腎サンゴ状結石における腎機能からみた治療方針

Abstract

1) 1976年より1984年までの珊瑚状結石84腎につきTc-DMSA腎シンチグラフィーにて評価をおこなった.2)術前の摂取率では腎保存手術群の間には差は認められないが, 腎保存群の平均摂取率が19.4%前後に対し, 腎摘症例群では9.2%と有意に低値を示した.3)腎機能の術前後の平均低下率は腎盂切石術で3.5%, 腎切石と併用した腎盂切石術で8.4%, 腎切石術で11%, 腎部分切除術では35%であった.術後の腎機能改善症例は, 腎盂切石術の3例と腎阻血をおこなっていない腎切石の1例のみであった.4)患側腎の腎機能が術前低下しているものほど術後の腎機能低下度が強い可能性があること, および非手術症例の一部は長期間の観察でも腎機能低下が予想より軽度であるということに留意する

From 1976 through 1984, 94 staghorn calculi of 86 patients were treated in this department. Kidney function was assessed by Tc-DMSA renal scintigraphy consisting of renal cortical imaging and DMSA renal uptake rate, in 84 kidneys preoperatively and 43 kidneys pre- and postoperatively. There was an increase in the postoperative DMSA renal uptake in the operated kidney, in 3 out of 14 kidneys in which pyelolithotomy was performed and in one out of 10 kidneys in which nephrolithotomy was done. It was still impossible to answer the question of which mode of operation should be chosen only from consideration of kidney function study. But it was suggested by the statistical investigation that nephrectomy seemed to be selected in the case of severely decreased renal function. It was reasonable that pyelolithotomy was the best method from the point of predicting the postoperative recovery of renal function. But in the near future, advances in endoscopical stone surgery and extracorporeal procedures, might reduce the damage of the renal function caused by conventional stone surgery.