Moon Y T, Kim S C
Department of Urology, College of Medicine, Chung-Ang University, Seoul, Korea.
J Endourol. 1993 Dec;7(6):453-6. doi: 10.1089/end.1993.7.453.
The stone-free rate of 248 cases of clinically insignificant residual fragments (CIRF) was 32.7% by 1 month, 73.0% by 3 months, and 92.7% by 6 months of follow-up. The stone-free rate decreased but not remarkably in accordance with the increment of the caliceal dilatation (92.9%, 94.9%, 85.7%, and 83.3% for no, mild, moderate, and severe dilatation, respectively) by 6 months of follow-up. The clearance of the CIRF was not influenced by their location, the pelviocaliceal angle, the infundibular length, or the number of the lower calices. Of 16 patients who had residual stone fragments at 6 months and underwent an additional session of extracorporeal shock wave lithotripsy (SWL), 12 became stone free by another 6 months of follow-up. Therefore, it is desirable to wait for clearance of CIRF for at least 6 months before offering further treatment, regardless of their location and anatomic variation of the calices containing CIRF. Repeated SWL, even for stone fragments of 3 to 4 mm in diameter found initially 1 month after the last session of SWL, might promote clearance of the CIRF, and additional SWL for persistent CIRF could be an appropriate adjunctive measure.
248例临床意义不大的残余结石碎片（CIRF）患者，随访1个月时结石清除率为32.7%，3个月时为73.0%，6个月时为92.7%。随访6个月时，结石清除率随肾盏扩张程度增加而降低，但降幅不显著（无扩张、轻度扩张、中度扩张和重度扩张患者的结石清除率分别为92.9%、94.9%、85.7%和83.3%）。CIRF的清除不受其位置、肾盂肾盏角、漏斗部长度或下肾盏数量的影响。16例6个月时仍有残余结石碎片并接受了额外一次体外冲击波碎石术（SWL）的患者，在随后6个月的随访中有12例结石清除。因此，无论CIRF的位置以及包含CIRF的肾盏的解剖变异情况如何，在提供进一步治疗前，最好等待至少6个月以观察CIRF是否清除。即使是在上次SWL术后1个月最初发现的直径3至4 mm的结石碎片，重复进行SWL也可能促进CIRF的清除，对持续存在的CIRF进行额外的SWL可能是一种合适的辅助措施。
