中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2012年
7期
529-531
,共3页
微创经皮肾镜碎石术%临床无意义残石%中期随访
微創經皮腎鏡碎石術%臨床無意義殘石%中期隨訪
미창경피신경쇄석술%림상무의의잔석%중기수방
Minimally invasive percutaneous nephrolithctomy%Clinically insignificant residual fragments%Medium-term follow-up
目的 探讨微创经皮肾镜碎石术(MPCNL)后患者临床无意义残石(clinically insignificant residual fragments,CIRF)的变化情况. 方法 2008年1月至2010年12月655例肾结石患者行MPCNL,75例(11％)术后3d经CT平扫证实为CIRF.其中68例获随访.男39例,女29例.年龄22～62岁,平均43岁.其中13例有开放取石手术史,20例有ESWL史.术后CIRF最大径平均1.8 mm.单纯肾上盏残石9例,肾中盏残石14例,肾下盏残石34例,肾盂输尿管连接处残石9例,肾上盏合并下盏残石2例.结石成分分析结果:单纯草酸钙结石40例,草酸钙+碳酸磷灰石15例,草酸钙+尿酸结石2例,草酸钙+六水磷酸镁铵结石+碳酸磷灰石3例,六水磷酸镁铵结石3例,尿酸结石2例,六水磷酸镁铵结石+碳酸磷灰石3例.随访时间12～36个月,平均23个月.随访内容包括病史、体检、血尿常规、有无症状等,行CT平扫检查比较残石的变化情况. 结果 随访期间14例(21％)出现临床症状,其中血尿合并肾绞痛2例,单纯血尿7例,下尿路症状5例.12例残石最大径＞4 mm.8例行手术治疗,其中1例肾中盏、2例肾上盏、2例肾盂CIRF行ESWL,3例输尿管CIRF行输尿管镜钬激光碎石术.术后结石均完全清除.4例肾下盏CIRF＞4 mm,但未引起临床症状者,予保守治疗.2例输尿管CIRF出现肾绞痛,予解痉、镇痛排石处理后结石自行排出.14例出现症状患者中,CIRF位于肾上盏3例,肾中盏1例,肾下盏4例,肾盂输尿管连接处6例.27％ (3/11)肾上盏,7％(1/14)肾中盏,11％ (4/36)肾下盏,67％ (6/9)肾盂输尿管连接处CIRF出现症状. 结论 MPCNL后CIRF可发生于肾脏和输尿管各个部位,其中肾下盏最多见,且多为草酸钙结石.术前有开放取石手术史和ESWL史的患者更易形成CIRF.中期随访结果表明肾盂输尿管连接处CIRF更易出现血尿、肾绞痛等临床症状.对于CIRF患者应密切随访,如发生临床症状应及时就诊,并对其进行相应的临床治疗.
目的 探討微創經皮腎鏡碎石術(MPCNL)後患者臨床無意義殘石(clinically insignificant residual fragments,CIRF)的變化情況. 方法 2008年1月至2010年12月655例腎結石患者行MPCNL,75例(11％)術後3d經CT平掃證實為CIRF.其中68例穫隨訪.男39例,女29例.年齡22～62歲,平均43歲.其中13例有開放取石手術史,20例有ESWL史.術後CIRF最大徑平均1.8 mm.單純腎上盞殘石9例,腎中盞殘石14例,腎下盞殘石34例,腎盂輸尿管連接處殘石9例,腎上盞閤併下盞殘石2例.結石成分分析結果:單純草痠鈣結石40例,草痠鈣+碳痠燐灰石15例,草痠鈣+尿痠結石2例,草痠鈣+六水燐痠鎂銨結石+碳痠燐灰石3例,六水燐痠鎂銨結石3例,尿痠結石2例,六水燐痠鎂銨結石+碳痠燐灰石3例.隨訪時間12～36箇月,平均23箇月.隨訪內容包括病史、體檢、血尿常規、有無癥狀等,行CT平掃檢查比較殘石的變化情況. 結果 隨訪期間14例(21％)齣現臨床癥狀,其中血尿閤併腎絞痛2例,單純血尿7例,下尿路癥狀5例.12例殘石最大徑＞4 mm.8例行手術治療,其中1例腎中盞、2例腎上盞、2例腎盂CIRF行ESWL,3例輸尿管CIRF行輸尿管鏡鈥激光碎石術.術後結石均完全清除.4例腎下盞CIRF＞4 mm,但未引起臨床癥狀者,予保守治療.2例輸尿管CIRF齣現腎絞痛,予解痙、鎮痛排石處理後結石自行排齣.14例齣現癥狀患者中,CIRF位于腎上盞3例,腎中盞1例,腎下盞4例,腎盂輸尿管連接處6例.27％ (3/11)腎上盞,7％(1/14)腎中盞,11％ (4/36)腎下盞,67％ (6/9)腎盂輸尿管連接處CIRF齣現癥狀. 結論 MPCNL後CIRF可髮生于腎髒和輸尿管各箇部位,其中腎下盞最多見,且多為草痠鈣結石.術前有開放取石手術史和ESWL史的患者更易形成CIRF.中期隨訪結果錶明腎盂輸尿管連接處CIRF更易齣現血尿、腎絞痛等臨床癥狀.對于CIRF患者應密切隨訪,如髮生臨床癥狀應及時就診,併對其進行相應的臨床治療.
목적 탐토미창경피신경쇄석술(MPCNL)후환자림상무의의잔석(clinically insignificant residual fragments,CIRF)적변화정황. 방법 2008년1월지2010년12월655례신결석환자행MPCNL,75례(11％)술후3d경CT평소증실위CIRF.기중68례획수방.남39례,녀29례.년령22～62세,평균43세.기중13례유개방취석수술사,20례유ESWL사.술후CIRF최대경평균1.8 mm.단순신상잔잔석9례,신중잔잔석14례,신하잔잔석34례,신우수뇨관련접처잔석9례,신상잔합병하잔잔석2례.결석성분분석결과:단순초산개결석40례,초산개+탄산린회석15례,초산개+뇨산결석2례,초산개+륙수린산미안결석+탄산린회석3례,륙수린산미안결석3례,뇨산결석2례,륙수린산미안결석+탄산린회석3례.수방시간12～36개월,평균23개월.수방내용포괄병사、체검、혈뇨상규、유무증상등,행CT평소검사비교잔석적변화정황. 결과 수방기간14례(21％)출현림상증상,기중혈뇨합병신교통2례,단순혈뇨7례,하뇨로증상5례.12례잔석최대경＞4 mm.8례행수술치료,기중1례신중잔、2례신상잔、2례신우CIRF행ESWL,3례수뇨관CIRF행수뇨관경화격광쇄석술.술후결석균완전청제.4례신하잔CIRF＞4 mm,단미인기림상증상자,여보수치료.2례수뇨관CIRF출현신교통,여해경、진통배석처리후결석자행배출.14례출현증상환자중,CIRF위우신상잔3례,신중잔1례,신하잔4례,신우수뇨관련접처6례.27％ (3/11)신상잔,7％(1/14)신중잔,11％ (4/36)신하잔,67％ (6/9)신우수뇨관련접처CIRF출현증상. 결론 MPCNL후CIRF가발생우신장화수뇨관각개부위,기중신하잔최다견,차다위초산개결석.술전유개방취석수술사화ESWL사적환자경역형성CIRF.중기수방결과표명신우수뇨관련접처CIRF경역출현혈뇨、신교통등림상증상.대우CIRF환자응밀절수방,여발생림상증상응급시취진,병대기진행상응적림상치료.
Objective To discuss the outcomes of the clinically insignificant residual fragments after minimally invasive percutaneous nephrolithotomy. Methods 75 patients (11％) with CIRF among 655 who underwent initial MPCNL from January 2008 to December 2010 were diagnosed by CT scan.Clinical data of 68 patients (39 male and 29 female) were analyzed retrospectively.Previous open surgery hadbeen performed in 13 and ESWL in 20 cases.The median residual fragment size was 1.8 mm.The anatomical distribution of CIRF was 9 at upper pole,14 at middle,34 at lower,9 at renal ureteropelvic junction and 2 at upper and lower pole.Stone analysis showed 40 cases of calcium oxalate calculi,15 of calcium oxalate calculi mixed with carbonate calculi,2 calcium oxalate calculi mixed with uric acid,3 calcium oxalate calculi mixed with struuvite stone,3 struuvite stone,2 uric acid stone and 3 carbonate apatite mixed with struvite stone.Mean follow up was 23 months (12-36).Follow-up consisted of physical examination,serum routine,urine routine and CT imaging. Results 14(21％) patients (3 upper pole,1 middle pole,4 lower pole and 6 ureteropelvic junction) had symptomatic episodes,including 9 hematuria,2 renal colic pain,5 lower urinary tract symptoms,12 with size of CIRF ＞ 4 rmm.8 patients required surgical procedures.5 patients (1 middle,2 upper pole and 2 renal pelvis) underwent ESWL.3 patients with ureteral CIRF were performed ureteroscopic lithotripsy.The CIRF were clear after surgeries.4 paticnts with CIRF ＞ 4 mm did not have symptoms.These patients were recommended to conservational treatments.2 patients with ureteral CIRF had renal colic pains.The stones were excluded after spasmolytic analgesic treatments.27％ (3/11)CIRF located in upper pole had symptom,compared with 4％ (1/14) in middle pole,11％ (4/36) in lower pole and 67％ (6/9) in ureteropelvic junction. Conclusions CIRF can be located variously in the kidney and ureter.Most CIRF are calcium oxalate calculi and locate in the lower pole.Patients with the history of previous open surgery or SWL are more likely to get CIRF.Medium-term follow-up of CIRF revealed that CIRF located in the renal ureteropelvis junction are more likely to have clinical symptoms.
