Husmann D A, Milliner D S, Segura J W
Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Urol. 1995 May;153(5):1399-402.
We reviewed 111 patients who presented with simultaneous renal calculi and a ureteropelvic junction obstruction. Of 34 patients with ureteropelvic junction obstruction and a coexisting struvite stone 62% had recurrent calculi. The use of antibiotics significantly affected the incidence of recurrent struvite calculi. In particular, if prolonged prophylactic antibiotics (greater than 3 months) were used 15% of the patients had recurrent stones, compared to 90% if only perioperative antibiotics (less than 15 days) were used (p < 0.001). Patients with ureteropelvic junction obstruction and coexisting nonstruvite calculi were treated by either observation alone (53) or metabolic evaluation with appropriate intervention (24). Metabolic evaluation of patients with nonstruvite calculi revealed that 76% had an identifiable metabolic abnormality, treatment of which significantly decreased the incidence of recurrent renal calculi: 17% of the patients on interventional therapy had recurrent stones compared to 55% treated by observation alone (p < 0.001).
我们回顾了111例同时患有肾结石和输尿管肾盂连接处梗阻的患者。在34例输尿管肾盂连接处梗阻并伴有鸟粪石结石的患者中，62%有复发性结石。抗生素的使用显著影响鸟粪石复发性结石的发生率。特别是，如果使用长期预防性抗生素（超过3个月），15%的患者有复发性结石，而仅使用围手术期抗生素（少于15天）时这一比例为90%（p<0.001）。输尿管肾盂连接处梗阻并伴有非鸟粪石结石的患者，要么仅接受观察（53例），要么进行代谢评估并给予适当干预（24例）。对非鸟粪石结石患者的代谢评估显示，76%有可识别的代谢异常，对其进行治疗可显著降低复发性肾结石的发生率：接受介入治疗的患者中有17%出现复发性结石，而仅接受观察治疗的患者中这一比例为55%（p<0.001）。
