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[尿石症结石内细菌的研究]

[A study on bacteria within stones in urolithiasis].

作者信息

Oka T, Hara T, Miyake O, Hosomi M, Matsumiya K, Takaha M, Tanaka M, Funahashi S, Toyomasu T, Kimura M

机构信息

Department of Urology, Osaka National Hospital.

出版信息

Hinyokika Kiyo. 1989 Sep;35(9):1469-74.

PMID:2816611
Abstract

The bacteria in 37 stones obtained from 37 patients with urinary stone diseases, that is, 11 renal stones (containing 2 staghorn calculi), 21 ureteral stones, 4 bladder stones and 1 urethral stone, were studied, according to the Nemoy & Stamey's method. The stones were collected by partial nephrectomy (1 case), nephrolithotomy (1 case), pyelolithotomy (1 case), percutaneous nephrolithotripsy (PNL) (6 cases), 12 ureterolithotomies, transurethral ureterolithotripsy (2 cases), cystolithotripsies (4 cases) and spontaneous deliveries (10 cases). According to a stone analysis by infrared spectrophotometer revealed 30 were noninfection stones (81.1%) and 7 infection stones (18.9%). Of these 37 stones, 5 stones (13.5% of 11 stones) had bacteria within them. These stones consisted of 4 infection stones (57.1% of all infection stones) and 1 noninfection stone (3.3% of all noninfection stones). Out of 4 patients having bacteria within their stones, urine culture of whom were carried out before stones were collected, only one patient (25%) had the same species of bacterium (E. coli) both within the stone and in urine. The E. coli within the stone and that in urine, however, showed quite different reactions to some antibiotics. The fact that all organisms within stones cannot be detected by urine culture before collecting stones of the patients in our present study, suggests that patients undergoing endourological surgery, such as extracorporeal shock wave lithotripsy and PNL, may have a risk of complications, such as severe urinary tract infection and urosepsis, if the possibility of the presence of organisms within stones is not taken into consideration.

摘要

采用Nemoy和Stamey的方法,对37例尿石症患者的37块结石中的细菌进行了研究。这些结石包括11块肾结石(含2块鹿角形结石)、21块输尿管结石、4块膀胱结石和1块尿道结石。结石的获取方式包括部分肾切除术(1例)、肾切开取石术(1例)、肾盂切开取石术(1例)、经皮肾镜取石术(PNL)(6例)、输尿管切开取石术12例、经尿道输尿管碎石术(2例)、膀胱碎石术(4例)以及自然排出(10例)。通过红外分光光度计进行的结石分析显示,30块为非感染性结石(81.1%),7块为感染性结石(18.9%)。在这37块结石中,有5块(占11块肾结石的13.5%)内部含有细菌。这些结石包括4块感染性结石(占所有感染性结石的57.1%)和1块非感染性结石(占所有非感染性结石的3.3%)。在4例结石内部含有细菌的患者中,在收集结石前进行了尿液培养,只有1例患者(25%)结石内部和尿液中的细菌种类相同(大肠杆菌)。然而,结石内的大肠杆菌和尿液中的大肠杆菌对某些抗生素的反应截然不同。在我们目前的研究中,患者在收集结石前通过尿液培养无法检测到结石内的所有微生物,这一事实表明,接受腔内泌尿外科手术(如体外冲击波碎石术和经皮肾镜取石术)的患者,如果不考虑结石内存在微生物的可能性,可能有发生严重尿路感染和尿脓毒症等并发症的风险。

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