儿童泌尿系结石临床治疗的疗效评估与代谢特征分析  

Clinical evaluation and metabolic characteristics of urinary calculi in children

作　　者：魏云飞[1] 汤井源 唐雷 马雪中[1] 陈雪花[1] 顾晓箭[1] 徐彦[1] WEI Yun-fei;TANG Jing-yuan;TANG Lei;MA Xue-zhong;CHEN Xue-hua;GU Xiao-jian;XU yan(Department of Urology,Jiangsu Province Hospital of Chinese Medicine,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,Jiangsu,China)

机构地区：[1]江苏省中医院(南京中医药大学附属医院)泌尿外科,南京210029

出　　处：《医学研究生学报》2021年第12期1288-1292,共5页Journal of Medical Postgraduates

摘　　要：目的儿童泌尿系结石发病率越來越高,针对儿童泌尿系统结石的治疗越来越重要文中旨在探讨江苏地区儿童泌尿系结石临床治疗的疗效评佔代谢特征,方法回顾性分析2016年6月至2019年6月江苏省中医院泌尿外科收治的82例江苏地区儿童泌尿系结石患者临床资料将82例患儿分为4个年龄段,分别为婴幼儿期(0岁≤年龄<3岁)、学龄前期(3岁≤年龄<6岁)、学龄期(6岁≤年龄<11岁)、青春期(11岁≤年龄<14岁)根据结石的部位、大小、硬度、结石成分、患肾积水程度及肾功能情况,采取经皮肾镜、输味管软镜、输尿管硬镜手术或体外冲击波碎石术。临床疗效指标主要包括结石清除率及手术并发症;术后结石采用红外光谱法进行结石成分分析,分析不同年龄段患儿结石成分的差异结果术后即刻清石率为80.49%(66/82),术后1个月清石率为92.68%(76/82)术后并发症患儿共8例,均为Clavien 1级,无尿源性脓毒血症等其他严重并发症发生。红外线光谱法进行结石成分分析结果显示,30(36.59%)例为单一成分,52(63.41%)例为混合成分。通过分析各年龄层次患儿结石成分分布显示:不同结石成分患者年龄分布差异有统计学意义(P=0.020),其中胱氨酸结石大多集中在0~3岁,感染性结石及伴有感染背景的结石在低龄患儿中分布较多代谢特征分析显示,含有异常指标的患儿共30(36.59%)例,其中最常见的为低枸橼酸尿和低尿磷尿(P<0.05)。结论选择经皮肾镜、输尿管软镜、输尿管硬镜手术或者体外冲击波碎石术来治疗儿童泌尿系结石安全、可行;儿童结石病患应尽可能进行代谢评估,以预防结石的形成和复发。Objective Few studies were performed on cliiiical diagnosis,treatment and metabolic evaluation of urinary calculi in children.This study aimed to investigate the efficacy of the clinical treatment and metabolic characteristics of urinary calculi in children in Jiangsu region.Methods 82 children with urinary calculi treated in Jiangsu Provincial Hospital of Traditional Chi-nese Medicine from June 2016 to June 2019 were included in this retrospective study and were divided into four groups by their age:Infant group(ages range from 0 to 3),pre-school group(ages range from 3 to 6),school group(ages range from 6 to 11)and puberty group(ages range from 11 to 14).Percutaneous nephrolithotripsy(PCNL),flexible ureteroscope(f-URS),ureteroscopy(URS)or extracorjwreal shock wave lithotripsy(ESWL)were performed based on tlic stone location,size,hardness,composition,hydronephrosis degree and renal function.Evaluation indicators included clearance rate and surgical complication.Infrared spectroscopy was adopted to detect the composition of stone,then the differences of calculus components in children of different ages were analyzed.Results The removal rate of immediate post-operation stood at 80.49%(66/82),and 92.68%(76/82)one month after operation.8 cases suffered Clavien I of postoperative complication,but no serious complication such as urinary sepsis occurred.The stone composition detected by infrared spectrophotometry presented 63.41%of hybrid component and 36.59%of single component.Analysis of stone composition in children with different ages exhibited statistically significant difference(P=0.020).Among that,most of the cystine stones occurred in 0-3 years old,and infectious stones occurred more in younger children.Metabolic assessment showed anomalous index in 30 children(36.59%),and the most common ones were low citrate urine and low phosphorus urine(P<0.05).Conclusion It is safe and viable to perform PCNL,f-URS,URS,ESWL for the treatment of urinary calculi in children.In addition,metabolic assessment should be carried o

关 键 词：儿童 泌尿系结石 治疗方案 代谢特征 

分 类 号：R691.4[医药卫生—泌尿科学]