微创经皮肾镜碎石术后临床无意义残石患者中期随访结果  

Medium-term follow-up of clinically insignificant residual fragments after minimally invasive percutaneous nephrolithotomy

作　　者：王博涵[1] 余琥[1] 姚炜敏[1] 杨欢[1] 夏丁[1] 陈志强[1] 叶章群[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院泌尿外科,武汉430030

出　　处：《中华泌尿外科杂志》2012年第7期529-531,共3页Chinese Journal of Urology

基　　金：同济医院新技术新业务资助项目（2010016）

摘　　要：目的探讨微创经皮肾镜碎石术（MPCNL）后患者临床无意义残石（clinicallyinsignifi—cantresidualfragments，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1．8mm。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〉4mm。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〉4mm，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 had been performed in 13 and ESWL in 20 cases. The median residual fragment size was 1.8 ram. 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 calcull mixed with struvite stone, 3 struvite 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 rou- tine, 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 mm. 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 patients 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. Conusions CIRF can be located variously in the kidney and ureter. Most CIRF are calcium oxalate calculi a

关 键 词：微创经皮肾镜碎石术 临床无意义残石 中期随访 

分 类 号：R692.4[医药卫生—泌尿科学]