CAJ | 학술논문

目的探讨经输尿管导管或肾造瘘管肾盂内直接灌注碱性药物溶石治疗三聚氰胺所致婴儿双肾结石的有效性和安全性. 方法双肾结石合并急性肾后性肾功能衰竭婴儿15例.年龄5～12个月,平均9个月.结石直径0.4～1.5 cm,平均0.8 cm.15例患儿均长期食用受三聚氰胺污染的奶粉,经影像学和实验室检查诊断为急性肾后性肾功能衰竭.13例经尿道输尿管镜下通过输尿管导管行肾盂内碱性药物灌洗,20 m1 5%NaHCO3于10 min内缓慢冲洗,然后置入双J管.2例经皮肾穿刺留置肾造瘘管,术后间歇碱性药物灌洗,100 ml 1.4%NaHCO3于4～6 h内持续低压滴注,1次/d,持续2周. 结果 15例患儿均成功实施碱性药物肾盂内灌洗溶石治疗.术后2～5 d尿量恢复正常,2～3 d SCr、BUN恢复正常.13例术中经输尿管导管直接肾盂内灌注5%NaHCO3者,术中均观察到大量混浊液体自输尿管口喷涌而出.术后2周复查CT,结石消失13例,结石直径缩d~>50%者2例. 结论经输尿管导管或肾造瘘管进行肾盂内直接碱性药物化学溶石治疗三聚氰胺所致婴儿肾结石安全、有效.
목적 탐토경수뇨관도관혹신조루관신우내직접관주감성약물용석치료삼취청알소치영인쌍신결석적유효성화안전성. 방법쌍신결석합병급성신후성신공능쇠갈영인15례.년령5～12개월,평균9개월.결석직경0.4～1.5 cm,평균0.8 cm.15례환인균장기식용수삼취청알오염적내분,경영상학화실험실검사진단위급성신후성신공능쇠갈.13례경뇨도수뇨관경하통과수뇨관도관행신우내감성약물관세,20 m1 5%NaHCO3우10 min내완만충세,연후치입쌍J관.2례경피신천자류치신조루관,술후간헐감성약물관세,100 ml 1.4%NaHCO3우4～6 h내지속저압적주,1차/d,지속2주. 결과 15례환인균성공실시감성약물신우내관세용석치료.술후2～5 d뇨량회복정상,2～3 d SCr、BUN회복정상.13례술중경수뇨관도관직접신우내관주5%NaHCO3자,술중균관찰도대량혼탁액체자수뇨관구분용이출.술후2주복사CT,결석소실13례,결석직경축d~>50%자2례. 결론 경수뇨관도관혹신조루관진행신우내직접감성약물화학용석치료삼취청알소치영인신결석안전、유효.
Objective To evaluate the efficacy and safety of direct renal chemolysis with alkaline drug through ureteral catheter or nephrostomy tube for the treatment of infantile renal calculus resul-ted from melamine. Methods Fifteen infants of acute post-renal failure resulted from bilateral renal calculi were treated. The age of the infants was 5--12 months(average, 9 months). Stone size varied from 0.4 to 1.5 cm (average, 0.8 cm). They were all fed on milk powder polluted with melamine for a long time and diagnosed with acute post-renal failure based on the imaging and chemical examination. Double-J stents insertion by ureteroscope was performed on 13 infants and direct renal chemolysis with alkaline drng(5% NaHCO3,20 ml)through ureteral catheter was performed during operation. Percuta-neous nephrostomy was performed on 2 infants to remove the obstruction of upper urinary tract and di-rect renal chemolysis with alkaline drug(1.4% NaHCO3, continuous perfusion by gravity) through ne-phrostomy tube was performed intermittently after operation. Results Direct renal chemolysis was performed successfully on the 15 infants. The urine volume recovered in 2--5 d, blood urea nitrogen and serum creatinine recovered in 2--3 d postoperatively. During the operation of the infants treated by direct renal chemolysis with 5%NaHCO3 throuth ureteral catheter, a large number of limous fluid spurted from ureterostoma. According to CT examination 2 weeks after operation, the stone frag-ments were removed thoroughly in 13 infants, the diameter of the stone lessened more than 50% in 2 infants. Conclusion Direct renal chemolysis with alkaline drug for eliminating infantile renal cal-culus resulted from melamine is sale and effective.