体外衝撃波による腎尿管結石破砕術(ExtracorporealShock-wave Lithotripsy:ESWL)の臨床的検討 第1報:ESWL 1,000例の治療成績

Abstract

1985年4月以降約2年間に, 1, 000名の腎尿管結石患者に対してESWLを行った.1)腎内小結石に対しては, ESWL単独療法を行い, 大結石や尿管結石に対しては, PNSやPNL, TULダブルJカテーテル留置といった内泌尿器的治療(endourology)を併用した.2)退院時の完全排石率は16%であったが, 3ヵ月以上経過すると, 58.4%が完全排石しており, 残石僅かな者を含めると84.2%がほぼ満足すべき状態であった.3)大きい合併症として, 脊損患者の自立神経過反射に伴う脳出血1例をみたが, 概して合併症や副作用の頻度は低く, 治療後の苦痛も軽度であった.4)今後腎尿管結石の手術的治療は, ESWLを中心に行われるものと思われるが, stone streetの処置や残石の経過観察, ならびに晩期合併症への対応が重要である

Between April, 1985 and May, 1987, we experienced 1, 000 cases of extracorporeal shock-wave lithotripsy (ESWL) using a Dornier HM3. In the treatment of smaller stones, no auxiliary treatment was required. On the other hand, endourological treatments such as percutaneous nephrostomy, percutaneous nephroureterolithotomy, transurethral ureterolithotripsy or double J catheterization were combined in the treatment of larger stones. Sixteen percent of the cases were stone-free at the time of discharge from hospital but after more than 3 months 58.4% were stone-free, and including cases with insignificant residual fragments, the outcome was good in 84.2%. As major complications, cerebral bleeding due to autonomic nerve hyperreflexia was observed in one spinal cord injury patient, but generally speaking, the frequency of complications after ESWL was lower than after open surgery and the post ESWL period was rather comfortable for the patient. Surgical therapy for renal and ureteral stones will be performed mainly by ESWL. Manipulations of post-ESWL stone street or residual fragments are important, and detection of late complications is also important.