A formal test of the hypothesis that idiopathic calcium oxalate stones grow on Randall's plaque.
A formal test of the hypothesis that idiopathic calcium oxalate stones grow on Randall's plaque.
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DOI：
10.1111/j.1464-410x.2008.08193.x
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发表时间：
2009-04
影响因子：
4.5
通讯作者：
Lingeman JE
中科院分区：
文献类型：
--
作者：
Miller NL;Gillen DL;Williams JC Jr;Evan AP;Bledsoe SB;Coe FL;Worcester EM;Matlaga BR;Munch LC;Lingeman JE
为了证实超过一半的特发性草酸钙结石生长在间质斑块上，因为草酸钙结石可以附着在间质磷灰石斑块上生长，但这是否是通常的结石形成机制尚不确定。在9例接受经皮肾镜取石或输尿管镜检查的特发性CaOx结石患者中，采用数字内窥镜对所有可触及的肾乳头进行了成像。所有结石被完整地取出，并由外科医生记录为附着或未附着；对于所有附着的结石，外科医生确定附着的部位是否在斑块上。通过回顾术中视频记录进一步验证了这一结论，只有在视频中可靠地看到斑块的情况下才用于分析。显微计算机断层扫描分析和乳头状活检相结合进一步验证了手术观察。采用固定样本检验和分组序贯抽样对结果进行统计分析。这9名患者共有115颗结石，主要是CaOx；附90块石头。其中，81个附着在空斑上；外科医生无法清晰地观察到其他9例患者的附着部位。根据这些数据，斑块附着结石数量的最终点估计值为0.754（95%置信区间0.575-0.933;P = 0.013）。在ICSF中，大多数结石附着在斑块上的乳头上生长，因此斑块上的生长是这一非常常见的患者结石形成的主要机制。
To confirm that more than half of all idiopathic calcium oxalate (CaOx) stones grow on interstitial plaque, as CaOx stones can grow attached to interstitial apatite plaque but whether this is the usual mechanism of stone formation is uncertain. In nine idiopathic CaOx stone formers (ICSF) undergoing percutaneous nephrolithotomy or ureteroscopy all accessible renal papillae were endoscopically imaged using a digital endoscope. All stones were removed intact, and recorded by the operating surgeon as being attached or unattached; for all attached stones the surgeon determined if the site of attachment was to plaque. This determination was further verified by reviewing the intraoperative video record, and only instances where plaque was reliably seen on video were used for analysis. Surgical observations were further validated by a combination of microcomputed tomographic analysis and papillary biopsy. The results were analysed statistically using fixed-sample testing and group sequential sampling. The nine patients had a total of 115 stones, primarily CaOx; 90 stones were attached. Of these, 81 were attached to plaque; surgeons could not visualize the site of attachment with sufficient clarity to judge in the other nine cases. Based on these data, the final point estimate for the number of stones attached to plaque was 0.754 (95% confidence interval 0.575–0.933; P = 0.013). In ICSF most stones grow attached to papillae, on plaque, so growth on plaque is the main mechanism for stone formation in this very common group of patients.