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体外衝撃波による砕石不成功例と,結石が小さく,X線上みにくい水腎症の高度な嵌頓尿管結石患者10例に対して,経皮的腎瘻造設術時に使用した腎盂バルーンを閉塞バルーンとして使用した経尿道的尿管砕石術を施行した。経皮的腎瘻造設術は手術前3~7日に施行した。手術時,腎盂バルーンを尿管結石上部に移動させて再固定し,主にレーザーにより砕石した。合併症は経皮的腎瘻造設術時の著明な腎出血,術中のバルーン破裂,敗血症がそれぞれ1例みられたが,術中の視野は確保され,砕石効果がバルーン使用により上がった。術中,腎盂への結石移動を気にせずに施行できた。残石はみられなかった。本法は著明な水腎症を伴う嵌頓上部尿管結石症例で有用な方法である。
Transureterolithotripsy(TUL)using nephrostomy balloon catheter as occlusion balloon was carried out in 10 patients with impacted stones associated with marked hydronephrosis for four years from March,2002 to March 2006. Extracorponeal shock wave lithotripsy(ESWL) therapy was unsuccessful for these impacted stones and small or fluoroscopically illegible stones. Percutaneos nephrostomy was performed 3 to 5 days before TUL. On operation,neprostomy tube was pushed down into the ureter above the stone and re-fixed by balloon inflation. Fragmenting ureteral calculi was carried out mainly with Holmium Laser. Gross hematuria on percutaneous nephrostomy was seen in one case,balloon rupture in one case,and postoperative sepsis in one case. As good visualization enabled effective fragmentation and fragmented stones did not migrate beyond balloon,therefore,TUL were successfully done without stone immigration to the renal pelvis during operation. No residual was seen. This procedure is useful for impacted upper ureteral caliculi with marked hydronephrosis.(Rinsho Hinyokika 60:997-1001,2006)
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