三聚氰胺所致婴幼儿尿路结石的综合治疗分析  

Comprehensive therapy of the infant urinary calculus induced by melamine

作　　者：张伟[1] 李文辉[1] 马文强[1] 李伟文[1] 贾兴明 闫红英[1] 吴永胜[1] 陈晓红[1] 路媛[1] 詹红丽[1] 郎晓玲[1] 

机构地区：[1]解放军第一医院泌尿外科,兰州730030

出　　处：《中华泌尿外科杂志》2009年第3期181-187,共7页Chinese Journal of Urology

摘　　要：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0．5～2．5cm；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0．4～1．1cm；膀胱结石合并尿潴留5例，尿道结石合并尿潴留lO例，结石直径0．5～1．3cm。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5～10d2例、无尿1～5d13例，实验室检查BUN平均32．3mmol／L，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0．15g，2次／d；23例口服柠檬酸氢钾钠2．4g／d；47例口服10％柠檬酸钾溶液，5ml，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SPSS13．0软件分析。结果组①患儿术后12～24h内即出现多尿，多尿期持续24～72h，尿量8002500ml／24h，术后48～96h尿量逐渐恢复正常，术后1～5dBUN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 uri- nary calculi were confirmed by B-ultrasound 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 calcus with acute urinary retention were treated by EMS through ureter- scope per urethra. Group 4.. The rest 183 cases without urinary obstruction received 1-8 week＇s urine 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 bicar- bonate. During treatment with alkalinity drug,

关 键 词：尿路结石 婴儿 三聚氰胺 综合疗法 

分 类 号：R686[医药卫生—骨科学]