99mTc-DMSA腎摂取率による体外衝撃波結石破砕術(ESWL)の腎機能におよぼす影響の検討 : 経皮的腎結石破砕術(PNL)との比較


99mTc-DMSA腎摂取率の再現性を健常成人で評価し,1側の腎結石に対し,ESWLまたはPNLを施行した48症例で,治療前後にDMSA腎シンチグラフィを施行し,治療法の腎機能への影響を検討した。健常成人では99mTc-DMSA腎摂取率は再現性は保たれているが,数%の変動がみられた。ESWL群,PNL群または両者併用群において治療前後で治療側腎摂取率には有意な変化はみられなかった。各群間を比較すると,PNL群および両者併用群とESWL群との間に有意な差が認められた(p<0.01)99mTc-DMSA renal scintigraphy was utilized to investigate the influence of ESWL on renal function in comparison with that of PNL. In the beginning, the reproducibility of renal uptake rate by the scintigraphy was examined in eleven healthy volunteers under both non-diuretic and diuretic states. The renal uptake rate was shown to be sufficiently reproducible in the same person in the two different trials. However, the differences and the standard deviations were shown to be a few percentages, which were not statistically significant. Changes in the repeated renal uptake rate seem to indicate not only changes of renal function with the treatment but also some technical errors. Herein, to investigate changes in renal function of the therapeutic side, the uptake ratio rate (rate of uptake rate in the therapeutic side/uptake rate in the contral lateral side) was utilized instead of uptake rate. Renal scintigraphy was carried out in 48 patients with unilateral renal stones before and after ESWL or PNL monotherapy or the combined ESWL and PNL therapies. Within one week of treatment, the uptake ratio rate significantly decreased in patients with PNL or the combined ESWL and PNL, although DMSA uptake rate in the therapeutic side did not significantly changes. Neither renal uptake rate nor uptake ratio rate significantly changed after ESWL treatment. There was no significant difference in changes of uptake ratio rate between Siemens Lithostars Plus and the improved Dornier HM-3 lithotriptors. This study indicated that ESWL monotherapy did not affect the uptake ratio rate, although PNL monotherapy and the combined ESWL and PNL therapies may affect the uptake ratio rate to some extent.


桜井 正樹 松阪市民病院
松浦 浩 三重大学泌尿器科
日置 琢一 愛知県がんセンター