サンゴ状結石の治療 : ESWL単独療法

Abstract

1)1988年11月から1992年6月までに当科で治療したサンゴ状結石41例44腎について検討した。2)治療法別の有効率はESWL単独(27腎)83.3%, PNL+ESWL(5腎)40%, 溶解療法+ESWL(6腎)100%, 腎盂切石術+ESWL(2腎)50%, 腎切石術+ESWL(1腎)100%, 溶解療法のみ(1腎)100%で, その他2腎には腎摘出術を行った。3)ESWL単独群で腎杯拡張のある完全サンゴ状結石3腎については入院日数73.7日, 有効率33.3%と成績不良であったが, 他は30～40日, 70～100%と良好な結果がえられた。4)ESWL単独療法における合併症はstone streetそのもの, もしくはこれによる発熱がほとんどで腎機能悪化症例はなく, poor risk患者にも安全に施行できる治療と考えられた

We investigated 41 cases (44 kidneys) of renal staghorn calculi treated in our hospital between November, 1988 and July, 1992. The efficacy of each treatment was 83.3% for extracorporeal shock-wave lithotripsy (ESWL) monotherapy (27 kidneys), 40% for percutaneous nephrolithotomy (PNL) with ESWL (5), 100% for dissolution with ESWL (6), 50% for pyelolithotomy with ESWL (2), 100% for nephrolithotomy with ESWL (1), and 100% for only dissolution (1). In the ESWL monotherapy group except for 3 cases that had complete staghorn calculi with severe caliectasis, the efficacy was between 70% and 100%, and the term of hospitalization was only about 1 month. The complications of ESWL monotherapy were stone street itself and high fever caused by it. However, renal function, could be successfully preserved by the timely drainage with D-J stent or nephrostomy tube. Thus, in most cases of staghorn calculi as well as other urolithiasis, ESWL monotherapy seemed to be more effective and safe than combined therapy of PNL and ESWL.