上尿路结石的细菌学研究及其临床意义

目的 探讨上尿路结石与细菌感染的相互关系。方法 对530例上尿路结石患者术前作中段尿细菌培养，术中取肾盂尿和结石消毒前后及结石处棉拭子作细菌培养。结果 530例结石中感染石120例（22．6％），女性高于男性。感染石菌种主要为表皮葡萄球菌和大肠杆菌，分别占60．1％和32．5％。结石直径≥1．0cm、表面粗糙、质松及阴性结石的感染石发生比例高于结石直径〈1．0cm、表面光滑、质硬，以及阳性结石，差异有统计学意义（P值均〈0、01）；输尿管上段感染石高于其它部位，差异有统计学意义（P值均〈0、01）。结石处棉拭子细菌培养阳性仅见于感染石患者，且菌种与结石菌种相同。感染石与非感染石患者的中段尿、肾盂尿细菌培养阳性比例分别为24．2％、39．2％ vs 6.3％、3.2％，临床泌尿系感染发生比例分别为15．8％和1、2％，P值均〈0.01。结论 细菌可作为上尿路结石成核成分之一，菌种以表皮葡萄球菌和大肠杆菌为主。感染石发生比例与结石性状有关，感染石易导致泌尿系感染。     

4714例尿路结石化学成份分析

采用纸片法、点滴反应等化学检验法测定尿路结石４７１４例。尿石主要以草酸钙和磷酸钙混合结石为主，占４９．２９％，其次是单纯草酸钙结石，占１７．７５％。含碳酸钙结石大多数可检测到磷酸盐成份，提示结石与尿路感染有关。肾、输尿管结石主要以草酸钙和磷酸钙混合结石及单纯草酸钙结石为主，两者的结石成份所占比例较一致，提示输尿管结石可能多非原发性结石。尿路结石部位和化学成份构成密切相关，肾、膀胱结石与其化学成份构     

南充地区泌尿系结石成分分析及其与国内各地结石成分的差异

目的 研究四川南充地区尿石症患者尿石成分,并与国内其他地区进行比较,为临床预防、治疗提供依据.方法 采用结石红外光谱自动分析系统对2011年3月至2012年9月255例南充市尿路结石患者结石标本进行成分测定,结合临床资料进行研究,并收集国内其他地区报道的结石成分文献进行分析研究.结果 南充地区尿路结石以草酸钙（91.37％）、碳酸磷灰石（62.35％）为主要成分,结石患者男女比为1.90∶1,上尿路结石占87.84％（224/255）,下尿路结石占12.16％（31/255）,上、下尿路结石比为7.23∶1,上尿路结石患者男女比例为1.60：1,下尿路结石患者男女比例为14.5∶1.结论南充地区泌尿系结石成分和国内其他地区结石成分无明显差异,但下尿路结石患者男性所占比例明显高于其他地区.     

积极治疗尿石病

尿石病是泌尿系统最常见的疾病之一，给全球带来严重的医疗负担。我国尿石病的发病率为1％～5％，是尿石病发病率最高的国家之一，而且其发病率还有升高趋势［1-2］。随着我国经济的快速发展和医疗水平的不断提高，泌尿外科医师已经能够利用现代诊断技术快速地对尿石病做出准确的诊断。随着体外冲击波技术及腔内技术的发展和普及，尿石病的外科治疗已经取得了重大突破，绝大多数结石均能达到临床治疗目的。然而，尿石病是一种终生性疾病，10年复发率可达50％，第二个10年复发率甚至可达100％［3］。在尿路结石的外科治疗得到突破的时候，其高复发率确没有得到明显改善，其中一个重要原因是尿石病作为一种终身性疾病还未取得足够的重视。     

儿童尿石病

近十年来对尿石病形成的病因进行了深入研究,根据病因分为二类:1) 形态及尿液动力学的病因,2) 尿液成分的改变。儿童尿石病原则上同成人尿石病无明显差别,但个别因素对儿童尿石病具有特殊意义,如反复尿道感染和泌尿道畸形。但仍有20—40％的尿石病其病因尚不能确定。儿童尿石病的发病率在西方国家占患尿石病总人数的3—5％,而在发展中国家约占30％。男女之间无明显差异。学龄儿童约占儿童尿石病的半数。以往     

尿石标本及双"J"管沉着结石的化学成分分析

目的 比较尿石标本与双“J”管沉着结石的化学成分。方法应用化学分析方法对220例泌尿系结石及74根双“J”管沉着结石化学成分分析。结果尿石标本中草酸钙占60．6％，明显高于双“J”管沉着结石的7．3％；双“J”管沉着尿酸钙结石占19．5％，明显高于尿石标本的6．7％；双“J”管沉着尿酸结石占58．5％，明显高于尿石标本的16．3％；双“J”管沉着尿酸、草酸混合标本结石占15．2％，明显高于尿石标本的3．4％。结论双“J”管表面结石成分与尿石成分不同，尿酸含量增高明显，碱化尿液是预防双“J”管表面结石形成、减少双“J”管阻塞、滞留，是对异物结石形成的一种有效的预防方法。     

对伴慢性肾功能不全的肾及输尿管结石病人的处理

无症状和漏诊的尿路结石在本研究所是慢性肾功能衰竭第二种最常见的病因。发病率占本所病人总数的10～15％。Mebel等证明:在肾石病伴慢性肾功能衰竭病人,手术优于保守治疗。对1980年1月至1983年12月间住院的403例上尿路结石病人进行回顾性分析,发现64例有不同程度的肾功能不全,血尿素大于6.6mmol/1,血清肌酸酐     

尿路结石成分分析（附326例报告）

目的：探讨尿路结石成分构成概况,为临床防治提供帮助。方法：收集尿路结石标本326例,通过红外光谱分析法进行尿路结石成分测定,并结合临床资料进行分析。结果：尿路结石发病率男性多于女性,男女比例为2．17：1;高发年龄为20～50岁;城乡比例为0．76：1;上尿路结石和下尿路结石比例为9．52：1。纯尿路结石和混合性尿路结石分别占结石总数的46．32％（151／326）和53．68％（175／326）,纯尿路结石以草酸钙结石为主,占72．19％（109／151）,混合性尿路结石以草酸钙和碳酸磷灰石成分为主,占82．86％（145／175）。结论：尿路结石成分分析对于了解结石的成因、预防结石的形成和复发具有重要的临床指导意义。     

微创经皮肾取石术(附92例报告)

目的 探讨微创经皮肾取石术治疗上尿路结石的疗效。方法 从2000年1月至2004年11月期间采用微创经皮肾取石术共治疗92例上尿路结石病人，其中单发肾盂结石47例（51％），多发性结石37例（40％）。输尿管上段结石8例（9％），有开放手术史11例。结果 一期穿刺取石86例（95％），一期造瘘、二期取石5例（5％）。单通道取石79例，多通道取石13例。12例术后复查KUB仍有残石，结石清除率87％。手术时间平均140min，术中、术后有明显出血6例（6．5％），均经保守治疗治敷，平均住院时间9d。结论 微创经皮肾取石术治疗上尿路结石安全、有效的方法，对病人创伤小，术后恢复时间短。     

复方消石冲剂的排石作用：附22例报告

采用复方消石冲剂治疗２２例横径〈１０ｍｍ的上尿路结石，观察其对尿路结石的排石作用。结果发现其排石有效率高达４０．９％，与对照组有效率（１６．６％）比较有极显著性差异（Ｐ〈０．０１）。说明该制剂有明显促进结石排出的作用，并就结石成分与排石的关系及排石的机制进行了讨论。     

Clinical characteristics of urolithiasis with stone analysis conducted over a 26-year period

OBJECTIVE: Stone analysis is an important examination for treatment and prevention of recurrence in urolithiasis. A twenty-six years clinical study of patient with urinary stone formers performed stone analysis was conducted. MATERIALS AND METHODS: 1,108 stone formers (male 726, female 382) who performed stone analysis from 1977 to 2002 was conducted. Location of the stone, sex, age, treatment and stone analysis was examined in this study. Phase 1 is from 1977 to 1983 mainly performed open surgery, phase 2 is from 1984 to 1992 mainly performed endoscopic surgery, and phase 3 is from 1993 to 2002 mainly performed extracorporeal shock wave lithotripsy (SWL). RESULTS: Analytic numbers per year increased, especially phase 3. In the treatment of upper urinary tract (UUT) stone, open surgery, endoscopic surgery and SWL was carried out 78.4%, 72.8% and 71.4% of all cases in each phase. Many transurethral lithotripsy were performed for lower urinary tract (LUT) stone. The numbers of UUT and LUT stone were 1,007 and 101 cases. The frequency of LUT stone was higher than that found in a nationwide urolithiasis survey carried out in Japan in 1995. The male-female ratio of UUT stone was 2.35:1, 1.74:1 in phase 2 and 3. The frequency of female increased in phase 2 more than that in phase 3. The incidence of calcium oxalate stone was increased, calcium phosphate stone and infectious stone was significantly decreased in UUT and calcium containing stone in LUT was decreased. The average age for incidence of UUT stone rose in man step by step. The frequency in male was significantly higher than that in female under 50's, not significantly higher over 50's in calcium oxalate with calcium phosphate stone former (p = 0.009). CONCLUSION: In the present study, the clinical features were as follows : important urinary stone analysis, high frequency of LUT stone, high frequency in females, tendency to aging, high frequency of calcium containing stone in LUT, resolution of the difference in male and female over 50's in calcium oxalate with calcium phosphate stone former.     

孤立肾上尿路结石的治疗（附53例报告）

目的 比较孤立肾上尿路结石的治疗方法。方法 对53例孤立肾上尿路结石的患者,8例采用体外冲击波碎石术(ESWL),36例采用微创经皮肾镜取石术(mPCNL),9例采用经尿道输尿管镜碎石术(URL)。结果 采用ESWL治疗的患者,3个月后结石排净率为85.9％;采用URL治疗的患者,输尿管中、下段结石取净率为100％,上...     

磁共振成像尿路造影在输尿管结石诊断中的价值

目的 探讨磁共振成像尿路造影（ＭＲＵ）在输尿管结石诊断中的价值。方法 采用ＭＲＵ诊断输尿管结石４７例,其中ＩＶＵ患侧输尿管不显影者１５例,孤立肾尿管结石者３例,双侧结石合并上尿路扩张、积水者６例,结石合并肾功能不全者５例,因逆行插管失败者３例,另外高龄者５例、碘过敏者２例,不通耐受腹部加压、拒绝行ＩＶＵ或逆行尿路造影者５例。结果 ４７例输尿管结石患者中３４例可清晰显示结石上下方的尿路情况（７２％）     

微创经皮肾取石术治疗重复肾并发上尿路结石

目的:评价微创经皮肾取石术治疗重复肾并发上尿路结石疗效。方法:回顾性分析2001年3月~2005年9月采用微创经皮肾取石术( Mini mally Invasive Percutaneous Nephrolithotomy ,MPCNL)治疗16例重复肾并发上尿路结石患者的资料。结果:所有病例手术均成功。平均手术时间为82 min(38 ~180 min) ,平均估计出血量约75 ml ,平均住院8天。一期结石清除率81 .3 %(13/16) ,二期结石清除率93 .8 %(15/16)。术中、术后无大出血、无周围器官损伤等严重并发症发生。术后三个月肾积水均有不同程度的改善。结论:MPCNL治疗重复肾并发上尿路结石具有手术时间短、出血量少、结石清除率高以及可重复取石的特点,是一种安全有效的方法。     

B超引导下经皮肾镜钬激光碎石术治疗上尿路结石的疗效

目的:探讨B超引导建立皮肤肾脏通路,行经皮肾镜联合钬激光治疗上尿路结石的安全性和临床疗效。方法:2005年4月至今采用B超引导穿刺建立通路,行经皮肾镜联合钬激光治疗上尿路结石患者117例,并记录碎石取石时间、结石取净率及手术并发症。结果:117例患者均一期成功建立皮肤肾脏通路,102例行一期碎石术,15例行二期碎石术。碎石手术时间80～150min。1例患者术后输血800ml,无气胸、腹腔脏器损伤等严重并发症发生。术后复查,98例患者排净结石,19例有结石残余,结石清除率为83.8%(98/117)。结论:采用B超引导穿刺经皮肾镜碎石术治疗上尿路结石安全、方便,疗效可靠。     

Results of urometabolic evaluation in 127 patients with renal calculous disease

One hundred twenty-seven selected stone formers were evaluated. With the simple ambulatory tests proposed by Pak for metabolic screening and a complete urologic evaluation an anomaly was found in more than 90 per cent of the cases. The patients were divided into three groups: (1) patients operated on for staghorn stones; (2) patients with episodes of spontaneous stone eliminations or young people with only one stone episode; and (3) patients operated on for stone disease. No significant differences were noted except for the occurrence of urinary tract infection and for struvite and calcium oxalate occurrence in the different groups. Urinary tract infection combined with a metabolic disorder appear to make the evolution from small kidney stone to staghorn stone a reality.     

采用微创经皮肾穿刺输尿管镜碎石取石治疗复杂性上尿路结石

目的：探讨微创经皮肾穿刺输尿管镜碎石取石术(mini—PCNL)治疗复杂性上尿路结石(肾结石及输尿管上段结石)的疗效及安全性。方法：对106例接受mini—PCNL治疗的复杂性上尿路结石患者的临床资料进行回顾性分析。结果：106例患者中,103例成功施行一期取石术,3例中转开放手术;一期取净结石66例,二期取净结石20例,三期取净结石7例,结石总取净率87．74％;平均手术时间130min,肾造瘘管留置时间平均5d,平均住院9d,其中2例需要输血,其余101例估计术中出血量25～190ml,平均70ml;其余未出现严重的并发症。结论：mini—PCNL具有损伤小、恢复快、住院时间短、结石清除率高、并发症少等优点,是治疗复杂性上尿路结石的较好的微创方法。     

Percutaneous nephrolithotripsy: experience with one-stage procedure

From November 1985 through September 1986, 20 cases of upper urinary tract calculi (14 kidney, 7 ureter) were treated by the one-stage procedure percutaneous nephrolithotripsy. Renal and ureteral calculi were successfully removed in all 20 cases (100%). After the procedure, a few small stone fragments remained in 3 cases (the rate of remnant stone : 14%). High fever was noted in 7 patients but did not last longer than 3 days. No patients required blood transfusion. The one-stage percutaneous procedure was considered a more efficient procedure to remove the upper urinary tract calculi, than open surgery or two stage percutaneous nephrolithotripsy. In one-stage percutaneous nephrolithotripsy, however, serum sodium concentration was lowered significantly after the procedure, although the hematocrit remained unchanged throughout. This should be carefully corrected by the supplement of irrigation fluid and intravenous infusion during the procedure.     

Incidence of upper urinary tract stone during 15 years in Tajima area,Japan: a hospital-based study

Time trend of incidence of upper urinary tract stone during 15 years was evaluated by hospital-based cohort study in Tajima area, northern part of Hyogo prefecture, Japan, which has only two general hospitals with Department of Urology. Due to isolation in terms of traffic network and geographic circumstances, almost all patients with urinary stone in Tajima area are referred to the two hospitals. During the period 2005–2007, patients of the two hospitals with radiologically proven upper urinary tract stone were included in this study. The survey included the age and gender, location of stones, history of urinary stone, treatment received, and stone composition, if available. Annual incidence of upper urinary tract stone was estimated using the data of population census of Japan 2005 and compared with the data of Tajima during 1991–1993. 1,305 patients were included in this study. Age-adjusted incidence (±95% CI) was 157 (±22.4) for men, and 57 (±12.6) for women, compared with 141 (±20.7) for men, and 63 (±13.4) for women during 1991–1993. In total, 30.7% of patients received interventional treatment including shock wave lithotripsy, endoscopic lithotripsy and open surgery, whereas 25.3% in 1991–1993. Calcium oxalate/phosphate stone was 89.6%, struvite stone was 4.5%, cystine stone was 1.0%, uric acid stone was 4.0%, and others were 1.0%. In Tajima area, incidence of upper urinary tract stone has not changed during 15 years.     

Recurrences during a 10-year follow-up after first renal stone episode

Summary Each of 92 patients in a Swedish district served by only one hospital had been treated for their first renal stone in 1977 and was evaluated 10 years later. Recurrent stone formation during the observation period was observed in 26% of the patients, with no difference between men and women. Of all the patients who had sought medical advice in 1977 because of urinary stone colic, 51% were experiencing their first stone episode. Ten years later 37% of the original patients were still classified as single stone formers. The recorded recurrence rate was lower than that prevously reported in the literature.