体外衝撃波による腎,尿管結石破砕術の臨床経験 第3報: 完全鋳型結石症59例(64腎結石)の治療経験

Abstract

1) ESWL(体外衝撃波腎結石破砕機)による治療が最も困難であるとされている完全鋳型結石64例につき, 2) ESWL単独療法は30例(46.8%)であり, 他の34例(53.2%)では補助的な操作が必要であった.3) ESWL治療後, 44例(68.7%)に疼痛および発熱が認められたが, 化学療法および補助的処置(尿管口切開・UUL・PNS)で改善した.4) 12週間以上の経過観察では97.4%が著効と考えられた.5)当院における完全鋳型結石の治療方針はi)腎杯の拡張および尿路の狭窄がない者にはESWL単独療法を, ii) obstructive pyelonephritisを併発し化学療法のみで改善しないものには補助的療法(PNS・UUL・etc)を, iii)腎杯の拡張例, 狭窄例, 尿路変更例, 単腎症例に対してはcombined treatmentを行う

This report describes the treatment of 64 cases of complete staghorn calculi using extracorporeal shock wave lithotripsy (ESWL). Thirty cases (46.8%) were successfully treated using ESWL monotherapy and the rest of the cases (53.2%) required ESWL combined with an auxiliary procedure. Forty-four of the cases (68.7%) had symptoms such as fever and pain after ESWL. These cases were treated with chemotherapeutic agents and an auxiliary procedure. X-ray examination showed that the result of ESWL treatment was satisfactory in 97.4% of the 34 cases followed up for more than 12 weeks after ESWL. Based on the results of this study, the following plan of treatment for complete staghorn calculi has been adopted in our hospital. ESWL monotherapy is performed in cases without a dilated collecting system or stricture. ESWL combined with an auxiliary procedure is performed in cases with a dilated collecting system, stricture, ileal conduit and solitary kidney.