Dretler S P, Young R H
Kidney Stone Center, Massachusetts General Hospital, Boston.
J Urol. 1993 Dec;150(6):1800-2. doi: 10.1016/s0022-5347(17)35899-8.
Ureteral stricture is a recognized complication of ureteroscopy and ureteral stone fragmentation. Although most strictures are either asymptomatic or easily dilated, there are some strictures that result in progressive ureteral obstruction, do not respond to ureteral dilation and require operative intervention. A review of 125 percutaneous nephrostolithotomies for staghorn stone disease and 652 ureteroscopic stone fragmentations revealed 5 cases in which refractory ureteral strictures developed, requiring operative intervention. In 4 patients a "stone granuloma," embedded particles of calcium oxalate associated with macrophages and foreign body giant cells, was found with surrounding fibrosis and ureteral obstruction. In the remaining patient a suture granuloma from a recent ureterolithotomy was the source of the stricture. In each instance of stone granuloma the particles of calcium oxalate had become embedded in the wall as a consequence of ureteroscopic stone fragmentation and partial ureteral wall disruption. During ureteroscopy and intracorporeal lithotripsy every effort should be made to prevent calcium oxalate particles from becoming embedded in the ureteral wall. They are not inert and may cause irreversible stricture formation. To our knowledge, stone granuloma is a previously undescribed phenomenon and should be suspected when ureteral strictures that occur following ureteroscopy do not respond to endourological methods of management.
输尿管狭窄是输尿管镜检查和输尿管结石碎石术公认的并发症。尽管大多数狭窄无症状或易于扩张，但仍有一些狭窄会导致输尿管进行性梗阻，对输尿管扩张无反应，需要手术干预。对125例鹿角形结石病经皮肾镜取石术和652例输尿管镜结石碎石术的回顾显示，有5例发生了难治性输尿管狭窄，需要手术干预。在4例患者中，发现了一种“结石性肉芽肿”，即与巨噬细胞和异物巨细胞相关的草酸钙嵌入颗粒，伴有周围纤维化和输尿管梗阻。在其余1例患者中，近期输尿管切开取石术后的缝线肉芽肿是狭窄的原因。在每例结石性肉芽肿中，草酸钙颗粒因输尿管镜结石碎石术和部分输尿管壁破坏而嵌入管壁。在输尿管镜检查和体内碎石术中，应尽一切努力防止草酸钙颗粒嵌入输尿管壁。它们并非惰性物质，可能会导致不可逆的狭窄形成。据我们所知，结石性肉芽肿是一种此前未被描述的现象，当输尿管镜检查后发生的输尿管狭窄对腔内泌尿外科治疗方法无反应时，应怀疑有结石性肉芽肿。
