斜仰卧位经皮肾镜取石术治疗上尿路结石临床疗效分析

目的:评价斜仰卧位经皮肾镜取石术(percutaneous nephrolithotomy,PNL)治疗上尿路结石的疗效和安全性。方法:回顾性分析2014年1月至2015年12月常熟市第二人民医院94例斜仰卧位行PNL的上尿路结石患者的临床资料,分析患者术后结石残留、出血、感染情况。结果:94例患者均顺利完成手术。术后一期清除结石90例,二期清除结石4例;需输血患者5例,其中保守治疗无效行肾动脉数字减影血管造影(digital subtraction angiography,DSA)栓塞术止血1例;尿脓毒血症8例,经抗感染治愈;无败血症休克病例。随访2个月~2年,患者均健在,无结石复发需二次手术患者。结论:斜仰卧位PNL一期结石清除率较高,并发症可控,对于上尿路结石的治疗安全、有效。     

63例膀胱结石成分及形成因素分析

目的分析63例膀胱结石成分,并探讨与下尿路疾病和泌尿系感染的关系。方法回顾性分析邢台医专第二附属医院2010年7月至2017年5月收治的63例膀胱结石患者的临床资料。方法所有收集到的标本均用红外光谱分析系统进行检测,包括结石成分分析、统计合并下尿路疾病、尿培养结果等。结果男女比例为3.85:1。患者以中老年居多,男性发病高峰年龄为>50~80岁(64%);女性为>40~70岁(77%)。最常见的结石成分为磷酸镁铵结石,63例患者中有46%含有磷酸镁铵成分,其次为含钙结石,包括草酸钙、磷酸钙和磷酸一氢钙结石(36.5%)。50例男性患者中49例合并下尿路疾病:18例(36.7%)合并前列腺增生,7例(14.3%)合并神经源性膀胱,3例(6.1%)为前列腺增生术后;13例女性患者中,12例为非胱氨酸结石,有11例(90.9%)合并下尿路疾病。21例含钙结石患者中有5例(23.8%)合并泌尿系感染,22例磷酸镁铵结石患者有11例(50%)患者合并泌尿系感染,9例尿酸结石患者中有2例(22.2%)合并泌尿系感染。尿培养中,变形杆菌占27.2%,其次为铜绿假单胞菌、大肠埃希菌和肠球菌。结论本研究发现膀胱结石成分主要为磷酸镁铵,其次为含钙结石,多数患者合并下尿路疾病或泌尿系感染。膀胱结石患者应注意下尿路疾病的治疗,调整饮食生活习惯,控制泌尿系感染。     

局部灌注溶石液治疗上尿路尿酸结石病人的护理

尿路结石是泌尿外科的常见病 ,随着人们生活水平的提高及饮食习惯的改变 ,近年来尿酸结石的发病率有逐渐上升趋势[1 ] ,占尿路结石的 2 0 %～ 40 %。由于尿酸结石为X线阴性结石 ,在有B超定位碎石机条件下 ,体外冲击波碎石 (ESWL)仍为尿酸结石的首选治疗方法[2 ] 。但残余结石碎片易引起结石复发。为此 ,我院 2 0 0 2年 6月— 2 0 0 3年 6月采用经输尿管逆行插管局部灌注碱性溶石液 (THAM -E)治疗尿酸结石 14例 ,取得了满意疗效。现将护理总结如下。1　资料与方法1.1　临床资料　本组 14例 ,男 12例 ,女 2例 ,年龄 2 5岁～ 68岁 ,平均 4…     

肾镜下超声/气压弹道碎石治疗下尿路结石

目的 探讨经尿道肾镜下超声/气压弹道碎石治疗下尿路复杂性结石的临床疗效.方法 采用肾镜经尿道行超声/气压弹道碎石术治疗下尿路复杂性结石90例.尿道结石18例,结石大小1.0 cm×0.8cm～1.2cm×2.2 cm:膀胱结石72例,膀胱结石长径平均(2.5±1.5)cm(1.0～6.5 cm),其中单发结石30例,2个结石12例,多发结石30例(最多10枚结石).结果 全部结石均1次碎石成功,结石清除率100%.粉碎并清除结石平均时间为(48.6±22.6)min(12～90min).术后平均住院天数(3.2±1.8)d(1～6 d),无严重并发症发生.结论 经尿道肾镜下超声/气压弹道碎石治疗下尿路复杂结石创伤小、安全、高效,可作为下尿路结石治疗的重要手段.     

局部灌注溶石液治疗上尿路尿酸结石病人的护理

尿路结石是泌尿外科的常见病，随着人们生活水平的提高及饮食习惯的改变，近年来尿酸结石的发病率有逐渐上升趋势，占尿路结石的20％-40％。由于尿酸结石为X线阴性结石，在有B超定位碎石机条件下，体外冲击波碎石(ESWL)仍为尿酸结石的首选治疗方法。但残余结石碎片易引起结石复发。为此，我院2002年6月-2003年6月采用经输尿管逆行插管局部灌注碱性溶石液(THAM—E)治疗尿酸结石14例，     

彩超与X射线平片在上尿路结石诊断中应用价值比较分析

目的:对比分析彩超与X射线平片用于上尿管结石诊断的价值。方法:选取我院2016年2月至2018年1月确诊为上尿路结石的100例患者,所有患者均接受手术治疗,并在术前接受彩超与X射线平片检查,对比两种影像学方法对上尿路结石诊断的有效率。结果:100例上尿路结石患者中经手术诊断发现61例为肾结石,39例为输尿管结石;彩超对肾结石诊断有效率高于X射线平片,但对输尿管结石诊断的有效率却低于X射线平片,差异有统计学意义(P 0. 05)。结论:在上尿路结石诊断中,X射线平片对输尿管结石诊断有效率高,而彩超对肾结石诊断有效率高,二者用于上尿路结石的诊断均有其优势与不足,临床应将二者联合用于上尿路结石的诊断中以提高诊断准确性。     

留置双J管治疗妊娠期上尿路结石并肾绞痛

目的:探讨留置双J管治疗妊娠期上尿路结石并发肾绞痛的有效性及安全性。方法:1996年5月-2007年6月对14例妊娠期上尿路结石并发肾绞痛的患者行表面麻醉下留置双J管治疗。结果:14例患者留置双J管时间2~7个月,平均4.5个月。14例患者在留置双J管后肾绞痛症状均缓解;1例置管后2周双J管脱出,再次留置2条双J管后未见脱出;排尿后患侧腰痛2例,1例出现肉眼血尿。无产科并发症。14例孕妇均顺利生产,婴儿健康;分娩后,4例结石自行排出,10例行体外冲击波碎石治疗。结论:经膀胱镜或输尿管镜留置双J管治疗妊娠期上尿路结石并发肾绞痛是一种安全有效的方法。     

数字胃肠机下静脉尿路造影在输尿管结石治疗前的应用价值

目的:探讨数字胃肠机下静脉尿路造影在输尿管结石治疗前的应用价值。材料与方法:对我院2008年1月～2010年3月经超声、KUB或CT诊断为输尿管结石的42例患者治疗前在数字胃肠机下静脉尿路造影资料及所得结果进行分析。结果:42例患者中,18例在常规时间内显影,20例行延时摄影,梗阻部位明确显示,结石定位准确;2例排除输尿管结石;2例由于重度肾积水无法显示,手术证实为输尿管结石。结论:输尿管结石在治疗前行数字胃肠机下静脉尿路造影显著提高了输尿管结石定位诊断的准确率,尤其是延时立位摄影更加有利于输尿管梗阻性结石的定位,同时输尿管梗阻程度的判定、肾功能的评估对临床治疗方法的选择上起到了重要的指导作用。     

金钱草片治疗尿路结石疗效观察

我院应用金钱草片治疗尿路结石20例,收效满意.兹报告如下: 1临床资料 20例中男12例,女8例;年龄21～60岁,平均38岁:病程2h～20d,平均10d;全部病例均为肾绞痛发作就诊,经B超或X线腹部平片、腹部CT确诊,结石均在1.5cm以下,其中肾结石5枚,输尿管结石12枚,膀胱结石3枚.     

湖南地区163例儿童泌尿系结石临床资料与结石成分分析

【目的】研究湖南地区儿童泌尿系结石的临床特点与结石成分。【方法】收集2013年6月至2014年10月在本院住院手术并取得结石标本的163例儿童资料,对结石进行红外光谱分析,对患者的临床资料进行回顾性分析。【结果】163例资料中男女比例约为3．7：1115（70．6％）例发生上尿路结石,36例（22．1％）发生下尿路结石,12例（7．4％）合并上下尿路混合结石。左侧、右侧和双侧上尿路结石儿童分别为41例（25．2％）、57例（35．o％）和29例（17．8％）。结石成分显示110例（67．5％）含有草酸钙成分,62例（38％）含有磷酸钙成分,23例（14．1％）合有感染性成分,53例（32．5％）含有尿酸成分,14例（8．6％）含有胱氨酸成分以及3例其他类结石成分。77例（47．2％）为单一成分结石,以单纯草酸钙类结石为最常见,其次为单纯尿酸类结石,86例（52．8％）为混合性结石,以草酸钙＋磷酸钙最常见,其次为草酸钙＋尿酸类。【结论】湖南地区儿童泌尿系结石各年龄阶段均有发生,在性别上主要以男性为主,发病部位主要为上尿路结石,结石成分中含草酸钙成分最多,其次为磷酸钙以及尿酸,约52．8％的儿童泌尿系结石为两种及以上混合成分结石。     

Diagnosis and prevention of uric acid stones

Uric acid stones occur in 10% of all kidney stones and are the second most-common cause of urinary stones after calcium oxalate and calcium phosphate calculi. The most important risk factor for uric acid crystallization and stone formation is a low urine pH (below 5.5) rather than an increased urinary uric acid excretion. Main causes of low urine pH are tubular disorders (including gout), chronic diarrhea or severe dehydration. Uric acid stone disease can be prevented and these are one of the few urinary tract stones that can be dissolved successfully. The treatment of uric acid stones consists not only of hydration (urine volume above 2000 ml daily), but mainly of urine alkalinization to pH values between 6.2 and 6.8. Urinary alkalization with potassium citrate or sodium bicarbonate is a highly effective treatment, resulting in dissolution of existing stones. Urinary uric acid excretion can be reduced by a low-purine diet. Potassium citrate is the treatment of choice for the prevention of recurrence of uric acid calculi. Allopurinol reduces the frequency of stone formation in hyperuricosuric patients with recurrent uric acid stones and/or gout.     

螺旋CT扫描预测体内尿酸结石的临床价值

目的研究螺旋CT对患者体内尿酸结石的预测价值。方法2005年12月至2009年12月,对391例上尿路结石患者在治疗前行螺旋CT平扫,测结石CT值,定量分析各种治疗方法所获取结石的化学成分,应用统计学分析,找出纯尿酸结石与非纯尿酸结石的CT值范围。结果33例纯尿酸结石(尿酸含量大于70%)与358例非尿酸结石及纯度小于70%的尿酸结石的CT值差异有统计学意义(P0.05);在CT软组织窗测得的结石平均CT值500HU以下为标准诊断纯尿酸结石,其灵敏度为93.94%,特异度为96.93%,阳性预测值为73.81%,阴性预测值为99.43%。结论结石的CT值可作为诊断尿酸结石的一种方法,CT值小于500HU的结石多考虑为纯尿酸结石。     

Pathophysiology,diagnosis and conservative therapy of non-calcium kidney calculi

While calcium oxalate and calcium phosphate make up at least 80% of all kidney stones, infection-induced and uric acid stones occur in 10% and 8%, respectively. Although any type of stone may become infected, the term "infection stones" means that stone formation exclusively depends on urease-producing bacteria. The splitting of urea leads to a rise in urinary pH which may induce crystallization of struvite (magnesium-ammonium-phosphate), the major constituent of infection stones, or carbonate apatite. Struvite stones account for the majority of staghorn calculi. They can grow quite large and may fill the entire collecting system. Patients with struvite stones may present with acute flank pain or remain completely asymptomatic. The cure of infection stones requires complete removal of the stone material. For uric acid crystallization and stone formation, low urine pH (below 5.5) is a more important risk factor than increased urinary uric acid excretion. Main causes of low urine pH are tubular disorders (including gout), chronic diarrheal states or severe dehydration. Accordingly, the treatment of uric acid stones consists not only of hydration (urine volume above 2000 ml per day), but mainly of urine alkalinization to pH values between 6.2 and 6.8. Urinary uric acid excretion can be reduced by a low-purine diet as well as--in case of recurrent uric acid stones and/or gout--by allopurinol. Cystinuria is a rare hereditary gene disorders with impaired tubular reabsorption of cystine. Stone formation occurs as a consequence of cystine's relatively low solubility at urine pH levels below 8. Only symptomatic diet and drug treatments are currently available, with urine dilution and urine alkalinization being the most efficient ones. Cystine stones respond poorly to shockwave lithotripsy, so that invasive procedures may regularly be necessary. 2,8-dihydroxy-adenine stones occur as a consequence of an enzyme deficiency that involves purine metabolism. These resulting stones are not visible by fluoroscopy and are therefore often misinterpreted as uric acid stones. Low-purine diet and allopurinol reduce the frequency of stone formation.     

双源 CT 在尿路结石成分分析中的临床研究

目的：探讨双源CT （DSCT）双能量技术应用于尿路结石成分分析中的临床价值。方法对75例尿路结石患者行DSCT双能量扫描及血清尿酸测定,对其结石成分进行分析,将结果与采用红外光谱法分析结石成分的结果作对比,计算DSCT在体分析尿酸盐结石及非尿酸盐结石的灵敏度与特异度。结果75例结石标本中尿酸盐结石25例,在140 kV能量下的CT值为（316.3±64.5）HU,在80 kV能量下的CT值为（336.4±55.7）HU;非尿酸盐结石为50例,在140 kV能量下的CT值为（680.7±334.1）HU,在80 kV能量状态下为（1005.2±221.3）HU。尿酸盐结石在2种能量状态下差值、比值分别为（20.1±8.1）、（1.06±0.02） HU;非尿酸盐结石在2种能量状态下差值、比值分别为（324.6±31.2）、（1.48±0.03）HU,尿酸盐结石差值、比值均明显低于非尿酸盐结石（均P＜0.05）。 DSCT能准确地区分尿酸盐结石和非尿酸盐结石,灵敏度及特异度分别为88.0%及98.0%。结论 DSCT能准确地区分尿酸盐结石和非尿酸盐结石。使用DSCT双能量技术在治疗前对尿路结石的成分进行初步分析,对了解结石成因、预防结石形成及指导治疗具有重要的意义。     

64排CT对上尿路结石成分分析的临床意义

目的探讨64排CT对上尿路结石成分分析的临床意义.方法选择肾盂结石及输尿管结石患者136例,64排CT扫描,对结石测量最大径和CT值,并对结石用红外光谱自动分析仪作成分分析.结果136例患者中纯结石患者78例,草酸钙结石和羟磷灰石结石的CT值显著高于L-胱氨酸结石和尿酸结石的CT值（P〈0.01）,草酸钙结石、羟磷灰石结石之间CT值差异无统计学意义,L-胱氨酸结石虽略高于尿酸结石CT值,但差异也无统计学意义.羟磷灰石结石CT值/结石最大横径较草酸钙结石差异有统计学意义（P〈0.05）,L-胱氨酸结石CT值/结石最大横径较尿酸结石差异有统计学意义（P〈0.05）.结论采用64排CT对结石CT值进行测定并计算CT值/最大横面直径能更好的判断结石成分,对于指导选择治疗方法及用药方案有积极作用.     

Uric acid calculi: types, etiology and mechanisms of formation

The study of the composition and structure of 41 stones composed of uric acid was complemented by in vitro investigation of the crystallization of uric acid. Uric acid dihydrate (UAD) precipitates from synthetic urine under physiological conditions when the medium is supersaturated with respect to this compound, though uric acid anhydrous (UAA) represents the thermodynamically stable form. Solid UAD in contact with liquid transforms into UAA within 2 days. This transition is accompanied by development of hexagonal bulky crystals of UAA and appearance of cracks in the UAD crystals. Uric acid calculi can be classified into two groups, differing in outer appearance and inner structure. Type I includes stones with a little central core and a compact columnar UAA shell and stones with interior structured in alternating densely non-columnar layers developed around a central core; both of them are formed mainly by crystalline growth at low uric acid supersaturation. Type II includes porous stones without inner structure and stones formed by a well developed outermost layer with an inner central cavity; this type of stones is formed mainly by sedimentation of uric acid crystals generated at higher uric acid supersaturation.     

Imaging-based assessment of the mineral composition of urinary stones: an in vitro study of the combination of hounsfield unit measurement in noncontrast helical computerized tomography and the twinkling artifact in color Doppler ultrasound

We evaluated the value of combining noncontrast helical computerized tomography (NCHCT) and color Doppler ultrasound in the assessment of the composition of urinary stones. In vitro, we studied 120 stones of known composition, that separate into the five main types: 18 calcium oxalate monohydrate (COM) stones, 41 calcium oxalate dihydrate (COD) stones, 24 uric acid stones, 25 calcium phosphate stones and 12 cystine calculi. Stones were characterized in terms of their Hounsfield density (HU) in NCHCT and the presence of a twinkling artifact (TA) in color Doppler ultrasound. There were statistically significant HU differences between calcium and non-calcium stones (p < 0.001), calcium oxalate stones and calcium phosphate stones (p < 0.001) and uric acid stones and cystine calculi (p < 0.001) but not between COM and COD stones (p = 0.786). Hence, the HU was a predictive factor of the composition of all types of stones, other than for COM and COD stones within the calcium oxalate class (p > 0.05). We found that the TA does not enable differentiation between calcium and non-calcium stones (p > 0.999), calcium oxalate stones and calcium phosphate stones (p = 0.15), or uric acid stones and cystine calculi (p = 0.079). However, it did reveal a significant difference between COM and COD stones (p = 0.002). The absence of a TA is a predictive factor for the presence of COM stones (p = 0.008). Hence, the association of NCHCT and Doppler enables the accurate classification of the five types of stones in vitro.     

Methylated purines in urinary stones

BACKGROUND: The aim of the study was to measure the content of methylated purines that appear as admixtures in uric acid stones. METHODS: We analyzed urinary calculi from 48 residents of Western Pomerania who underwent surgery at the urology ward in Szczecin. Stone samples were dissolved in 0.1 mol/L NaOH. Extracts were diluted in 50 mmol/L KH(2)PO(4) and analyzed by reversed-phase HPLC with ultraviolet detection and use of a gradient of methanol concentration and pH. RESULTS: Uric acid was the main component of 9 stones. All 9 showed admixtures of 9 other purine derivatives: endogenous purine breakdown products (xanthine, hypoxanthine, and 2,8-dihydroxyadenine) and exogenous methyl derivatives of uric acid and xanthine (1-, 3-, and 7-methyluric acid; 1,3-dimethyluric acid; and 3- and 7-methylxanthine). Amounts of these purine derivatives ranged from the limit of detection to 12 mg/g of stone weight and showed a strong positive correlation (Spearman rank correlation coefficients, 0.63-0.94) with the uric acid content of the samples. The main methylated purine in the stones was 1-methyluric acid. CONCLUSIONS: Urinary purines at concentrations below their saturation limits may coprecipitate in samples supersaturated with uric acid and appear as admixtures in urinary stones. The amount of each purine depends on its average urinary excretion, similarity to the chemical structure of uric acid, and concentration of the latter in the stone. These findings suggest that purines in stones represent a substitutional solid solution with uric acid as solvent. Methylxanthines, which are ubiquitous components of the diet, drugs, and uric acid calculi, may be involved in the pathogenesis of urolithiasis.     

Is idiopathic recurrent calcium urolithiasis in males a cellular disease? Laboratory findings in plasma, urine and erythrocytes, emphasizing the absence and presence of stones, oxidative and mineral metabolism: an observational study.

BACKGROUND: The site of origin of idiopathic recurrent calcium urolithiasis (IRCU)--a disorder characterized by stones composed of calcium oxalate (CaOx) and/or calcium phosphate (CaPi)--is uncertain, because in urine such risk factors for stones as disturbed Ox, Ca and Pi are not regularly observed. AIMS: To evaluate whether imbalance of antioxidants and oxidants might be present in IRCU patients that is then followed by abnormal urine, plasma and intracellular mineral homeostasis, and stones. METHODS: Males were investigated in the laboratory under standardized conditions, and three trials were organized. Trial 1 was cross-sectional, comparing IRCU patients with (n = 111) and without stones in situ (n = 126), focussing on abnormalities of oxypurines and minerals in urine and plasma, and metabolic activity (MA) of the disease. Trial 2 was partly controlled (n = 14 healthy subjects; n = 53 IRCU patients), comparing the plasma levels of total antioxidant status (TAS) and uric acid, the major antioxidant in humans, using the subsets Low (n = 26) and High (n = 27) TAS among IRCU patients in terms of plasma levels of uric acid, ascorbic acid, albumin, alpha-tocopherol and minerals, urinary minerals, CaOx and CaPi (hydroxyapatite) supersaturation. Trial 3, comprising stone-free IRCU patients (n = 8) and healthy controls (n = 8), compared minerals and mineral ratios in plasma and red blood cells (RBCs). Established analytical methodologies were used throughout. RESULTS: In trial 1, uricemia, hypoxanthinuria and proteinuria were elevated, fractional urinary clearance (FE) of uric acid was decreased in stone-bearing patients, and MA correlated positively with uricemia and urinary total protein excretion. In trial 2, TAS was significantly decreased in IRCU patients vs. healthy controls; low TAS coincided with low plasma uric acid and albumin, unchanged ascorbic acid, alpha-tocopherol and parathyroid hormone, but increased FE-uric acid and Pi excretion; the latter correlated negatively with TAS. In trial 3, plasma minerals were significantly decreased in IRCU patients vs. controls, and Ca/Pi, (Ca/Pi)/Mg and (Ca/Pi)/Na molar ratios increased; the latter ratio was also increased in RBCs, and correlated highly positively with the same ratio in plasma. CONCLUSIONS: In IRCU 1) renal stones in situ in combination with high fasting uricemia, high hypoxanthinuria and protein-uria, and high MA suggest that a systemic metabolic anomaly underlies stone formation; 2) antioxidant deficit is frequent, unrelated to the presence or absence of stones but apparently related to poor renal uric acid recycling, low uricemia and albuminemia, exaggerated urinary Pi excretion, and low MA; 3) the combination of low plasma TAS, disordered Ca/Pi and other mineral ratios in urine, plasma and RBCs, but unchanged urinary Ca salt supersaturation is compatible with the view that CaPi solid and Ca microlith formation start inside oxidatively damaged cells.