CAJ | 학술논문

目的探讨临床无意义残留结石(CIRF)患者在微创经皮肾镜碎石术(MPCNL)后的中期随访变化情况.方法回顾性分析72例获得中期随访CIRF患者的临床资料.结果 72例CIRF患者,CIRF位于肾上盏10例,肾中盏15例,肾下盏35例,肾盂输尿管连接处10例,肾上盏合并肾下盏2例.结石成分:单纯草酸钙结石41例,草酸钙结石+碳酸磷灰石16例,草酸钙结石+尿酸结石3例,草酸钙结石+六水磷酸镁铵结石+碳酸磷灰石4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.随访期间15例出现临床症状,其中血尿合并肾绞痛2例,单纯血尿8例,下尿路症状5例.15例出现临床症状患者中,CIRF位于肾上盏4例,肾中盏1例,肾下盏4例,肾盂输尿管连接处6例,肾盂输尿管连接处残石相对于肾上盏、肾中盏、肾下盏残石更易发生临床症状(6/10比4/12,11/5,4/37,P＜ 0.05).8例行手术治疗,其中1例肾中盏、2例肾上盏、2例肾盂输尿管连接处CIRF行体外冲击波碎石术,3例输尿管CIRF行输尿管镜钬激光碎石术,术后残石均完全清除.另7例予解痉、镇痛排石处理后残石自行排出.结论中期随访结果表明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体外冲击波碎石术史的患者更易形成CIRF.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,并对其进行相应的治疗.
목적 탐토림상무의의잔류결석(CIRF)환자재미창경피신경쇄석술(MPCNL)후적중기수방변화정황.방법 회고성분석72례획득중기수방CIRF환자적림상자료.결과 72례CIRF환자,CIRF위우신상잔10례,신중잔15례,신하잔35례,신우수뇨관련접처10례,신상잔합병신하잔2례.결석성분:단순초산개결석41례,초산개결석+탄산린회석16례,초산개결석+뇨산결석3례,초산개결석+륙수린산미안결석+탄산린회석4례,륙수린산미안결석3례,뇨산결석2례,륙수린산미안결석+탄산린회석3례.수방기간15례출현림상증상,기중혈뇨합병신교통2례,단순혈뇨8례,하뇨로증상5례.15례출현림상증상환자중,CIRF위우신상잔4례,신중잔1례,신하잔4례,신우수뇨관련접처6례,신우수뇨관련접처잔석상대우신상잔、신중잔、신하잔잔석경역발생림상증상(6/10비4/12,11/5,4/37,P＜ 0.05).8례행수술치료,기중1례신중잔、2례신상잔、2례신우수뇨관련접처CIRF행체외충격파쇄석술,3례수뇨관CIRF행수뇨관경화격광쇄석술,술후잔석균완전청제.령7례여해경、진통배석처리후잔석자행배출.결론 중기수방결과표명MPCNL후CIRF가발생우신장화수뇨관각개부위,기중신하잔최다견,차다위초산개결석.술전유개방취석수술사화체외충격파쇄석술사적환자경역형성CIRF.신우수뇨관련접처CIRF경역출현혈뇨、신교통등림상증상.대우CIRF환자응밀절수방,여발생림상증상응급시취진,병대기진행상응적치료.
Objective To discuss the medium-term follow-up of clinically insignificant residual fragments (CIRF) after minimally invasive percutaneous nephrolithotomy lithotripsy (MPCNL).Methods The clinical data of 72 patients with CIRF medium-term follow-up were analyzed retrospectively.Results Seventy-two patients with CIRF.The anatomical distribution of CIRF was 10 at upper pole,15 at middle,35 at lower,10 at renal ureteropelvie junction and 2 at upper and lower pole.Stone analysis showed that 41 cases of calcium oxalate calculi,16 of calcium oxalate calculi mixed with carbonate calculi,3 calcium oxalate calculi mixed with uric acid,4 calcium oxalate calculi mixed with struvite stone,3 struvite stone,2 uric acid stone and 3 carbonate apatite mixed with struvite stone.Fifteen cases had clinical symptoms,including 2 renal colic pain,8 hematuria,5 lower urinary tract symptoms,4 cases CIRF located in upper pole,1 case in middle pole,4 cases in lower pole,6 cases in ureteropelvic junction,the incidence of clinical symptoms in ureteropelvic junction was significantly higher than that in other locations (6/10 vs.4/12,1/15,4/37,P ＜0.05).Eight cases required surgical procedure,5 cases underwent extracorporeal shock wave lithotripsy,3 cases with ureteral CIRF were performed with ureteroscopic lithotripsy.CIRF were clear after surgery,7 patients with ureteral CIRF had renal colic pains.The stones were excluded after spasmolytic analgesic treatments.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 extracorporeal shock wave lithotripsy are more likely to get CIRF.Medium-term follow-up of CIRF reveals that CIRF located in the renal ureteropelvis junction are more likely to have clinical symptoms.