Ahlstrand C, Tiselius H G
Department of Urology, University Hospital, Linköping, Sweden.
J Stone Dis. 1993 Jan;5(1):32-8.
Minimally invasive surgical procedures are particularly desirable in patients with cystine stones because of their often multiple previous operations, complicated stone situations, and high risk of recurrences. Twenty-four treatment episodes for cystine stones were carried out, 12 with extracorporeal shock wave lithotripsy (ESWL) as monotherapy and 12 with a combination of ESWL and percutaneous irrigation with chemolytic solutions. In the ESWL monotherapy group, five of 12 renal units became stone-free and one more patient was discharged stone-free, except for an untreated stone in a calix diverticulum. Combined treatment, most often given in association with more complicated stone situations, rendered seven out of 12 kidneys stone-free. Even in this group, one patient was discharged with an untreated residual stone in a calix diverticulum. Our results show that even complicated cystine stone situations can be successfully treated in a minimally invasive way, with the best results obtained with a combination of ESWL and percutaneous chemolysis. Alkalization of urine seemed to be insufficient in preventing stone formation. No difference in recurrence rate was observed between our two treatment groups.
对于胱氨酸结石患者，微创外科手术尤为可取，因为这些患者通常之前接受过多次手术，结石情况复杂，且复发风险高。共进行了24例胱氨酸结石治疗，其中12例采用体外冲击波碎石术（ESWL）作为单一疗法，12例采用ESWL与经皮灌注化学溶解液相结合的方法。在ESWL单一疗法组中，12个肾单位中有5个实现无结石，另有1例患者出院时无结石，但肾盏憩室中有1颗结石未治疗。联合治疗通常用于更复杂的结石情况，12个肾脏中有7个实现无结石。即使在该组中，仍有1例患者出院时肾盏憩室中有1颗残留结石未治疗。我们的结果表明，即使是复杂的胱氨酸结石情况也可以通过微创方式成功治疗，ESWL与经皮化学溶解相结合可取得最佳效果。尿液碱化在预防结石形成方面似乎不足。我们的两个治疗组之间未观察到复发率的差异。
