Management of cystinuric patients: An observational, retrospective, single-centre analysis
Management of cystinuric patients: An observational, retrospective, single-centre analysis
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DOI：
10.1159/000112603
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发表时间：
2008-01-01
影响因子：
1.6
通讯作者：
Dasgupta, Prokar
中科院分区：
文献类型：
--
作者：
Ahmed, Kamran;Khan, Mohammad Shamim;Dasgupta, Prokar
目的：对过去6年来在我科治疗的胱氨酸结石患者的治疗进行了严格的评价，并分析了多种治疗方法的结果。研究设计：一项观察性、单中心回顾性研究.方法：我们回顾了1998年至2005年6年期间所有结石患者的记录。记录的数据包括人口统计学详细信息、接受/处方的药物治疗、药物治疗依从性、治疗模式、结石清除和研究期间的任何复发。结果：从1998年到2005年初的6年间，共有30例胱氨酸尿症患者在我院接受治疗。其中16例为男性，14例为女性，末次随访时的平均年龄为39岁（范围15 - 70岁）。2名患者成功接受了药物治疗。其余患者（n = 28）共接受了237次手术（转诊至我们单位前后），平均每例患者接受7.9次手术，共发生126次结石事件（4.2次事件/患者）。治疗方式包括体外冲击波碎石术（n = 143）、输尿管肾镜碎石术（n = 50）、经皮肾镜取石术（n = 28）和开放手术（n = 16）。两名患者需要在我们单位进行开放手术。在转诊到我们的专用科室之前，患者接受了体外冲击波碎石术（多次）、输尿管镜检查（n = 14）、经皮肾镜取石术（n = 4）和开放取石术（n = 14）治疗。我们单位的大多数结石都是使用微创治疗进行管理的。结论：胱氨酸尿症患者对药物治疗的依从性通常较差，并且患者经历需要多次干预的复发性结石发作。胱氨酸结石的现代治疗应采用分期微创手术，以避免多次开放手术的并发症，只要可能，沿着适当的药物预防。版权所有（C）2008 S. Karger AG，巴塞尔。
Objective: A critical appraisal of the management of patients with cystine stones treated in our unit in the past 6 years and to analyze the outcome of multimodality therapies. Study Design: An observational, single- centre retrospective study. Methods: We reviewed the records of all patients with stones referred to our centre over a 6- year period from 1998 to 2005. Data recorded included demographic details, medical therapies received/ prescribed, compliance with medical therapies, mode of treatment, stone clearance and any recurrence during this period of study. Results: A total of 30 cystinuric patients were treated in our institution over the period of 6 years from 1998 to early 2005. Of these 16 were males and 14 females with an average age at last follow-up of 39 years ( range 15 - 70). Two patients were successfully managed medically. The remaining patients ( n = 28) underwent a total of 237 procedures ( pre- and postreferral to our unit), with an average of 7.9 procedures per patient for 126 stone episodes ( 4.2 episodes/ patient). The modes of treatment included extracorporeal shockwave lithotripsy ( n = 143), ureterorenoscopy and intracorporeal lithotripsy (n = 50), percutaneous nephrolithotomy ( n = 28) and open procedures ( n = 16). Two patients needed open surgery at our unit. Prior to referral to our dedicated unit, patients had received treatment with extracorporeal shockwave lithotripsy ( multiple sessions), ureteroscopy ( n = 14), percutaneous nephrolithotomy ( n = 4) and open stone removal ( n = 14). Most of the stones at our unit were managed using minimally invasive therapies. Conclusion: Compliance of cystinuric patients with medical treatment is often poor and patients experience recurrent stone episodes requiring multiple interventions. Modern management of cystine calculi should be with staged minimally invasive procedures to avoid the complications of multiple open procedures wherever possible along with appropriate medical prophylaxis. Copyright (C) 2008 S. Karger AG, Basel.