目的 总结含三聚氰胺配方奶粉所致婴幼儿尿路结石的治疗手段及疗效.方法 有三鹿奶粉喂养史尿路结石患儿228例.男165例,女63例,年龄4个月～3岁.平均11个月.双肾结石144例.单侧肾结石54例.结石直径0.5～2.5 cm;双侧输尿管结石合并中重度肾积水8例.一侧输尿管结石合并中重度肾积水7例,结石直径0.4～lI 1 cm;膀胱结石合并尿潴留5例,尿道结石合并尿潴留10例,结石直径O.5～1.3 cm.患儿均经B超、CT检查确诊.分4组:①肾功能衰竭组15例(6.6%),少尿5～10 d 2例、无尿1～5 d 13例,实验室检查BUN平均32一mmol/I,SCr平均750μmol/L.13例采用经尿道输尿管镜下碎石、碱性药物溶石、双J管置入术,术后碱性药物溶石治疗;2例在B超引导下行经皮肾穿刺造瘘引流术、肾盂内间歇性碱性药物灌洗溶石.②输尿管结石合并中重度肾积水15例,行输尿管镜下碎石清石、双J管置入术及碱性药物溶石治疗.③膀胱、尿道结石合并急性尿潴留15例,采用经尿道输尿管镜下第三代碎石清石系统碎石清石.④单纯肾结石183例,采用碱性药物治疗1～8周.其中113例口服碳酸氢钠片0.15 g,2次/d;23例口服柠檬酸氢钾钠2.4 g/d;47例口服10%柠檬酸钾溶液,5 m1,3次/d.61例经碱性药物治疗＞8周疗效差者行ESWL及碳酸氢钠注射液溶石治疗,尿pH＞7.5时停药.对有肾功能损害患儿每天复查肾功、电解质直至正常.228例患儿随访1～3个月.统计数据采用SPSS 13.0软件分析.结果 组①患儿术后12～24 h内即出现多尿,多尿期持续24～72 h.尿量800～2500 ml/24 h,术后48～96 h尿量逐渐恢复正常,术后1～5 d BuN及SCr均恢复正常,1～2周4例肾、输尿管结石基本排净,2～4周15例结石全部排净.组②患儿治疗后1～2周结石完全排净.组③患儿经微创手术均一次性清除结石,立即恢复正常排尿,3 d后复查B超,膀胱、尿道内均无残余结石.组④经碳酸氢钠治疗组结石2周排净4例,4周排净18例,13周排净15例,8周后结石明显变小变淡34例,结石无明显变化42例;口服柠檬酸氧钾钠治疗组结石1周排净4例,2周排净7例,4周排净10例,6周排净2例;口服10%柠檬酸钾溶液组结石1周排净3例.2周排净5例,4周排净16例,8周排净11例,8周后结石明显变小变淡8例,结石无变化4例.柠檬酸盐治疗组与碳酸氢钠治疗组疗效比较差异有统计学意义(P-O.001),柠檬酸盐组内比较差异无统计学意义(P=0.372).61例患儿行ESWL及继续碱性药物溶石治疗患儿1～6周结石排净49例,结石缩小8例,无明显变化4例.结论 三聚氰胺所致婴幼儿尿路结石早期以内科观察治疗为主,发生急性肾功能衰竭、输尿管中重度积水及下尿路急性梗阻时应以外科干预为主,解除梗阻、保护肾功能、恢复正常排尿.治疗后期,结石特点发生变化,单纯碱性药物治疗无效者应采用ESWL治疗.
目的 總結含三聚氰胺配方奶粉所緻嬰幼兒尿路結石的治療手段及療效.方法 有三鹿奶粉餵養史尿路結石患兒228例.男165例,女63例,年齡4箇月～3歲.平均11箇月.雙腎結石144例.單側腎結石54例.結石直徑0.5～2.5 cm;雙側輸尿管結石閤併中重度腎積水8例.一側輸尿管結石閤併中重度腎積水7例,結石直徑0.4～lI 1 cm;膀胱結石閤併尿潴留5例,尿道結石閤併尿潴留10例,結石直徑O.5～1.3 cm.患兒均經B超、CT檢查確診.分4組:①腎功能衰竭組15例(6.6%),少尿5～10 d 2例、無尿1～5 d 13例,實驗室檢查BUN平均32一mmol/I,SCr平均750μmol/L.13例採用經尿道輸尿管鏡下碎石、堿性藥物溶石、雙J管置入術,術後堿性藥物溶石治療;2例在B超引導下行經皮腎穿刺造瘺引流術、腎盂內間歇性堿性藥物灌洗溶石.②輸尿管結石閤併中重度腎積水15例,行輸尿管鏡下碎石清石、雙J管置入術及堿性藥物溶石治療.③膀胱、尿道結石閤併急性尿潴留15例,採用經尿道輸尿管鏡下第三代碎石清石繫統碎石清石.④單純腎結石183例,採用堿性藥物治療1～8週.其中113例口服碳痠氫鈉片0.15 g,2次/d;23例口服檸檬痠氫鉀鈉2.4 g/d;47例口服10%檸檬痠鉀溶液,5 m1,3次/d.61例經堿性藥物治療＞8週療效差者行ESWL及碳痠氫鈉註射液溶石治療,尿pH＞7.5時停藥.對有腎功能損害患兒每天複查腎功、電解質直至正常.228例患兒隨訪1～3箇月.統計數據採用SPSS 13.0軟件分析.結果 組①患兒術後12～24 h內即齣現多尿,多尿期持續24～72 h.尿量800～2500 ml/24 h,術後48～96 h尿量逐漸恢複正常,術後1～5 d BuN及SCr均恢複正常,1～2週4例腎、輸尿管結石基本排淨,2～4週15例結石全部排淨.組②患兒治療後1～2週結石完全排淨.組③患兒經微創手術均一次性清除結石,立即恢複正常排尿,3 d後複查B超,膀胱、尿道內均無殘餘結石.組④經碳痠氫鈉治療組結石2週排淨4例,4週排淨18例,13週排淨15例,8週後結石明顯變小變淡34例,結石無明顯變化42例;口服檸檬痠氧鉀鈉治療組結石1週排淨4例,2週排淨7例,4週排淨10例,6週排淨2例;口服10%檸檬痠鉀溶液組結石1週排淨3例.2週排淨5例,4週排淨16例,8週排淨11例,8週後結石明顯變小變淡8例,結石無變化4例.檸檬痠鹽治療組與碳痠氫鈉治療組療效比較差異有統計學意義(P-O.001),檸檬痠鹽組內比較差異無統計學意義(P=0.372).61例患兒行ESWL及繼續堿性藥物溶石治療患兒1～6週結石排淨49例,結石縮小8例,無明顯變化4例.結論 三聚氰胺所緻嬰幼兒尿路結石早期以內科觀察治療為主,髮生急性腎功能衰竭、輸尿管中重度積水及下尿路急性梗阻時應以外科榦預為主,解除梗阻、保護腎功能、恢複正常排尿.治療後期,結石特點髮生變化,單純堿性藥物治療無效者應採用ESWL治療.
목적 총결함삼취청알배방내분소치영유인뇨로결석적치료수단급료효.방법 유삼록내분위양사뇨로결석환인228례.남165례,녀63례,년령4개월～3세.평균11개월.쌍신결석144례.단측신결석54례.결석직경0.5～2.5 cm;쌍측수뇨관결석합병중중도신적수8례.일측수뇨관결석합병중중도신적수7례,결석직경0.4～lI 1 cm;방광결석합병뇨저류5례,뇨도결석합병뇨저류10례,결석직경O.5～1.3 cm.환인균경B초、CT검사학진.분4조:①신공능쇠갈조15례(6.6%),소뇨5～10 d 2례、무뇨1～5 d 13례,실험실검사BUN평균32일mmol/I,SCr평균750μmol/L.13례채용경뇨도수뇨관경하쇄석、감성약물용석、쌍J관치입술,술후감성약물용석치료;2례재B초인도하행경피신천자조루인류술、신우내간헐성감성약물관세용석.②수뇨관결석합병중중도신적수15례,행수뇨관경하쇄석청석、쌍J관치입술급감성약물용석치료.③방광、뇨도결석합병급성뇨저류15례,채용경뇨도수뇨관경하제삼대쇄석청석계통쇄석청석.④단순신결석183례,채용감성약물치료1～8주.기중113례구복탄산경납편0.15 g,2차/d;23례구복저몽산경갑납2.4 g/d;47례구복10%저몽산갑용액,5 m1,3차/d.61례경감성약물치료＞8주료효차자행ESWL급탄산경납주사액용석치료,뇨pH＞7.5시정약.대유신공능손해환인매천복사신공、전해질직지정상.228례환인수방1～3개월.통계수거채용SPSS 13.0연건분석.결과 조①환인술후12～24 h내즉출현다뇨,다뇨기지속24～72 h.뇨량800～2500 ml/24 h,술후48～96 h뇨량축점회복정상,술후1～5 d BuN급SCr균회복정상,1～2주4례신、수뇨관결석기본배정,2～4주15례결석전부배정.조②환인치료후1～2주결석완전배정.조③환인경미창수술균일차성청제결석,립즉회복정상배뇨,3 d후복사B초,방광、뇨도내균무잔여결석.조④경탄산경납치료조결석2주배정4례,4주배정18례,13주배정15례,8주후결석명현변소변담34례,결석무명현변화42례;구복저몽산양갑납치료조결석1주배정4례,2주배정7례,4주배정10례,6주배정2례;구복10%저몽산갑용액조결석1주배정3례.2주배정5례,4주배정16례,8주배정11례,8주후결석명현변소변담8례,결석무변화4례.저몽산염치료조여탄산경납치료조료효비교차이유통계학의의(P-O.001),저몽산염조내비교차이무통계학의의(P=0.372).61례환인행ESWL급계속감성약물용석치료환인1～6주결석배정49례,결석축소8례,무명현변화4례.결론 삼취청알소치영유인뇨로결석조기이내과관찰치료위주,발생급성신공능쇠갈、수뇨관중중도적수급하뇨로급성경조시응이외과간예위주,해제경조、보호신공능、회복정상배뇨.치료후기,결석특점발생변화,단순감성약물치료무효자응채용ESWL치료.
Objective To explore the comprehensive therapy of infants with urinary calculus induced by melamine.Methods Clinical data of 228 infants(aged from 4 months to 3 years,mean age 11 months)with urinary calculus induced by melamine were analyzed. Bilateral renal calculi were found in 144 cases and one-side renal calculus in 54 cases,of which the diameter ranged from 0.5-2.5 cm.Ureteral calculi with moderate to severe hydronephrosis were found in 15 cases,of which the diameter ranged from 0.4-1.1 cm. Bladder calculi with urinary retention were found in 5 cases and urethral calculi with urinary retention in 10 cases,of which the diameter ranged from 0.5-1.3 cm. All the urinary calculi were confirmed by B-uhrasound examination and CT. Group 1 : Of the 15 cases with acute renal failure, 13 underwent shattering and dissolving renal and ureternal calculus by pelvis clysis with alkalinity drug, detaining double J tubes through ureteroscope. After operation, these patients were treated with alkalinity drugs. Two cases were treated by percutaneous nephrostomy guided by B ultrasound and underwent shattering and dissolving renal calculus by intermittent pelvis clysis with alkinity drug. Group 2:15 cases of ureteral calculus with serious nephrohydrops underwent shattering and detaining double J tubes through ureteroscope, then treated with alkalinity drug. Group 3:15 cases of infant bladder and urethral caleus with acute urinary retention were treated by EMS through ureterscope per urethra. Group 4: The rest 183 cases without urinary obstruction received 1-8 week'surine alkalization therapy. Among them, 113 cases received sodium bicarbonate 0.15 g twice per day,23 cases received potassium sodium hydrogen citrate 2.4g/d, and 47 cases received 10% potassium citrate solution 5 ml 3 times per day. Sixty-one cases who were of no effect with alkalinity drug were treated by extracorporeal shock wave lithotripsy (ESWL) and dissolving calculus with sodium bicarbonate. During treatment with alkalinity drug, urine Ph was observed by urine analysis once per day.When it exceeded 7.5, alkalinity drug. Was withdrawn. All the patients were followed up for 1 to 3 months. Statistical analysis was done with the SPSS 13.0 software. ResultsHyperdiuresis emerged 12-24 h after operation in group 1. The duration of hyperdiuresis was 24-72 h with the urine volume of 800-2500 ml/24h. Urine volume revived gradually 48--96h after operation while serum BUN and Cr revived 1-5 d after operation. Four cases with renal and ureteral calculus became almost stone-free in 1-2 weeks and 14 cases became completely stone-free in 2-4 weeks after operation. Patients of group 2 became completely stone-free in 1-2 weeks. Patients of group 3 were cured by one EMS session through ureterscope per urethra and smooth urination was seen immediately after operation. No retained calculus in the bladder and urethra was found by B ultrasound 3 days later. In the sodium bicarbonate group, 4 cases became completely stone-free in 2 weeks, 18 cases in 4 weeks, 15cases in 13 weeks. The stones lessened and faded in 34 cases and had no changes in 42 cases. In the potassiun sodium hydrogen citrate group, 4 cases became completely stone-free in 1 weeks, 7 cases in 2 weeks, 10 cases in 4 weeks, 2 cases in 6 weeks. In the potassium citrate group, 3 cases became completely stone-free in 1 weeks, 5 cases in 2 weeks, 16 cases in 4 weeks, 11 cases in 8 weeks. The stones lessened and faded in 8 cases in 8 weeks and had no changes in 4 cases. The efficacy of the sodium bicarbonate group was significantly different with the efficacy of the citrate group (P=0. 001). No significant difference was found between the potassium sodium hydrogen citrate group and the potassium citrate solution group(P=0. 372). ConclusionsConservative treatment should be employed mainly in the earlier stage for the infant urinary calculus induced by melamine . When the diagnosis of acute renal failure, moderate to severe hydronephrosis and acute lower urinary tract obstruction are established, surgical intervention should be the main method to relieve obstruction, protect renal function and resume normal rnicturition. With the development of the characteristics of the stones later,the oral dissolution therapy with alkalirtity drug could not dissolve the calculi and ESWL should be employed.
