17例胱氨酸结石患者的临床诊治  

Clinical diagnosis and treatment of 17 patients with cystine stone

作　　者：李佳明 谢永鹏 邓远忠[1] LI Jiaming;XIE Yongpeng;DENG Yuanzhong(Department of Urology,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院泌尿外科,400016

出　　处：《重庆医学》2022年第4期663-666,共4页Chongqing medicine

基　　金：重庆市自然科学基金面上项目(cstc2020jcyj-msxmX0717)。

摘　　要：目的探讨胱氨酸结石患者的临床特点、诊断、治疗及随访管理。方法回顾性分析2015年6月至2020年10月该院收治的17例胱氨酸结石患者,男13例,女4例,年龄16~76岁,均采取手术治疗,手术方式包括:经皮肾镜取石术、输尿管软镜碎石术及输尿管镜碎石术,术后影像学未发现结石则判为结石完全清除,单个残留结石直径小于或等于4 mm则为临床无意义残留结石,若结石残留较多则再次手术。结果患者平均手术次数为(1.82±1.13)次/人,手术次数为1次者9例,2次者4例,3次者3例,5次者1例,通过1次手术达到无结石残留者8例,一期清石率为47.06%,术后仍有结石残留者6例。手术次数≥2次的患者鹿角结石构成比明显高于手术次数<2次的患者(87.5%vs.11.1%,P=0.003)。16例患者术后血肌酐水平低于术前,13例患者术后肾小球滤过率估计值(eGFR)高于术前,但差异均无统计学意义(P>0.05)。结论临床上胱氨酸结石病例较少见,易复发,常需多次手术,手术应尽量微创达到完全清石并联合水化、饮食及药物等综合治疗,建立长期随访及管理体制。Objective To explore the clinical characteristics,diagnosis,treatment and follow-up management of patients with cystine stone.Methods A total of 17 patients with cystine stones admitted to this hospital from June 2015 to October 2020 were analyzed retrospectively.There were 13 males and four females,aged from 16 to 76 years old,and all of them were treated with surgery.Surgical methods included:percutaneous nephrolithotomy,retrograde intrarenal stone surgery and ureteroscopy lithotomy.If no stone was found in postoperative imaging,the stone was considered to be completely removed,and the diameter of single residual stone less than or equal to 4 mm was regarded as clinically meaningless.If there were more stones remaining,the operation should be performed again.Results The average number of operations for patients was(1.82±1.13)times/person,nine cases were performed once operation,four cases were performed twice,three cases were performed three times,one case was performed five times,eight cases achieved no residual stones through one operation,the primary stone removal rate was 47.06%,and six cases had residual stones after the operation.The proportion of staghorn stones in patients with≥2 operations was significantly higher than that in patients with<2 operations(87.5%vs.11.1%,P=0.003).The postoperative serum creatinine level was lower than the preoperative level in 16 patients,the postoperative estimated glomerular filtration rate(eGFR)was higher than the preoperative eGFR in 13 patients,and there was no statistically significant the difference(P>0.05).Conclusion Clinical cases of cystine stones are rare,prone to recurrence,and often require multiple operations.The operation should be minimally invasive to achieve complete stone removal,combined with comprehensive treatment such as hydration,diet and drugs,and establish a long-term follow-up and management system.

关 键 词：胱氨酸结石 泌尿系结石 诊断 手术治疗 经皮肾镜取石 碎石 

分 类 号：R691.4[医药卫生—泌尿科学]