サンゴ状結石の成り立ち

Abstract

サンゴ状結石の形成要因, 過程を臨床像の検討, 摘出結石の構築の観察より推定した.1)感染結石は核部も同一成分のものと核部が蓚酸結石の2種があり, 前者は膀胱機能障害やVURなどの感染の基礎疾患があり, 後者は蓚酸結石の形成後に感染が加わり変化したもので, 感染の要因として蓚酸結石形成そのものが考えられる.感染の基礎疾患のないものは一過性あるいはきわめて軽度の異常が推察される.2)代謝性結石はそれぞれ成分の高度の代謝異常があり, 結晶の折出, 凝集が結石形成増大の本体と思われる.3)感染結石と代謝性結石はいずれも形成速度は速く, 再発もしやすいため, その原因の検索を十分におこない, 対策を考える必要がある

To study the process of formation of staghorn calculi, 58 patients with staghorn calculi were evaluated clinically and the removed stones were studied architecturally. Of 35 patients with infection stones composed of struvite and/or apatite in the nuclei as well as peripheral layers, 18 had identified predisposing factors related to infection. Of 13 patients with infection stones containing calcium oxalate in the nuclei, 7 had predisposing factors of infection but only 2 had metabolic disorders. The patients with infection stones who had no predisposing factors may have transient or subclinical abnormalities. Initial stone formation of oxalate may also be one of the predisposing factors of infection. Most of the patients with staghorn calculi composed of uric acid, oxalate and cystine, had metabolic disorders related to these substances. Large numbers of bacteria and large amounts of organic matrix were found extensively within infection stones and were thought to be important components as well as crystals. Metabolic stones contained little matrix. In this case crystal aggregation is thought to play the most important role in stone formation.