Parr N J, Ritchie A W, Smith G, Moussa S A, Tolley D A
Scottish Lithotriptor Centre, Western General Hospital, Edinburgh.
Br J Urol. 1991 Dec;68(6):565-7. doi: 10.1111/j.1464-410x.1991.tb15415.x.
Small persistent fragments (less than or equal to 4 mm) following extracorporeal shock wave lithotripsy have been termed clinically insignificant residual fragments (CIRF), but their presence may be associated with an increased rate of development of recurrent symptomatic renal calculi. We have adopted a policy of further extracorporeal piezoelectric shock wave lithotripsy (EPL) for patients with CIRF in an attempt to promote complete clearance. A series of 22 patients with a mean initial stone burden of 16 mm (range 7-48) developed CIRF after a median of 2 EPL treatment sessions (range 1-9). CIRF were in the lower calices (n = 20), middle calices (n = 1) and upper calices (n = 1). These calices were normal (n = 6), slightly dilated (n = 9), moderately dilated (n = 2) or grossly dilated (n = 5). After 6 to 14 months, patients underwent a further session of EPL. One month later, 3 patients with normal calices showed a considerable reduction in CIRF, but all other patients showed no change. When CIRF form in normal calices a further session of EPL may promote clearance. However, when calices containing CIRF are significantly dilated, further EPL is of no value.
体外冲击波碎石术后残留的小碎片（小于或等于4毫米）在临床上被称为无意义残留碎片（CIRF），但其存在可能与复发性有症状肾结石的发病率增加有关。我们采取了对患有CIRF的患者进一步进行体外压电冲击波碎石术（EPL）的策略，试图促进结石的完全清除。一系列22例患者，平均初始结石负荷为16毫米（范围7 - 48毫米），在中位2次EPL治疗疗程（范围1 - 9次）后出现CIRF。CIRF位于下盏（n = 20）、中盏（n = 1）和上盏（n = 1）。这些肾盏正常（n = 6）、轻度扩张（n = 9）、中度扩张（n = 2）或重度扩张（n = 5）。6至14个月后，患者接受了进一步的EPL治疗。1个月后，3例肾盏正常的患者CIRF明显减少，但其他所有患者均无变化。当CIRF在正常肾盏中形成时，进一步的EPL治疗可能促进结石清除。然而，当含有CIRF的肾盏明显扩张时，进一步的EPL治疗没有价值。
