Clinical study on flexible ureteroscopic laser lithotripsy for the treatment of medullary sponge kidney combined with renal stones
-
摘要: 目的 探讨输尿管软镜钬激光碎石术治疗髓质海绵肾合并肾结石的临床疗效及其安全性。 方法 回顾性分析2019年1月—2022年3月于江苏省中医院泌尿外科微创中心行输尿管软镜钬激光碎石手术的15例髓质海绵肾合并肾结石患者的临床资料。患者术前行泌尿系CT造影(computed tomography urography，CTU)或静脉肾盂造影(intravenous pyelography，IVP)明确诊断，收集的资料包括结石的累计最大直径、手术时间、住院时间、结石成分及24 h尿液代谢分析，手术并发症等级分别根据Satava分级系统和Clavien-Dindo分级系统(Clavien-Dindo classification system，CDCS)评估，疼痛程度采用视觉模拟评分法(visual analog scale，VAS)量化评分。术后3个月门诊随访并复查泌尿系CT、血尿常规及肾功能进一步评估。 结果 15例患者中13例(左侧7例，右侧6例)行单侧肾结石输尿管软镜钬激光碎石，2例行双侧软镜碎石；平均手术时间(94.3±44.9) min，平均住院时间(10.1±3.1) d。结石成分分析：草酸钙结石(一水草酸钙、二水草酸钙或混合性含钙结石)9例，无水尿酸结石1例，感染性结石(六水磷酸铵镁、碳酸磷灰石)5例。24 h尿液代谢分析结果显示：高钙尿症3例，低枸橼酸尿症1例。围手术期主要并发症为感染性发热和血尿，其中1例因严重感染并发感染性休克经治疗后好转。 结论 输尿管软镜钬激光碎石术是治疗髓质海绵肾合并肾结石安全有效的方法，特别是对于复发性有临床症状的尿路结石患者，腰痛症状及尿路感染情况改善明显，且围手术期并发症较轻微。Abstract: Objective To evaluate the clinical efficacy and safety of flexible ureteroscopic laser lithotripsy for the treatment of medullary sponge kidney combined with renal stones. Methods Fifteen patients with medullary sponge kidney combined with renal stones who underwent flexible ureteroscopic laser lithotripsy at the minimally invasive center of urology in Jiangsu Province Hospital of Traditional Chinese Medicine from January 2019 to March 2022 were retrospectively analyzed. The patients were diagnosed preoperatively by the urological computed tomogramphy urography(CTU) or intravenous pyelography(IVP). The data collected included the cumulative maximum diameter of the stones, the operative time, the hospitalization time, urine laboratory test such as the stone composition test and the metabolic evaluation of the 24-hour urine. Complication grade was assessed according to Satava classification system and Clavien-Dindo classification system(CDCS) respectively, and pain level was quantitatively scored by visual analog scale(VAS). Postoperative outpatient follow-up and repeat urologic CT, blood and urine routine and renal function were further evaluated at 3 months after surgery. Results Thirteen of the 15 patients(7 on the left side and 6 on the right side) underwent unilateral procedure, and 2 cases underwent bilateral procedures. The mean unilateral operation time was(94.3±44.9) min and the mean hospital stay was (10.1±3.1) d. The analyses of the component of stones by urine laboratory test were as follows: 9 cases of calcium oxalate stones (calcium oxalate monohydrate, calcium oxalate dihydrate, or mixed calcium stones), 1 case of anhydrous uric acid stones, 5 cases of struvite stones (magnesium ammonium phosphate hexahydrate, apatite carbonate). The results of 24-hour urine metabolism analysis results were 3 cases of hypercalciuria and 1 case of hypocitraturia. The main perioperative complications were managed conservatively such as fever, hematuria, and 1 case of sepsis shock got better after treatment. Conclusion Holmium laser lithotripsy with flexible ureteroscopy is a safe and effective method for the treatment of medullary sponge kidney combined with renal stones, especially for patients with recurrent urinary stones combined with clinical symptoms such as chronic renal colic and urinary infection, and the clinical effect is obvious. The perioperative complications were relatively mild.
-
-
表 1 15例MSK合并肾结石患者临床资料
例(%)，X±S 项目 数值 年龄/岁 45.1±13.3 性别 男 3(20.0) 女 12(80.0) 临床症状 腰痛 13(86.7) 肉眼血尿 5(33.3) 发热 2(13.3) 无症状 1(6.7) 合并症 高血压 1(6.7) 甲状旁腺功能亢进 1(6.7) 干燥综合征 2(13.3) 远端肾小管酸中毒 2(13.3) 低钾血症 5(33.3) 结石累计最大径/cm 2.4±1.4 尿细菌培养 阴性 9(60.0) 大肠埃希菌 4(26.7) 奇异变形杆菌 2(13.3) 尿结石成分分析 草酸钙结石(一水和/或二水草酸钙合物) 9(60.0) 无水尿酸结石 1(6.7) 鸟粪石(六水磷酸铵镁、碳酸磷灰石) 5(33.3) 手术时间/min 94.3±44.9 住院天数/d 10.1±3.1 
下载: 导出CSV
表 2 患者手术并发症分析
例(%) 并发症 Satava分级 Clavien-Dindo
分级例数 术中并发症 出血 Grade Ⅰ 1(6.7) 术后并发症 血尿 Clavien Ⅱ 1(6.7) 发热(>38℃) Clavien Ⅲ 2(13.3) 感染性休克 Clavien Ⅳ 1(6.7)
下载: 导出CSV
表 3 15例MSK合并肾结石患者手术前后临床症状及指标比较
例(%)，X±S，M(P25，P75) 临床症状/指标 术前 术后3个月 P值 肉眼血尿 6(40.0) 1(6.7) 0.084 尿白细胞/(/uL) 70(13，384) 20(12，56) 0.008 疼痛评分/分 5.5±2.8 1.9±0.8 ＜0.001 血红蛋白/(g/L) 133.1±16.4 130.5±11.9 0.184 肾功能Cr/(μmol/L) 82.1±35.0 78.9±22.0 0.622
下载: 导出CSV
-
[1] Fabris A, Lupo A, Bernich P, et al. Long-term treatment with potassium citrate and renal stones in medullary sponge kidney[J]. Clin J Am Soc Nephrol, 2010, 5(9): 1663-1668. doi: 10.2215/CJN.00220110
[2] Imam TH, Patail H, Patail H. Medullary Sponge Kidney: Current Perspectives[J]. Int J Nephrol Renovasc Dis, 2019, 12: 213-218. doi: 10.2147/IJNRD.S169336
[3] Kerbl K, Clayman RV. Endourologic treatment of nephrocalcinosis[J]. Urology, 2000, 56(3): 508.
[4] 林鹭, 郁胜强. 髓质海绵肾的新认识[J]. 中国全科医学, 2015, 18(18): 2213-2216. doi: 10.3969/j.issn.1007-9572.2015.18.023
[5] Evan AP, Worcester EM, Williams JC Jr, et al. Biopsy proven medullary sponge kidney: clinical findings, histopathology, and role of osteogenesis in stone and plaque formation[J]. Anat Rec(Hoboken), 2015, 298(5): 865-877. doi: 10.1002/ar.23105
[6] El-Reshaid K, Al-Terki A, Al-Bader S. Detailed Nephro-urological Management of a Case of Medullary Sponge Kidney with Distal Renal Tubular Acidosis and Obstructive Uropathy[J]. Saudi J Kidney Dis Transpl, 2022, 33(6): 828-832. doi: 10.4103/1319-2442.390261
[7] McPhail EF, Gettman MT, Patterson DE, et al. Nephrolithiasis in medullary sponge kidney: evaluation of clinical and metabolic features[J]. Urology, 2012, 79(2): 277-281. doi: 10.1016/j.urology.2011.07.1414
[8] Gambaro G, Goldfarb DS, Baccaro R, et al. Chronic pain in medullary sponge kidney: a rare and never described clinical presentation[J]. J Nephrol, 2018, 31(4): 537-542. doi: 10.1007/s40620-018-0480-8
[9] Noordin NS, Cox CJ, Wilkinson MM, et al. Spinal cord stimulation for visceral pain associated with medullary sponge kidney[J]. Pain Manag, 2023, 13(11): 641-646. doi: 10.2217/pmt-2023-0075
[10] Taub DA, Suh RS, Faerber GJ, et al. Ureteroscopic laser papillotomy to treat papillary calcifications associated with chronic flank pain[J]. Urology, 2006, 67(4): 683-687. doi: 10.1016/j.urology.2005.10.041
[11] Xu G, Wen J, Wang B, et al. The Clinical Efficacy and Safety of Ureteroscopic Laser Papillotomy to Treat Intraductal Papillary Calculi Associated With Medullary Sponge Kidney[J]. Urology, 2015, 86(3): 472-476. doi: 10.1016/j.urology.2015.06.037
[12] Seifman BD, Rubin MA, Williams AL, et al. Functional effects of unilateral laser papillectomy in the pig[J]. Urology, 2001, 57(4): 832-836. doi: 10.1016/S0090-4295(00)01121-3
[13] Gambaro G, Danza FM, Fabris A. Medullary sponge kidney[J]. Curr Opin Nephrol Hypertens, 2013, 22(4): 421-426. doi: 10.1097/MNH.0b013e3283622b86
[14] 陈雪花, 周月, 徐彦, 等. 红外光谱法对22750例泌尿系结石成分分析[J/OL]. 泌尿外科杂志(电子版), 2021, 13(2): 36-39.
[15] Fabris A, Anglani F, Lupo A, et al. Medullary sponge kidney: state of the art[J]. Nephrol Dial Transplant, 2013, 28(5): 1111-1119. doi: 10.1093/ndt/gfs505
[16] 徐彦, 顾晓箭, 张东方, 等. 体外冲击波碎石术中国专家共识[J]. 临床泌尿外科杂志, 2024, 39(4): 265-270. https://lcmw.whuhzzs.com/article/doi/10.13201/j.issn.1001-1420.2024.04.001
[17] 洪扬, 许清泉, 黄晓波, 等. 经皮肾镜取石术治疗髓质海绵肾合并结石的效果分析[J]. 中华外科杂志, 2017, 55(10): 742-745.
[18] Geavlete P, Nita G, Alexandrescu E, et al. The impact of modern endourological techniques in the treatment of a century old disease--medullary sponge kidney with associated nephrolithiasis[J]. J Med Life, 2013, 6(4): 482-485.
[19] Imam TH, Patail H, Patail H. Medullary Sponge Kidney: Current Perspectives[J/OL]. Int J Nephrol Renovasc Disease, 2019, 12: 213-218.
-
计量
- 文章访问数: 98
- 施引文献: 0