上尿路胱氨酸结石诊治22例报告

Diagnosis and Treatment of Upper Urinary Cystine Calculi: a Report of 22 Cases

目的探讨上尿路胱氨酸结石的诊治方法。方法 2005年3月-2013年3月治疗22例上尿路胱氨酸结石,其中肾脏铸型结石10例,肾多发结石9例,肾多发结石合并输尿管结石3例,8例仅行经皮肾镜碎石清石术（percutaneous nephrolithotomy lithotripsy,PCNL）,3例行PCNL＋输尿管镜碎石术（ureteroscopic lithotripsy,URL）,9例行PCNL＋体外冲击波碎石（extracorporeal shock wave lithotripsy,ESWL）＋经肾造瘘管肾盂内灌注氨基丁三醇-E（THAM-E）溶石,2例仅行ESWL。结果 17例结石完全清除,5例结石残留,清石清除率77.2%（17/22）,无严重并发症发生。22例随访6-36个月,平均24个月,3例结石复发,5例结石残留中4例结石体积增大。结论 PCNL联合ESWL及药物溶石治疗上尿路复杂胱氨酸结石,结石清除效果满意。

Objective To evaluate diagnosis and treatment of upper urinary cystine calculi. Methods We retrospectively analyzed clinical data of 22 patients with upper urinary cystine calculi from March 2005 to March 2013. There were 10 cases of staghorm calculi,9 cases of multiple calculi,and 3 cases of upper ureteral calculi combined with multiple renal calculi. Eight patients underwent PCNL only,3 patients underwent PCNL ＋ URL,9 patients underwent PCNL ＋ ESWL ＋ litholytic therapy with THAM-E perfusing into renal pelvis through nephrostomy tubes,and 2 patients underwent ESWL only. Results The calculi completely disappeared in 17 cases（ 77. 2%）,while residual stones occurred in 5 cases,the clearance rate being 77. 2%（ 17 /22）. No major complications were noted. All the 22 patients were followed up for 6-36 months,with an average of 24 months. Recurrence of calculi was found in 3 cases,and calculi enlarged with different degree in 4 out of 5 cases of residual stones. Conclusion Combination of PCNL,ESWL,and litholytic therapy has good effects in the treatment of complicated renal cystine calculi.