経皮的腎尿管結石摘出術243例の検討

Abstract

Between May, 1982 and April, 1987, upper urolithiasis of 247 kidneys of 243 patients, 174 male and 69 female, were treated by percutaneous nephrolithotomy (PNL). The main stone was successfully removed from 236 kidneys (about 95.5%). Seven cases of ureteral stone could not be removed by PNL, and were treated by traditional ureterolithotomy. In 3 cases of pelvic stone, the stone descended to the ureter during the PNL procedure, and was also removed by ureterolithotomy. In one case of pelvic stone, complete obstruction of uretero-pelvic junction after PNL occurred, and pyeloplasty was needed. One pelvic stone patient who had basical hypertension and arrhythmia died soon after PNL, because of acute myocardial infarction. Blood transfusion was needed in 31 cases (12.8%). The residual stones over 5 mm were noticed in 48 cases (20.3%). The most important point to succeed in PNL is to make a nephrostomy through the most suitable calyx to the stone. The easiest way to identify the location and connection of the aimed calyx with the stone in three dimensional position, is to take X-ray films in intravenous pyelograms not only from postero-anterior but also oblique positions. Additional transureteral lithotripsy (TUL) for the fragment descending to the ureter after PNL produces a much better result.