結石内細菌のESWL治療におよぼす影響

Abstract

ESWL治療を行い, 結石成分の分析に加え結石内細菌の有無も検索しえた26例の, いわゆる"非感染結石"を有する上部尿路結石症患者のうち, 5例で結石内細菌が陽性を示した.結石内細菌陽性のために, ESWL治療後重篤な感染症の合併をみた症例はなかったが, 結石内細菌陽性群では治療後1日目に体温の有意な上昇が認められたことなどより, 尿路粘膜の浮腫やSteinstrasseなどにより, ESWL治療後に尿路の閉塞が持続した場合などには特に, 結石内細菌がESWL治療後の感染症合併の危険因子となりうる可能性がある

On 26 patients with upper urinary stones treated by extracorporeal shock wave lithotripsy (ESWL), the influences of the bacteria within the stones on the inflammatory complications, especially on urinary tract infection, after the ESWL treatment, were studied. The constituents of the stones obtained from these 26 patients consisted of the mixed stone of calcium oxalate and calcium phosphate (10 patients), calcium oxalate alone (2 patients), calcium phosphate alone (1 patient) and uric acid (1 patient). Of these 26 stones including no infection stones such as struvite and carbonate apatite, 5 stones (19.2%) had bacteria within the stone. Although no patients had severe inflammatory complications after ESWL treatments, the fact that the patient group having bacteria within the stones had a significantly elevated body temperature at one day after ESWL treatment compared to that on the preoperative day (P < 0.01) suggests that we should take into consideration the bacteria within non-infection stones as one of the risk factors of inflammatory complications after ESWL treatment.