Treatise-Research Report Clinical features and minimally invasive treatment of renal matrix calculi (Report of 4 cases)
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摘要: 目的 肾基质结石是一种发病率极低的泌尿系结石类型。本文总结诊断和治疗肾基质结石的临床特点及微创经皮肾镜取石术(PCNL)的治疗效果。方法 分析2018年10月—2020年12月收治的4例肾基质结石患者的诊治经过，对患者术前检查、术中发现、手术经过、围手术期治疗和随访情况进行分析。结果 腰痛和尿路感染是肾基质结石患者常见的就诊原因。影像学CT检查可显示肾盂内高密度影，CT值介于69~308 HU。手术中内镜下对结石形态的判断是诊断基质结石的重要手段。所有患者均行PCNL手术治疗，平均术后住院7.5 d。其中1例患者术后出现尿源性脓毒症，经积极治疗后痊愈，其余患者术后未发生严重并发症。患者平均随访9.5个月，均未见复发。结论 肾基质结石是一种罕见的泌尿系结石疾病，术前缺乏有效的判断方案。患者术前伴有泌尿系感染病史，泌尿系CT表现结合术中内镜下可见特殊结石形态是诊断基质结石的临床特征。PCNL是目前治疗肾基质结石的主要方法，围手术期控制感染对患者的治疗非常重要。Abstract: Objective Renal matrix calculi are a type of urinary stone with very low incidence rate. We described the clinical features and studied the efficacy of percutaneous nephrolithotomy (PCNL) in the management of renal matrix calculi.Methods We retrospectively identified and reviewed the records of 4 patients (2 women and 2 men) having renal matrix calculi from October 2018 to December 2020. These patients' clinical, laboratory and radiological features were studied, and the surgical procedures and outcomes were analysed.Results Flank pain and recurrent urinary tract infection were clinical presentations in all patients. Non-contrast computed tomography (CT) showed high density in pelvic in low CT value 69-308 Hu. Urine examination showed that white blood cells increased and there was no significant finding in blood routine examination preopertively. All patients were treated with PCNL. An important means for the diagnosis of matrix stones is diagnostic endoscopy. The mean hospital stay was 7.5 days. One patient developed urosepsis postoperatively and recovered after anti-infection treatment. No serious complications occurred in other patients. During a mean follow-up period of 9.5 months, no patients had recurrence.Conclusion Renal matrix stones are a rare form of urinary calculi and it is difficult to make a definite diagnosis before operation. PCNL is an optimal minimally invasive management for it. Perioperative infection prevention is important for the patients.
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Key words:
- renal stone /
- matrix stone /
- percutaneous nephrolithotomy
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表 1 患者术前临床情况
序号 性别 年龄/岁 患侧 结石最大径线/cm 术前CT值/HU 术前并发症 术前处理 术前尿细菌培养 术前尿白细胞 1 男 67 左 3.0 115 UTI，DM，HTN 留置双J管，抗感染 大肠杆菌 + 2 男 70 右 2.5 69 UTI，DM，HTN 留置双J管，抗感染 - + 3 女 50 左 2.5 225 UTI，DM，HTN 抗感染治疗 大肠杆菌 + 4 女 31 左 2.0 308 UTI 抗感染治疗 奇异变异杆菌 +/- UTI：泌尿系感染; DM：糖尿病; HTN：高血压。 
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表 2 患者手术及术后的临床情况
序号 性别 PCN通道数 手术时间/ min 术后PCT 脓毒症 出院前尿白细胞 随访时间/月 1 男 1 90 升高 有 +/- 10 2 男 1 60 升高 无 - 10 3 女 1 45 升高 无 - 9 4 女 1 45 升高 无 - 9
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[1] Schubert G. Stone analysis[J]. Urol Res, 2006, 34(2): 146-150. doi: 10.1007/s00240-005-0028-y
[2] Boyce WH, Garvey FK. The amount and nature of the organic matrix in urinary calculi: a review[J]. J Urol, 1956, 76(3): 213-227. doi: 10.1016/S0022-5347(17)66686-2
[3] Stoller ML, Gupta M, Bolton D, et al. Clinical correlates of the gross, radiographic, and histologic features of urinary matrix calculi[J]. J Endourol, 1994, 8(5): 335-340. doi: 10.1089/end.1994.8.335
[4] Shah HN, Kharodawala S, Sodha HS, et al. The management of renal matrix calculi: a single-centre experience over 5 years[J]. BJU Int, 2009, 103(6): 810-814. doi: 10.1111/j.1464-410X.2008.08065.x
[5] Rowley MW, Faerber GJ, Wolf JS Jr. The University of Michigan experience with percutaneous nephrostolithotomy for urinary matrix calculi[J]. Urology, 2008, 72(1): 61-64. doi: 10.1016/j.urology.2007.12.080
[6] Cobley J, Phan YC, Mahmalji W. Matrix Stone Occupying an Entire Renal Collecting System: A Case Report and Video of Diagnostic Ureterorenoscopy[J]. Case Rep Urol, 2018, 2018: 5892438.
[7] 庞然, 卢建新, 高筱松, 等. 内腔镜下超声弹道联合碎石清石系统治疗上尿路基质结石4例报告[J]. 临床泌尿外科杂志, 2010, 25(6): 474-475.
[8] Hein S, Suarez-Ibarrola R, Gratzke C, et al. Therapy-Refractory Matrix Staghorn in a Kidney Transplant Recipient: Endoscopic Percutaneous Morcellation as a Novel Treatment Option[J]. J Endourol Case Rep, 2020, 6(3): 209-212. doi: 10.1089/cren.2020.0008
[9] Miwa S, Yamamoto H, Sugata T. Antibiotics therapy was effective in preventing bilateral staghorn renal matrix stones[J]. Urol Res, 2011, 39(1): 69-72. doi: 10.1007/s00240-010-0252-y
[10] 李雄才, 钟芳灵, 吴伟宙, 等. 基质蛋白在泌尿系结石形成中的作用及其机制的研究进展[J]. 临床泌尿外科杂志, 2019, 34(9): 741-744. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMW201909016.htm
[11] Merchant ML, Cummins TD, Wilkey DW, et al. Proteomic analysis of renal calculi indicates an important role for inflammatory processes in calcium stone formation[J]. Am J Physiol Renal Physiol, 2008, 295(4): F1254-F1258. doi: 10.1152/ajprenal.00134.2008
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