サンゴ状腎結石の治療経験 : ESWL単独治療の成績とその問題点について

Abstract

珊瑚状結石107例をESWL単独で治療したが, 4mm未満の結石サイズにまでした成功例は73例(68%)で, 不成功例は34例(37%)であった。結石別ではcalcium phsophate, calcium oxalate, magnesium ammonium phosphate, cytine, uric acidでそれぞれ34, 29, 38, 60, 75%であった。また120結石の珊瑚状結石に対する治療では腎瘻, TUL, 尿管ステントなどの補助療法が効果あった。治療期間は手術では1日であるが, ESWLでは平均18ヵ月, 治療費も手術より多かった。以上の事実はESWL単独治療の問題点を浮きぼりにした

We evaluated retrospectively 107 patients with staghorn calculi who underwent extracorporeal shock wave lithotripsy (ESWL) monotherapy from 1985 to 1990. The 107 patients consisted of 65 complete staghorn calculi and 55 partial staghorn calculi. Staghorn calculi required an average of 4.3 treatment sessions. Using a Dornier HM3 lithotriptor, the stone-free rate was 33% in patients with complete staghorn calculi, and 35% in patients with partial calculi. For stone evacuation following ESWL procedure, ureteral stenting, nephrostomy and transurethral lithotripsy were necessary. Four of the 21 patients who underwent ESWL monotherapy and were available for long-term followup showed stone growth, while all of the 10 patients who underwent open surgery during the previous 5 years became stone free. The average period of hospitalization and cost were 38.3 days and 700, 000 yen in patients who had received open surgery, and 25.8 and 1, 720, 000 yen in patients receiving ESWL monotherapy. In conclusion, ESWL monotherapy is useful, and if patients require complete removal of all stone fragments, a percutaneous lithotripsy should be performed following ESWL monotherapy.