パルス波ダイレーザーによる経尿道的尿管砕石術の治療成績 : 初回治療とESWL後の二次的治療の比較検討

Abstract

極細硬性尿管鏡Micro 6及びパルス波ダイレーザー砕石装置Paltholithを用いてTULを施行した. 1)全対象例138例における成功率は82.6%であった. 2)TULを第一選択とした症例における成功率, 残石率はESWL後補助療法で施行された症例よりも良好な傾向にあり, efficiency quotientは0.75であった. 3)U2, U3の下部尿管における成功率はそれぞれ96.0%, 86.2%と良好な結果が得られた. 4)以上より, TULは, U2及びU3の下部尿管結石に対して第一選択治療となりうることが示唆された

Between September 1993 and December 1996, 138 patients underwent transurethral ureterolithotripsy (TUL) either as primary treatment or as a second-line therapy after extracorporeal shock wave lithotripsy. In all patients, a semirigid 6.0 F ureteroscope was used. Lithotripsy was performed using a pulsed-dye laser. The overall success rate was 82.6%. The success rates according to the location of stones were as follows, 76.9% for stones in the upper ureter (U1), 96.0% for those in the midureter (U2), and 86.2% for those in the distal ureter (U3). In 68 patients treated with TUL as primary therapy, the success rate was 88.2% and efficiency quotient, which was modified for TUL was 0.75. Complications were rare: no ureteral perforations and no major bleeding occurred, but urosepsis developed in 2 patients. In conclusion, transurethral ureterolithotripsy using a small caliber ureteroscope with pulsed-dye laser is recommended as the primary treatment for mid- and distal ureteral stones, because of its superior success rate. In addition, for upper ureteral stones, laser tripsy is recommended as a helpful auxiliary procedure.