摘要 肾结石是泌尿系统常见病,其发病率、复发率和治疗费用都很高。体外震波碎石术(ESWL)、经皮肾镜取石术(PCNL)、逆行肾内手术(RIRS)是目前治疗肾结石最常用的方式。首次接受治疗后的患者未来5～10年复发率约为50%。经过治疗后的残石大小和位置是决定后期是否出现临床症状和继续治疗的主要因素。ESWL后肾脏残石(RFs)<4 mm 或 PCNL、RIRS 后 RFs<2 mm 的患者应该每年行CT检查1次,同时密切随访。若非手术治疗无效,则建议通过输尿管镜进行治疗。RFs应该通过结石分析及明确结石形成原因来进行药物治疗,有助于提前预防结石复发和残石生长。
Bobulescu I A,Park S K,Xu L,et al.Net acid excretion and urinary organic anions in idiopathic uric acid nephrolithiasis[J].Clin J Am Soc Nephrol,2019,14(3):411-420.
[2]
Paleerath P,Visith T.Kidney stone prevention[J].Adv Nutr,2023,14 (3):555-569.
[3]
Obek C,Onal B,Kantay K,et al.The efficacy of extracorporeal shock wave lithotripsy for isolated lower pole calculi compared with isolated middle and upper caliceal[J].J Urol,2001,166(6):2081-2085.
[4]
Turna B,Ekren F, Nazli O,et al.Comparative results of shockwave lithotripsy for renal calculi in upper, middle, and lower calices[J]. J Endourol, 2007,21(9):951-956.
[5]
Sozen S,Kupeli B,Acar C,et al.Significance of lower-pole pelvicaliceal anatomy on stone clearance after shockwave lithotripsy in nonobstructive isolated renal pelvic stones[J]. J Endourol, 2008,22(5),877-881.
[6]
Park J,Hong B,Park T,et al.Hyung.Effectiveness of noncontrast computed tomography in evaluation of residual stones after percutaneous nephrolithotomy[J]. J Endourol, 2007,21(7):684-687.
[7]
Ben Saddik M A,Al-Qahtani Sejiny S,Ndoye M,et al.Flexible ureteroscopy in the treatment of kidney stone between 2 and 3 cm[J].Prog Urol, 2011,21(5):327-332.
[8]
Breda A,Ogunyemi O,Leppert J T,et al.Flexible ureteroscopy and laser lithotripsy for multiple unilateral intrarenal stones[J]. Eur Urol, 2009,55(5):1190-1197.
[9]
Chen W C,Chou W H,Chu H W,et al.The Rs1256328 (ALPL) and Rs12654812 (RGS14) polymorphisms are associated with susceptibility to calcium nephrolithiasis in a Taiwanese population[N].Sci Rep,2019,9(1):17296.
[10]
Türk C,Knoll T,Petrik A,et al.Residual Stones[M].Arnhem:EAU Guidelines of Urolithiasis,2011.
[11]
Afshar K, McLorie G, Papanikolaou F,et al.Outcome of small residual stone fragments following shock wave lithotripsy in children[J]. J Urol, 2004,172(4):1600-1603.
[12]
Candau C,Saussine C,Lang H,et al.Natural history of residual renal stone fragments after ESWL[J]. Eur Urol, 2000,37(1):18-22.
[13]
Osman M M,Alfano Y,Kamp S,et al.5-Year-follow-up of patients with clinically insignificant residual fragments after extracorporeal shockwave lithotripsy[J]. Eur Urol,2005,47(6):860-864.
[14]
Türk C, Petrik A, Sarica K,et al.EAU guidelines on interventional treatment for urolithiasis[J]. Eur Urol, 2016, 69(3): 475-482.
[15]
Nahas A R,Assmy A M,Madbouly K,et al.Predictors of clinical significance of residual fragments after extracorporeal shockwave lithotripsy for renal stones[J]. J Endourol, 2006,20(11):870-874.
[16]
Rassweiler J J,Renner C,Chaussy C,et al.Treatment of renal stones by extracorporeal shockwave lithotripsy: An update[J]. Eur Urol, 2001,39(2):187-199.
Raman J D,Bagrodia A,Gupta A,et al.Natural history of residual fragments following percutaneous nephrostolithotomy[J] . J Urol,2009, 181(3):1163-1168.
[23]
Altunrende F,Tefekli A,Stein R J,et al.Clinically insignificant residual fragments after percutaneous nephrolithotomy:medium-term follow-up[J].J Endourol,2011,25(6):941-945.
[24]
Lojanapiwat B,Tanthanuch M,Pripathanont C,et al.Alkaline citrate reduces stone recurrence and regrowth after shockwave lithotripsy and percutaneous nephrolithotomy[J].Int Braz J Urol,2011,37(5):611-616.
Perlmutter A E,Talug C,Tarry W F,et al.Impact of stone location on success rates of endoscopic lithotripsy for nephrolithiasis[J]. Urology, 2008,71(2): 214-217.
[31]
Tanriverdi O,Silay M S,and Miroglu C.Computed tomography-determined stone-free rates for ureteroscopy of upper tract stones[J]. J Endourol, 2009,23(11):379-382.
[32]
Rebuck D A,MacEjko A,Bhalani V,et al.The natural history of renal stone fragments following ureteroscopy[J].Urology, 2011,77(3):564-568.
[33]
Cicerello E,Merlo F,Gambaro G,et al.Effect of alkaline citrate therapy on clearance of residual renal stone fragments after extracorporeal shock wave lithotripsy in sterile calcium and infection nephrolithiasis patients[J]. J Urol,1994,151(1):5-9.
[34]
Fine J K,Pak C Y C,Preminger G M,et al. Effect of medical management and residual fragments on recurrent stone formation following shock wave Lithotripsy[J]. J Urol,1995,153(1):27-33.
[35]
Kang D E,Maloney M M,Haleblian G E,et al.Effect of medical management on recurrent stone formation following percutaneous nephrolithotomy[J]. J Urol,2007,177(5):1785-1789.
[36]
Sarica K,Erturhan S,Yurtseven C,et al.Effect of potassium citrate therapy on stone recurrence and regrowth after extracorporeal shockwave lithotripsy in children[J]. J Endourol,2006,20(11): 875-879.
[37]
Soygür T,Akbay A,Küpeli S.Effect of potassium citrate therapy on stone recurrence and residual fragments after shockwave lithotripsy in lower caliceal calcium oxalate urolithiasis:a randomized controlled trial[J]. J Endourol, 2002,16(3):149-152.
Koo V,Young M,Thompson T,et al.Cost- effectiveness and efficiency of shockwave lithotripsy vs flexible ureteroscopic holmium:yttrium-aluminium-garnet laser lithotripsy in the treatment of lower pole renal calculi[J]. BJU Int, 2011.
[40]
Hyams E S and Shah O.Percutaneous nephrostolithotomy versus flexible ureteroscopy/holmium laser lithotripsy: cost and outcome analysis[J]. J Urol,2009,182(3):1012-1017.
[41]
Lotan Y,Cadeddu J A,and Pearle M S.International comparison of cost effectiveness of medical management strategies for nephrolithiasis[J].Urol Res, 2005,33(3):223-230.
2024, Vol. 35 
