爆薬を用いた体外衝撃波結石破砕法の臨床経験

Abstract

1987年3月10日より5月28日までに46症例, 66回のEMLを施行したのでその治療成績より臨床的検討を行った.EMLは, 1)無麻酔でできる非観血的手術である.2)再手術例や外科的手術で問題のある全身疾患を有する人でも可能なことが多い.3)特に術前・術後の併用処置を必要としないため外来でも治療が受けられると考える

A total of 46 cases underwent 66 treatments with extracorporeal microexplosive lithotripsy (EML) for upper urinary tract calculi between March 10, 1987 and May 28, 1987. The efficacy of EML therapy was investigated in all cases over 3 months. The lithotripter of EML made by the Yachiyoda Co. Ltd (SZ-1) was adapted to a microexplosion (10 mg silver azide) as the source of energy for underwater shock wave generation. Fifteen cases (32.6%) had a history of previous open lithotomy of the same upper urinary tract as being treated by EML. Pre-treatments with ureteral catheters and ureteral stents were performed in 4 and 4 cases (8.7% and 8.7%), respectively. The microexplosions were conducted in syncronization with patient exhalation from 100 to 400 times during 1 session, depending upon the size of the stone. The patients felt pressure only on their back at the pulse of explosion and complained occasionally a dull pain, but this pain was mild and tolerable, and no patients required anesthesia. When stone disintegration was judged to be unsatisfactory, that is the stone remained unfragment or the size of the residual stone fragments was greater than 5 mm., an additional session was performed, usually 1 week after the previous session. On the X-ray film obtained three months after EML treatment, 26 cases (57%) were completely free from stone concerments, 17 cases (37%) had stone fragments of equal to or less than 5 mm and 3 cases (6%) had ones of greater than 5 mm. Treatment of EML alone was performed in 44 cases (96%), while 2 cases (4%) required transurethral stone manipulation following EML.(ABSTRACT TRUNCATED AT 250 WORDS)