肾盂内灌注碱性药物溶石治疗三聚氰胺所致婴儿双肾结石

目的 探讨经输尿管导管或肾造瘘管肾盂内直接灌注碱性药物溶石治疗三聚氰胺所致婴儿双肾结石的有效性和安全性. 方法双肾结石合并急性肾后性肾功能衰竭婴儿15例.年龄5～12个月,平均9个月.结石直径0.4～1.5 cm,平均0.8 cm.15例患儿均长期食用受三聚氰胺污染的奶粉,经影像学和实验室检查诊断为急性肾后性肾功能衰竭.13例经尿道输尿管镜下通过输尿管导管行肾盂内碱性药物灌洗,20 m1 5%NaHCO3于10 min内缓慢冲洗,然后置入双J管.2例经皮肾穿刺留置肾造瘘管,术后间歇碱性药物灌洗,100 ml 1.4%NaHCO3于4～6 h内持续低压滴注,1次/d,持续2周. 结果 15例患儿均成功实施碱性药物肾盂内灌洗溶石治疗.术后2～5 d尿量恢复正常,2～3 d SCr、BUN恢复正常.13例术中经输尿管导管直接肾盂内灌注5%NaHCO3者,术中均观察到大量混浊液体自输尿管口喷涌而出.术后2周复查CT,结石消失13例,结石直径缩d~>50%者2例. 结论 经输尿管导管或肾造瘘管进行肾盂内直接碱性药物化学溶石治疗三聚氰胺所致婴儿肾结石安全、有效.     

输尿管镜在婴儿肾结石合并急性肾后性肾功能衰竭手术治疗中的应用

目的 探讨输尿管镜在婴儿肾结石合并急性肾后性肾功能衰竭手术中的临床应用.方法双肾结石合并急性肾后性肾功能衰竭患儿13例.男11例,女2例.年龄5～12个月,平均9个月.其中双肾结石并肾积水5例,一侧肾结石合并对侧输尿管结石嵌顿3例,双侧输尿管结石嵌顿3例,双肾结石合并肾积水伴尿道结石2例.无尿1～3 d者11例,少尿5～10 d者2例.实验室检查血BUN及SCr均高于正常,高尿酸血症8例,高血钾症9例.13例尿pH均<6.5,平均5.5.KUB检查均未见阳性结石.B超检查13例均有不同程度肾积水,9例肾积水直径>2.5 cm.CT检查结石直径0.5～1.5 cm.均未行透析治疗.13例均行输尿管镜下溶石、碎石、置入双J管内引流术治疗. 结果 13例患儿术后24 h内出现多尿,出现多尿期平均时间为术后12 h,多尿期持续24～72 h,24 h尿量约800～2500 ml,术后48～96 h尿量逐渐恢复正常.术后1～5 d BUN及SCr均恢复正常,8例高尿酸血症患儿术后1～7 d血尿酸恢复正常,9例高钾血症患儿术后1～3 d血钾恢复正常.13例患儿留置双J管2～4周,复查B超,结石排净11例、结石变小2例. 结论 对肾结石合并急性肾后性肾功能衰竭要儿应用输尿管镜下腔内手术治疗,采用溶石、碎石,置入双J管内引流,可立即解除上尿路梗阻,恢复排尿,改善肾功能.具有安全有效、损伤小的优点.可作为婴儿肾结石合并急性肾后性肾功能衰竭手术解除梗阻的首选方法.     

输尿管镜碎石取石术治疗小儿输尿管中下段结石32例报告

目的探讨输尿管镜碎石取石术治疗小儿输尿管中下段结石的临床效果。方法对32例输尿管中下段结石患儿行输尿管镜碎石取石术治疗的临床资料进行回顾性分析。培果32例患儿全部一次手术成功,术后即排净结石18例,留置双J管2～4周排净结石14例。手术时间25～80min,平均42．5min术后1～3d血尿消失;术后3～6d出院,平均4．3d;无输尿管穿孔、撕脱、发热、尿路感染等围手术期并发症。随访2～12个月,无结石复发,患侧肾积水消失。结论输尿管镜碎石取石术治疗小儿输尿管中下段结石具有安全、有效、损伤小、恢复快、成功率高等优点,在应用小直径输尿管镜及具有丰富经验的医师操作情况下,可作为小儿输尿管中下段结石的首选治疗方法。     

输尿管镜气压弹道碎石治疗输尿管结石110例

目的总结输尿管镜气压弹道碎石治疗输尿管结石的临床效果。方法采用F8/9.8 Wolf硬性输尿管镜、JUN—AIR气压弹道碎石机治疗110例输尿管结石。结果输尿管镜直视下一次碎石成功105例，成功率95．5％（105／110），1～6周内结石全部排净。2例因置镜失败改开放手术，3例输尿管上段结石上移至肾脏行ESWL2例，口服排石药物治疗1例。术后泌尿系感染5例，轻度肉眼血尿1～3d。结论输尿管镜气压弹道碎石是治疗输尿管中、下段结石的有效方法之一，具有碎石率高、安全、并发症少、操作简单的优点。     

一期微创手术治疗肾肿物合并输尿管结石

目的探讨一期微创手术治疗肾肿物合并输尿管结石的安全性和可行性。方法回顾性分析2011年3月～2018年5月同期治疗肾肿物合并结石11例资料。肾肿物左侧7例,右侧4例,5例肾囊肿长径4. 2～5. 8 cm,平均4. 9cm,6例肾实性肿瘤长径1. 7～4. 1 cm,平均2. 4 cm。输尿管结石9例与肾肿物同侧,2例为对侧。先行输尿管镜碎石取石术,再行后腹腔镜肾囊肿开窗或肾部分切除术。结果 5例肾囊肿行输尿管镜碎石取石+后腹腔镜肾囊肿开窗术,手术时间72～226 min,平均122. 8 min,出血量5～10 ml,无输血,术后住院时间4～7 d,平均4. 8 d,未见明显并发症,病理均为肾囊肿; 6例肾实性肿瘤行输尿管镜碎石取石+后腹腔镜肾部分切除术,手术时间158～314 min,平均220. 3 min,出血量20～100 ml,中位数20 ml,无输血,术后住院时间6～11 d,平均7. 7 d,未见明显并发症,病理均为肾透明细胞癌。结论对于肾肿物合并输尿管结石,可以考虑行输尿管镜碎石取石术,根据肿物性质同期行后腹腔镜肾囊肿开窗或肾部分切除术,安全有效。     

输尿管软镜下钬激光碎石术后输尿管石街形成的处理时机

目的探讨输尿管软镜碎石术(flexible ureteroscopic lithotripsy,FURL)后输尿管石街形成的腔内微创手术处理的时机。方法 2011年2月～2017年6月我院采用FURL处理经选择的直径 2 cm肾或输尿管上段结石388例,术后复查腹部平片(KUB)或CT示输尿管石街56例,石街长度1. 5～4. 6 cm,按照Coptcoat石街分型,Ⅰ型16例,Ⅱ型12例,Ⅲ型28例。积极保守药物排石治疗4～8周后,石街未完全排除患者行输尿管镜钬激光碎石取石(ureteroscopic lithotripsy,URL)处理。结果 56例输尿管石街保守药物排石治疗4周后,仅18例输尿管末段短距离石街(Ⅰ型16例,Ⅱ型2例)顺利排出,其余38例(Ⅱ型10例,Ⅲ型28例)术后4～8周行URL,其中31例术后保守治疗4周后行URL,5例保守治疗6周后行URL,2例保守治疗8周后行URL。38例输尿管石街全部一期URL碎石取石成功,手术时间32～110 min,平均56 min。14例因术后输尿管黏膜严重水肿再次留置输尿管支架管。无一例发生术中严重并发症,术后3例出现高热,经积极抗感染治疗后好转。术后住院2～5 d,平均3 d。结论对于FURL术后Ⅱ或Ⅲ型(长距离石街或者石街中混合有较大体积结石碎片)输尿管石街,长时间停留结石碎片的局部刺激容易出现黏膜水肿,自行排石效果更不理想,建议在术后4周积极采用URL清除石街,及时解除梗阻,以减少进一步的肾功能损害。     

经尿道输尿管镜下第三代碎石清石系统治疗婴儿膀胱结石及尿道结石合并急性尿潴留

目的 评价经尿道输尿管镜下第三代碎石清石系统(EMS)治疗婴儿膀胱结石及尿道结石合并急性尿潴留的疗效. 方法应用输尿管镜下EMS治疗三聚氰胺所致膀胱结石及尿道结石合并急性尿潴留患儿10例.男9例,女1例.平均年龄9个月.膀胱结石2例,尿道结石8例,结石直径0.5～1.1 cm,平均0.8 cm.全麻下行经尿道输尿管镜下碎石清石术,采用Wolf 8.0～9.8 F输尿管镜,在电视监视下,从输尿管镜操作通道伸入EMS超声碎石探针将膀胱结石及尿道结石完全粉碎吸出,术中膀胱内保持50～100 ml液体,灌注泵压力为160～210 kPa(1 kPa=10.20 cm H2O),平均180 kPa,超声碎石能量40%～60%,占空比30 0A～70%,平均60%.术后留置8 F双腔气囊导尿管. 结果 10例平均手术时间25 min,均将尿道结石冲入膀胱,在输尿管镜下一次性清除结石,麻醉清醒后拔除导尿管,均能立即顺利排尿.3 d后复查B超.膀胱、尿道内均无残留结石. 结论 对婴儿膀胱结石及尿道结石合并急性尿潴留患儿,应用输尿管镜下EMS清除结石,可以立即解除下尿路梗阻,恢复正常排尿,具有安全、高效、损伤小的优点,可作为膀胱结石及尿道结石合并急性尿潴留患儿手术解除下尿路梗阻的首选方法.     

输尿管镜下钬激光碎石在小儿输尿管结石中的应用

目的 探讨输尿管镜下钬激光碎石治疗小儿输尿管结石的安全性和效果.方法 患儿7例,男5例,女2例,年龄1.5～13岁,平均6.5岁.输尿管上段结石1例,中下段6例.左侧4例,右侧3例.结石直径0.5～0.9 cm.均伴中、轻度肾积水.临床主要表现为患侧腰腹疼痛和/或血尿,无泌尿系畸形、感染和血、尿生化、电解质异常.结果 全部手术一次成功,无并发症,2例并发输尿管息肉同时处理.手术时间6～15 min,平均12min.术后1～3天拔除导尿管,2～5天后出院,2周拔除双"J"管.术后复查结石排净6例,另1例再过2周排净.随访1～12个月无结石复发,肾积水均恢复正常.结论 输尿管镜联合钬激光碎石术治疗小儿输尿管结石安全有效,但还需要积累更多的病例,进行更长时间的随访.     

体外冲击波碎石联合坦索罗辛治疗输尿管下段结石

目的评价坦索罗辛对体外冲击波碎石后输尿管结石排出的临床效果。方法将126例输尿管下段结石的患者随机分成两组：对照组和治疗组各63例。对照组患者均服用中成药排石冲剂4 g/次,2次/d,或肾石通颗粒4 g/次,2次/d。治疗组服用坦索罗辛（哈乐）0.4 mg,1次/d,口服2~4周。结果两组在结石排出率、结石排出时间、不良反应（强止痛剂使用及副作用）发生率方面比较,差异有统计学意义（P〈0.05）。结论体外冲击波碎石术后联合应用坦索罗辛治疗输尿管下段结石安全、有效,能提高排石率,缩短排石时间,减轻排石的疼痛症状等作用,不良反应少,副作用轻微,可作为输尿管下段结石辅助排石治疗的一种有效的选择方法。     

输尿管镜钬激光碎石术中并发输尿管穿孔原因及对策

目的探讨输尿管镜钬激光治疗输尿管结石并发输尿管穿孔的原因及防治方法。方法回顾性分析2004年8月至2006年12月经尿道输尿管镜钬激光碎石术268例中25例并发输尿管穿孔的临床资料。男14例,女11例;结石单发者21例,多发者4例;上段结石18例,下段结石7例;结石直径1．2～3．2em,平均（1．8±0．5）cm,25例均合并输尿管息肉及中、重度肾盂积水。术后常规放置双J管4—8周。结果25例输尿管镜手术时间15～70min,平均（40．4±18．3）min。11例一次性碎石成功,6例术中改开放取石治疗,8例结石上移至肾盂内,1周后予以体外冲击波碎石治疗。结论输尿管结石合并息肉是输尿管镜钬激光碎石致输尿管穿孔的主要原因之一,术中轻巧操作是预防出现输尿管穿孔的关键,早期及时开放手术可以避免严重并发症的发生。     

Effects of pyruvate salts, pyruvic acid, and bicarbonate salts in preventing experimental oxalate urolithiasis in rats

Sodium pyruvate, potassium pyruvate, pyruvic acid, sodium bicarbonate and potassium bicarbonate were added to a calcium-oxalate lithogenic diet (a glycolic-acid diet) in order to determine their effects in preventing lithogenicity. Male Wistar-strain rats who had been fed the glycolic-acid diet developed marked urinary calculi within four weeks. Rats in the sodium and potassium pyruvate groups had, however, almost no stones in the urinary system. Rats in the bicarbonate and pyruvic-acid groups showed slightly less effect than those in the pyruvate groups. Urinary oxalate excretion was high in all the groups during the experiment. The urinary oxalate concentration was relatively higher in the sodium-pyruvate group, and significantly higher in the potassium-pyruvate group, than in the glycolic-acid group. Urinary citrate excretion was high both in the pyruvate and bicarbonate groups; the urinary citrate concentration was, however, significantly higher in the pyruvate groups than in the bicarbonate groups at the fourth experimental week. The urinary calcium and magnesium concentrations were irrelevant to the diets administered. Therefore, it can be concluded that pyruvate salts inhibit urinary calculi formation, not by decreasing oxalate synthesis, but by increasing the urinary citrate concentration; bicarbonate salts work in the same manner, but a little less effectively.     

多发性多部位肾结石的体外冲击波碎石后加用经皮肾穿刺造瘘取石(附34例报告)

目的:探讨提高多发性多部位肾结石疗效的方法.方法:对34例多发性多部位肾结石采用ESWL治疗,对其中的未排净残石或未碎结石再联用PCNL治疗.结果:34例中,29例ESWL治疗3～6次排净结石,排净率为85.3%;4例经联用PCNL Ⅰ期清除残石或未碎结石,结石总排净率达97.1%.结论:经ESWL治疗后,再联用PCNL取净肾内残留结石来治疗多发性多部位肾结石,具清除率高、损伤少、安全性好、并发症少等优点,是一种经济而有效的治疗方法.     

A comparison of the effects of potassium citrate and sodium bicarbonate in the alkalinization of urine in homozygous cystinuria

For many years, urine alkalinization has been one of the cornerstones in the treatment of homozygous cystinuria. Because of the relationship found between the excretion of urinary sodium and cystine, potassium citrate has emerged as the preferred sodium-free alkalizing agent. To evaluate the usefulness of potassium citrate for urine alkalization in cystinuric patients, sodium bicarbonate and potassium citrate were compared in 14 patients (10 on tiopronin treatment and four without treatment with sulfhydryl compounds). The study started with 1 week without the use of any alkalizing agents (Period 0) followed by 2 weeks with sodium bicarbonate (Period 1) and 2 weeks with potassium citrate (Period 2). Urinary pH, volume, excretion of sodium, potassium, citrate and free cystine, as well as the plasma potassium concentration, were recorded. Potassium citrate was shown to be effective as an alkalizing agent and, in this respect, not significantly different from sodium bicarbonate. Even though a normal diet was used, a significant increase in urinary sodium excretion was observed with sodium bicarbonate (Period 1). Urinary potassium and citrate excretion increased with potassium citrate (Period 2). A significant correlation was found between urinary sodium and cystine in the tio-pronin-treated patients. No significant differences in cystine excretion were recorded in Periods 0, 1 and 2. Plasma potassium was significantly higher during Period 2, but only one patient developed a mild hyperkalemia (5.0 mmol/l). The use of potassium citrate for urine alkalization in homozygous cystinuria is effective and can be recommended in the absence of severe renal impairment.     

经皮肾造瘘软膀胱镜下钬激光碎石术治疗上尿路结石

目的 探讨经皮肾造瘘软膀胱镜下应用钬激光治疗上尿路结石的有效性与安全性.方法经皮肾造瘘软膀胱镜下应用钬激光治疗肾和输尿管中上段结石26例.其中肾结石合并输尿管结石8例、肾多发结石5例、单纯肾盏结石4例、输尿管中上段结石9例.结石直径1.0～3.2 cm,平均2.2 cm.肾轻度积水4例,中度积水15例,重度积水7例,合并肾功能不全13例.均在B超引导下经肾中盏穿刺单通道取石.结果 22例一期取石成功,4例二期取石.18 F穿刺通道18例,24 F穿刺通道6例.手术时间45～140 min,平均72 min.结石取净率96.2%(25/26),术中和术后均无输血.术后高热1例,抗感染治疗2 d后体温正常,无其他明显并发症.术后22例平均随访(11±4)个月,B超复查患肾积水明显减轻,未见结石复发.结论 经皮肾造瘘软膀胱镜下钬激光碎石是治疗上尿路结石的一种有效的微创方法,尤其适用于肾盏和输尿管中上段结石.     

Citrate (CG-120) therapy for urolithiasis. 1. Clinical effects

Urinary citrate is an important determinant for crystallization of calcium salts, and recently oral administration of citrate has been suggested to be clinically useful in the management of renal stone disease. The effect of CG-120, a citrate compound (potassium citrate, sodium citrate and citric acid) produced by Dr. Madaus (Germany), on upper urinary tract stones was investigated in 398 patients in this study group. The patients were treated with 3 or 4 g CG-120 daily. Two hundred thirty-one of them were treated accurately according to the protocol of the study for more than 32 weeks. The cumulative percentage of positive clinical effect for the stone (disappearance, passage or decrease in size) was 30.3% (70/231). There were no differences in the clinical effect between the group of 3 g/day and the group of 4 g/day. CG-120 seemed to be more effective in the cases of ureteral stone, young patients and females, but was less effective in the recurrent stone formers. Although there were 45 episodes of side effects in 38 patients in this study, no serious side effects attributed to CG-120 were experienced. CG-120 was proved as a useful drug in the treatment of upper urinary tract calculi as well as its prevention.     

枸橼酸氢钾钠在大负荷肾尿酸结石治疗中的应用(附6例报告并文献复习)

目的:探讨枸橼酸氢钾钠在大负荷肾尿酸结石治疗中的效果。方法:回顾性分析2018年1月至2020年7月天津医科大学第二医院以枸橼酸氢钾钠治疗的6例大负荷肾尿酸结石(长径>4cm)患者的临床资料。患者均为男性,平均年龄51.3(42～66)岁,平均结石长径6.0(4.1～7.6)cm,腹部X线片(KUB)阴性,平均CT值4...     

影响肾结石行经皮肾镜术后清石率的多因素回归分析

目的探讨影响肾结石行经皮肾镜碎石取石术（PCNL）后清石率的相关因素。 方法回顾性分析2011年5月至2016年5月125例首次行PCNL治疗的肾结石患者的临床资料,利用术前超声、腹部平片（KUB）、静脉尿路造影（IVU）、CT平扫+三维重建影像资料,评估肾脏集合系统解剖情况、结石体表面积、肾积水程度、结石解剖分布、受累肾盏数、结石CT值。根据手术记录统计穿刺通道数、穿刺通道长度、穿刺通道大小、术中出血情况以及手术者经验情况。结石完全清除或残余碎片≤4 mm即为治疗成功。先对相关数据进行单因素分析,找出差异有统计学意义因素,再利用这些因素进行Logistic多因素回归分析。 结果92例患者结石一次性清除,清石率为73.6%。单因素分析表明,结石体表面积、结石解剖分布、肾脏集合系统解剖异常、受累肾盏数、穿刺通道长度、术中活动性出血、术者经验与清石率明显相关。多因素分析表明,结石体表面积、结石解剖分布、肾脏集合系统解剖异常、受累肾盏数是影响术后清石率的独立危险因素,术者经验是影响术后清石率的保护因素。 结论肾脏集合系统解剖异常、结石大小及在肾盏的分布是影响肾结石行经皮肾镜取石术后效果的独立因素,可用于术前评估手术清石效果,术者的经验有益于提高清石率。     

顺行输尿管软镜碎石术治疗尿流改道后上尿路结石分析

目的：评价顺行输尿管软镜碎石术治疗各种尿流改道后上尿路结石的临床应用价值、安全性及疗效。方法：2009年1月～2012年2月采用顺行输尿管软镜碎石术治疗尿流改道后上尿路结石患者19例,其中左侧13例,右侧5例,双侧1例;输尿管结石12例,肾结石5例,同时合并肾结石和输尿管结石2例。4例采用C臂X线引导,15例采用B超引导肾造瘘。11例一期行经皮肾造瘘＋顺行输尿管软镜碎石术;8例合并感染及急性梗阻患者一期行经皮肾造瘘,1周后二期行输尿管软镜碎石术。结果：19例患者均取得手术成功,平均手术时间为（61±21）min,平均住院时间为（5．6±3．2）d,术中出血量均〈50ml,术中及术后均未发生严重并发症。17例经历一次碎石程序即完全清除,2例经过2次碎石程序。术后4周复查CT,仅1例显示肾盂残留小片状结石,一期结石清除率达94．7％。平均随访15个月,2例患者复发,显示结石复发率为10．5％（2／19）,1例经过ESWL得到成功治疗,另1例再次顺行输尿管软镜碎石治疗成功。结论：顺行输尿管软镜是处理尿流改道后上尿路结石治疗的首选方式,具有安全性高、手术成功率高、结石清除率高、复发率低、并发症少等优点,值得临床推广应用。     

Laxative abuse as a cause for ammonium urate renal calculi

Nine women with laxative abuse and predominantly ammonium urate renal calculi underwent metabolic studies to identify common chemical abnormalities and determine pathophysiology. The 24-hour urine studies demonstrated marked decreases in volume (902 cm.3), sodium (28 mEq.), citrate (116 mg.) and potassium (21 mEq.). A significant elevation in ammonium urate supersaturation was found compared to control subjects when studied by the computer model EQUIL 2. Of the patients 7 had 1 or more urine specimens positive for phenolphthalein. Gastrointestinal loss of fluid and electrolytes allowed for chronic extracellular volume depletion. Intracellular acidosis was present as judged by low urinary citrate and potassium. The fact that the ion product for ammonium urate is increased significantly compared to controls reflects the stated pathophysiological changes. Laxative abuse should be suspected whenever a woman has an ammonium urate renal calculus in sterile urine.