サンゴ状結石の治療 : Combined therapyと結石再発について

Abstract

'86年4月より'92年9月までに29の広範なサンゴ状結石を24例の患者に治療したが, 体外衝撃波砕石術(ESWL)が11例, ESWL先行経皮腎砕石術(PNL)が7例, PNL先行ESWLが11例であった。その結果ESWL単独では腎杯の拡張のない場合でも1年後の完全排石率は22.4%と低率で, PNL先行療法では4mm以下の自力排出可能のものを含むと19/11例に排出に成功し, また治療期間も短く, 感染も少ない。腎杯の拡張した大きなサンゴ状結石にはPNL先行療法が積極的に行われるべきことを述べた

Between April 1986 and September 1992, 29 extensive staghorn calculi were treated in 24 patients. Treatment was with extracorporeal shock-wave lithotripsy (ESWL) monotherapy in 11, initial ESWL followed by percutaneous nephrolithotomy (PNL) in 7 and initial PNL followed by ESWL in 11. A comparison based on treatment demonstrated that initial PNL followed by ESWL resulted in a lower rate and shorter duration of the "stone street" while stone-free rate at 1 year after the last treatment, recurrence rate, residual stone-growth rate and other complication rates were similar. Initial PNL followed by ESWL should be considered the efficacious treatment option, especially for patients with extensive traghorn calculi.