Cohen T D, Streem S B, Lammert G K
Department of Urology, Cleveland Clinic Foundation, Ohio 44195.
J Urol. 1994 Oct;152(4):1091-4. doi: 10.1016/s0022-5347(17)32510-7.
We evaluate the efficacy of selectively applied minimally invasive management of calculi in 30 patients with urinary diversions (ileal/jejunal conduit in 23, cutaneous ureterostomy in 2, nonrefluxing colon conduit in 4 and ureterosigmoidostomy in 1). Upper tract calculi in 38 renal units were managed with extracorporeal shock wave lithotripsy or endo-urologically. Patients were divided into 3 treatment groups determined primarily by stone size and location: group 1-25 renal units with a mean stone burden of 1.78 cm.2 treated with extracorporeal shock wave lithotripsy alone, group 2-7 renal units with a mean stone burden of 12.75 cm.2 treated with percutaneous nephrostolithotomy alone and group 3-6 renal units with a mean stone burden of 19.03 cm.2 treated with a combination of both procedures. Stone-free results were 92%, 100% and 67% in groups 1 to 3, respectively. Total hospital stay averaged 4.3, 11.1 and 13.7 nights, while complications occurred in 1, 3 and 2 patients, respectively. We conclude that selective application of contemporary techniques for minimally invasive management of calculi in patients with a urinary diversion can provide acceptable results, even with progressively large and complex stone burdens, and that these results will be equivalent to those achieved in patients without urinary diversion.
我们评估了选择性应用微创方法治疗30例尿流改道患者结石的疗效（23例为回肠/空肠导管，2例为皮肤输尿管造口术，4例为抗反流结肠导管，1例为输尿管乙状结肠吻合术）。38个肾单位的上尿路结石采用体外冲击波碎石术或腔内泌尿外科手术治疗。患者主要根据结石大小和位置分为3个治疗组：第1组-25个肾单位，平均结石负荷为1.78 cm²，仅采用体外冲击波碎石术治疗；第2组-7个肾单位，平均结石负荷为12.75 cm²，仅采用经皮肾镜取石术治疗；第3组-6个肾单位，平均结石负荷为19.03 cm²，采用两种手术联合治疗。第1至3组的结石清除率分别为92%、100%和67%。平均住院天数分别为4.3、11.1和13.7晚，并发症分别发生在1例、3例和2例患者中。我们得出结论，对于尿流改道患者，选择性应用当代微创技术治疗结石即使结石负荷逐渐增大且复杂，也能取得可接受的结果，且这些结果与非尿流改道患者所取得的结果相当。
