头孢曲松泌尿系结石的理化分析

目的 探讨头孢曲松钠引发尿路结石的理化性质. 方法 2012年4月收检头孢曲松钠引发的儿童尿路结石2例.其中1例于2012年3月行头孢曲松钠治疗,过程中突发尿路结石,经治疗后自行排出沙粒状结石.另一例于2012年4月行头孢曲松钠治疗5d后突发下腹痛、呕吐,B超检查示右输尿管结石,KUB检查未见结石影,CT检查示右输尿管上段结石伴积水.保守治疗3d后结石排出,复查B超和IVU未见结石影.采用红外光谱、扫描电子显微镜及能谱仪分析2例尿路结石的成分. 结果 2例尿路结石样本均由头孢曲松和钙离子构成,摩尔比为1∶1. 结论 头孢曲松钠可引发尿石症,该结石具有X线下不显影的影像学特征,尿路结石成分为头孢曲松钙盐.     

儿童泌尿系统结石的代谢评估

代谢评估是泌尿系统结石病因诊断的金标准。儿童泌尿系统结石的主要病因是代谢紊乱,且具有发病早和复发率高的特点,因此非常有必要对此类患儿行代谢评估。儿童泌尿系统结石的代谢评估内容包括血清学检查、尿液检查、结石成分分析及24 h尿液代谢检查。本文结合近年来的国内外指南和研究进展,就儿童泌尿系统结石代谢评估的基本内容和重点问题进行回顾和分析。     

冲击波碎石技术的发展动态

1980年2月,世界上第一台Dornier HM1（人体型机）冲击波碎石机在德国应用于临床。1984年,DomierHM3型冲击波碎石机通过了美国FDA认证,因其有效、安全,不久就成为治疗上尿路结石的首选方法。30年来冲击波碎石机经历了一、二、三代的发展。与第一代DomierHM3碎石机相比,第二、三代碎石机的可操作性和功能性有了明显进步,     

结石红外光谱自动分析系统在尿路结石成分分析中的应用

目的 评价红外光谱自动分析系统检测尿路结石成分的临床应用价值.方法 尿路结石标本1450例.男1032例,女418例.年龄6个月～88岁.男性平均年龄(41.7±15.3)岁,女性(42.0±15.6)岁.肾结石875例(60.34%),输尿管结石504例(34.76%),膀胱结石71例(4.90%).均采用LIIR型结石红外光谱自动分析系统分析.解析结果均行红外光谱人工解析验证,必要时辅以偏光显微镜、X线衍射或化学方法进行验证. 结果在结石总体构成比上,一水草酸钙结石714例(49.24%),碳酸磷灰石结石444例(30.62%),无水尿酸结石93例(6.41%),二水草酸钙结石92例(6.34%),六水磷酸铵镁结石28例(1.93%),胱氨酸结石23例(1.59%),尿酸铵结石20例(1.38%),二水尿酸结石16例(1.10%),二水磷酸氢钙结石12例(0.83%),一水尿酸钠结石2例(0.14%),碳酸钙结石1例(0.07%),其他5例(0.34%).结石的组合成分上,混合性结石1053例(72.62%),单一成分结石仅397例(27.38%).混合性结石主要为含钙类结石.其中15例婴幼儿结石为食用三聚氰胺污染奶粉所致,成分为二水尿酸与尿酸铵的混合结石.验证结果表明,结石主要成分误检6例(0.41%),将无水尿酸误检为尿酸铵或碳酸磷灰石;漏检9例(0.62%),其中漏检六水磷酸铵镁或碳酸磷灰石7例,性质不明2例.在2种和3种成分的混合性结石中,含量相对低的成分各漏检6例和10例,均为六水磷酸铵镁或碳酸磷灰石. 结论结石红外光谱自动分析系统分析尿路结石成分具有准确、自动、快捷等优点,适合临床常规使用.

Abstract：

Objective To determine the value of applying LIIR Automatic Analysis System of Infrared Spectroscopy in analyzing urinary stone composition. Methods 1450 samples of urinary stones were collected from 1032 male and 418 female patients. The age of patients ranged from 6 months to 88 years. The mean ages were 41.7±15.3 and 42.0±15.6 years for male and female patients, respectively. Of 1450 stones, 875 cases were located in kidney (60.34%), 504 cases in ureter (34.76%) and 71 cases in bladder (4.90%). All stones were analyzed by LIIR Automatic Analysis System of Infrared Spectroscopy (Tianjin). Analysis results were reevaluated by the artificial analysis of spectrogram, if necessary, with polarization microscope, chemical analysis, and X-ray diffraction.Results Calcium oxalate monohydrate stones were found in 714 cases (49. 24%), carbonate apatite stones in 444 cases (30.62%), anhydrous uric acid stones in 93 cases (6.41%), calcium oxalate dihydrate stones in 92 cases (6. 34 % ), ammonium magnesium phosphate hexahydrate stones in 28 cases (1.93%), cystine stones in 23 cases (1.59%), ammonium urate stones in 20 cases (1.38%), uric acid dihydrate stones in 16 cases (1.10%), brushite stones in 12 cases (0.83%), sodium urate monohydrate stones in 2 cases (0. 14%), calcium carbonate stones in 1 cases (0. 07%), and other stone types in 5 cases (0. 34%). Most urinary stones were composed of 2 or more compositions, and pure stones were only observed in 397 cases (27.38%). Most of the mixed stones contained calcium and non-calcium mixed stone was rarely observed. In addition, 15 stones were found in infants who had consumed melamine-contaminated milk powder. These stones were composed of uric acid dihydrate and ammonium urate. The results of reevaluation by artificial analysis showed the following: among pure and mixed stones, false detection occurred in 6 cases (0.41%), of which the composition was ammonium urate or carbonate apatite determined by automatic system but the true composition was anhydrous uric acid. False negative detection occurred in 9 cases (0.62%), of which the composition was ammonium magnesium phosphate hexahydrate or carbonate apatite in 7 cases, but in other 2 cases the composition could not be determined by artificial analysis. The false negative detection of components with relatively low content occurred in 6 cases and 10 cases in stones with 2 components and 3 components, respectively. The undetected composition in these cases was ammonium magnesium phosphate hexahydrate or carbonate apatite. Conclusion Automatic Analysis System of Infrared Spectroscopy has many advantages in accuracy, automation and is quick in analyzing the composition of urinary stones, and is worthy of promotion in clinical use.     

Randall斑的现代研究进展

近年来,我国尿石症的发病率大幅度提升,虽然新兴技术的发展不断推动着结石治疗手段和方法创新,但是尿石形成的病因和机制却仍有许多未知。目前关于结石形成机制有多种学说,包括Randall斑学说、过饱和结晶学说、游离颗粒和固定颗粒学说等,但是现在还没有一种学说能够较为全面解释结石形成。目前对结石患者肾乳头和皮质活检证实了Randall斑在结石形成中的作用。本文回顾Randall斑块学说的历史发现,综合当代最新研究进展,揭示更多的生理病理机制并重新定义Randall斑学说。     

儿童泌尿系结石诊疗中国专家共识

一、引言由于解剖、生理上的不同,儿童泌尿系结石的发病原因、发展过程、临床处理、疾病转归及预后的情况都与成人有极大的差异。因此,中华医学会泌尿外科学分会尿路结石学组与中国泌尿系结石联盟委托长期从事儿童泌尿系结石临床诊疗工作的专家,在广泛复习文献的基础上,就相关的问题进行反复讨论,最终形成此中国专家共识,供大家在临床工作中学习与参考。     

完全平卧位逆行输尿管软镜碎石术治疗上尿路结石的临床研究

目的:探讨完全平卧位下行逆行输尿管软镜碎石术(retrograde intrarenal surgery, RIRS)治疗上尿路结石的有效性及安全性。方法:回顾性分析2014年7月—2021年12月在江苏省中医院泌尿外科完成的41例完全平卧位下RIRS的上尿路结石患者的临床资料，作为观察组。同时选取24例同期采用截石位RIRS手术的患者作为对照组。比较2组住院时间、手术时间、结石清除率、术前及术后24 h内D-二聚体水平以及术后并发症发生率的差异。结果:2组患者在手术时间、住院时间、结石清除率、术后并发症方面差异均无统计学意义(P>0.05)。但观察组患者术后24 h内D-二聚体水平显著低于对照组，并且术后双下肢舒适度显著高于对照组，差异有统计学意义(P<0.05)。结论:对于高龄、结石负荷大预计手术时间较长或者截石位摆放困难的患者，选择完全平卧体位完成RIRS是安全有效的。