単一結石に対するESWLの治療成績2 : 尿管結石に対するカテーテル使用の有用性について

Abstract

過去5年間にDornier社腎結石破砕装置HMIIIを用いてESWLを施行し, 追跡可能であった1, 200例の単一結石について検討した.1)長径20 mm以下の結石については, 腎盂・腎杯部で最も成績がよく84%の成功率をえた.成績不良部位は尿管で62%の成功率であった.2)尿管結石について検討するとin situ症例と尿管カテーテル使用症例の間には成績上, 差はないが, D-Jカテーテル留置症例では10 mmより大きな結石でin situ症例および尿管カテーテル使用症例に比し, 有意に成績は良かった.3)術前IV

We performed extracorporeal shock-wave lithotripsy (ESWL) on 1, 701 patients in a total of 2, 438 sessions using the Dornier kidney lithotriptor Model HM III from July 1985 to the end of June 1990. Among the patients with a solitary stone, 1, 200 cases were available for the follow-up study in which the results of ESWL were analyzed according to the location and size of the stone. ESWL performed against stones at pelvis and calyces gave the best results. The results obtained on stones less than 20 mm in diameter were especially favorable with a success rate of 84%. ESWL performed against ureter stones showed poor results with a success rate of 62% for the stones smaller than 20 mm in diameter. We further studied the results of ESWL performed against ureter stones by dividing the patients into three groups: the patients treated in situ, the patients with ureteral stents and the patients with D-J stents. The results for stones larger than 10 mm in diameter were significantly better in the patients with D-J stents than in the patients treated in situ or the patients with ureteral stents. Among the patients treated in situ, the results were significantly worse for impacted stones than for non-impacted stones when the stone size was 10-20 mm in diameter.