SIEMENS Lithostar Multilineによる上部尿路結石の治療成績および前機種Lithostarとの比較  [in Japanese] TREATMENT OF UPPER URINARY TRACT CALCULI USING SIEMENS LITHOSTAR MULTILINE, AND COMPARISON WITH PREVIOUS MACHINE : LITHOSTAR  [in Japanese]

(目的)電磁誘導方式でX線照準であるESWL新旧2機種による治療効果や透視時間,疼痛の違いを評価し,新機種の有用性を解析するとともに,ESWL機として望まれる要素を検討する.(対象と方法)Siemens社Lithostarにて2,985結石(L部:腎691,尿管2,294), Lithostar Multilineにて639結石(M部:腎153,尿管486)の治療を行った.3ヵ月後までに完全排石または残石4mm以下となったものを「有効」と定義し有効率を算出した.(結果)外来のみで行ったものはL:2,547例(85.3%),M:608例(95.1%)であった.尿管結石の有効率はL:92.2‰M:82.7%,腎尿管合計の有効率はL:89.6‰M:81.4%とL部で有効率が有意に高かった.尿管結石では,LM両部において,U1に比べU3で有効率が高かった.尿管結石の平均治療回数はL:1.62回,M:1.64回とL部で回数が少なかった.腎結石の有効率はL:81.0%, M:77.1%と差がなかった.透視時間はU2を除きすべての区分で短縮され,腎尿管合計の平均ではL:3.67分,M:2.76分であった.鎮痛剤が必要であったのはL:50.8‰M:腿7%でM部で滅少した.(結論)Multilineでは有効率こそ前機種を上回らなかったが,透視時間が短縮し鎮痛剤の頻度も減少した.Endourologyの十分なバックアップを前提条件に,Multilineは外来治療として十分に簡便・安全であり一定の有用性が確認された.

(Purpose) We compared the efficacy, safety and conveniency of previous and present lithotriptors for the treatment of upper urinary tract calculi. (Patients and method) 691 patients with renal calculi and 2,294 patients with ureteral calculi were treated using a 2nd generation electromagnetic fluoroscopic guided lithotriptor, the Lithostar (L group), and 153 with renal calculi and 486 with ureteral calculi were treated using a 3rd generation lithotriptor, the Lithostar Multiline (M group). The success rates, defined as stone-free or residual fragments that were 4 mm or less on three months later, were calculated and compared. (Results) The percentage of outpatient were 85.3% (L) and 95.1% (M). The success rates of the L group for the overall and the ureteral calculi patients were indicated significantly better than the M group (89.6% vs 81.4%, 92.2% vs 82.7%, respectively). Mean number of treatment of the L group (1.62) for the ureteral calculi were significantly less than the M group (1.64). For the renal calculi, no significance of the success rates were observed (L : 81.0% vs M : 77.1%). Mean fluoroscopy time of the M group (2.8 min.) were significantly shorter than the L group (3.7 min). Less percentage of pentazocine required in the M group (34.7%) than in the L group (50.8%). (Conclusion) This study shows that the success rate of the Multiline does not exceed the previous machine, however, the Multiline achieved shorter fluoroscopy time and decreased rate of adapting analgesia. The Lithostar Multiline is useful, safe and convenient on an outpatient basis.