Hirao Y, Ozono S, Okamoto S, Moriya A, Nakatsuji F, Okajima E, Hiramatsu T, Yoshida K, Yamada K, Ikuma S
Department of Urology, Nara Medical University.
Hinyokika Kiyo. 1989 Dec;35(12):2077-86.
Three hundred seventy cases with calculi in upper urinary tract were treated by endourology, 210 cases were subjects of percutaneous nephrolithotripsy (PNL) and 160 cases of transurethral ureterolithotripsy (TUL), in Nara Medical University Hospital and 13 affiliated hospitals. Of the PNL cases, PNL was completed in 184 cases (87.6%) and not completed in 16 cases (12.4%). 168 cases (80.0%) had successful results by PNL alone, stone-free or stone fragments less than 5 mm, in spite of the stone location and size. No serious adverse effect was experienced throughout the study. However, changes like a scar formation or fibrosis around the nephrostomy tract were revealed as a late complication by excretory urography, computed tomography and renal scanning. Of the 160 TUL cases, TUL was successful in 132 cases (82.5%) and unsuccessful in 28 cases (17.5%). The results of TUL for the calculi above the upper iliac cresta were not favorable, success rate for stone 6-10 mm in diameter was 70.3% and that for stones larger than 11 mm 37.5%. However, the results of TUL for the calculi below the upper ileac cresta were favorable, the success rate for the 6-10 mm calculi was 91.5% and for the calculi larger than 11 mm 88.4%. Of 28 TUL failures, 7 cases underwent PNL and 21 cases received open surgery. Throughout our endourologic treatments, the most problematic stone was calculi impact in the ureter. The indication of endourology for the calculi in upper urinary tract is discussed with consideration of ESWL which is becoming the main stream of stone treatment.
奈良医科大学医院及其13家附属医院采用腔内泌尿外科技术治疗了370例上尿路结石患者，其中210例行经皮肾镜取石术（PNL），160例行经尿道输尿管镜碎石术（TUL）。在PNL组中，184例（87.6%）完成了手术，16例（12.4%）未完成。168例（80.0%）单纯PNL治疗成功，无论结石位置和大小，结石清除或结石碎片小于5mm。整个研究过程中未出现严重不良反应。然而，排泄性尿路造影、计算机断层扫描和肾脏扫描显示，肾造瘘管周围出现瘢痕形成或纤维化等变化为晚期并发症。在160例TUL患者中，132例（82.5%）手术成功，28例（17.5%）失败。髂嵴上方结石的TUL效果不佳，直径6 - 10mm结石的成功率为70.3%，直径大于11mm结石的成功率为37.5%。然而，髂嵴下方结石的TUL效果良好，直径6 - 10mm结石的成功率为91.5%，直径大于11mm结石的成功率为88.4%。在28例TUL失败病例中，7例行PNL，21例行开放手术。在我们整个腔内泌尿外科治疗过程中，最棘手的结石问题是输尿管结石嵌顿。结合正成为结石治疗主流的体外冲击波碎石术（ESWL），对上尿路结石的腔内泌尿外科治疗指征进行了讨论。
