluated 3 months after the initial treatment. The overall success rate at 3 months after ESWL was 85% in the standard-tube cases and 93% in the C-tube cases; the stone-free rate was 72% and 82%, respectively. There were no cases in which had to be discontinued due to ESWL severe side effects. However, in 66.1% of the C-tube cases and 31.1% of the standard-tube cases, a sufficient destructive intensity could not be used because of pain. Within a group that received sufficient destructive intensity, the C-tube was able to reduce both duration of the procedure and the number of shots to two thirds of that of the standard-tube.