肾结石合并高钙血症4例报告及文献复习  

Renal calculi with hypercalcemia:a report of 4 cases and literature review

作　　者：赵磊[1] 尹水平[1] 阮厚鑫[1] 郝宗耀[1] ZHAO Lei;YIN Shuiping;RUAN Houxin;HAO Zongyao(Department of Urology,The First Affiliated Hospital of Anhui Medical University,Hefei 230021,China)

机构地区：[1]安徽医科大学第一附属医院泌尿外科,安徽合肥230021

出　　处：《现代泌尿外科杂志》2021年第10期863-866,共4页Journal of Modern Urology

摘　　要：目的探讨肾结石合并高钙血症的病因、诊断和治疗。方法回顾性分析安徽医科大学第一附属医院泌尿外科2020年1月至2021年3月因肾结石合并高钙血症住院的4例患者的临床资料,分析高钙血症的原因及与肾结石的关系,探讨肾结石合并高钙血症的常见病因、诊断和治疗。结果男性2例,女性2例,年龄34~66岁。3例患者因原发性甲状旁腺功能亢进(PHPT)导致高钙血症,予降钙治疗后再行甲状旁腺手术,术后病理:2例甲状旁腺增生,1例腺瘤;2~4周后行2期经皮肾镜碎石术,手术均成功。3例PHPT患者甲状旁腺手术前、后中位血钙[3.38(3.14~3.56)vs.1.95(1.87~2.14)mmol/L]、甲状旁腺激素(PTH)[1326(1110~1885)vs.31.5(5.77~294)pg/mL]水平比较差异有统计学意义(P<0.05)。随访6~36个月,结石无复发。另1例高钙血症患者合并有肾恶性肿瘤伴骨转移,高血钙与骨转移有关,恶液质表现,2个月后死亡。结论肾结石合并高钙血症常见原因有PHPT和恶性肿瘤骨转移,前者更多见。PHPT导致的高钙血症行甲状旁腺腺瘤切除,可恢复血钙水平,减少肾结石复发。Objective To investigate to the etiology,diagnosis and treatment of renal calculi with hypercalcemia.Methods The clinical data of 4 cases of renal calculi with hypercalcemia treated in our department during Jan.2020 and Mar.2021 were retrospectively analyzed.The causes of hypercalcemia and its relationship with renal calculi were analyzed.The common causes,diagnosis and treatment were also analyzed.Results There were 2 males and 2 females,aged 34 to 66 years.In 3 cases,the hypercalcemia was caused by primary hyperparathyroidism(PHPT).Parathyroid adenoma resection was performed after hypercalcemia treatment.Postoperative pathology showed parathyroid hyperplasia in 2 cases and adenoma in 1 case.Percutaneous nephrolithotomy was performed successfully 2 to 4 weeks later.There were significant differences in median serum calcium[3.38(3.14-3.56)vs.1.95(1.87-2.14)mmol/L]and parathyroid hormone(PTH)[1326(1110-1885)vs.31.5(5.77-294)pg/mL]before and after parathyroid surgery in these patients(P<0.05).No recurrence of renal calculi was found during 6-36 months of follow-up.Another case of hypercalcemia was associated with malignant renal tumor and bone meta-stasis.The hypercalcemia was considered to be related to bone metastasis.The patient showed cachexia and died 2 months later.Conclusion PHPT and bone metastasis are the common causes of renal calculi with hypercalcemia,and the former is more common.For hypercalcemia caused by PHPT,parathyroid adenoma resection is needed to restore blood calcium so as to reduce the recurrence of renal calculi.

关 键 词：肾结石 高钙血症 原发性甲状旁腺功能亢进 

分 类 号：R692.4[医药卫生—泌尿科学]