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目的:探讨儿童胱氨酸结石的临床特点、诊断和治疗方法。方法:回顾性分析13例儿童胱氨酸结石患者的临床资料:男9例,女4例。年龄1~14岁,平均3.5岁。双侧肾结石4例,其中1例同时伴发同侧输尿管结石;单侧肾结石6例,其中1例同时伴发对侧输尿管结石;单侧输尿管结石3例。结石大小0.8~4.0cm,平均2.2cm。除4例侧单纯输尿管结石未行双J管置入术外,其余14例侧均于术前2~3周行双J管置入术。结果:14例侧采用一期单纯输尿管硬镜或软镜碎石术,4例侧采用一期经皮肾镜碎石术。一期结石清空率为66.7%(12/18)。7例侧(2例经皮肾镜和5例输尿管软镜)行二期输尿管软镜或硬镜清石术。手术时间为45(25~160)min,术中冲洗液用量为1 000(400~10 000)ml,出血量约7(1~30)ml。所有患者均经结石成分分析确诊,纯L-胱氨酸结石11例,L-胱氨酸伴碳酸磷灰结石2例。结论:儿童胱氨酸结石在儿童结石中所占比例较高,治疗存在其特殊性;输尿管软镜手术在治疗儿童胱氨酸结石中有独特优势,对于较大或多发的胱氨酸结石,需采用经皮肾镜或联合输尿管软镜碎石。
Objective: To investigate the clinical features, diagnosis and treatment of cystine stones in children. Methods: A retrospective analysis of 13 cases of cystine stones in children with clinical data: 9 males and 4 females. Ages 1 to 14 years old, average 3.5 years old. Bilateral renal stones in 4 cases, including 1 case accompanied by ipsilateral ureteral calculi; unilateral renal stones in 6 cases, of which 1 case accompanied by contralateral ureteral calculi; unilateral ureteral calculi in 3 cases. Stone size 0.8 ~ 4.0cm, an average of 2.2cm. Except 4 cases of simple ureteral calculi without double J tube placement, the remaining 14 cases were treated with double J tube implantation 2 to 3 weeks before operation. Results: One case of simple ureteroscopic or soft-lens lithotripsy was used in 14 cases, and one-stage percutaneous nephrolithotomy was performed in 4 cases. A stone clearance rate of 66.7% (12/18). Seven cases (2 cases of percutaneous nephrolithotomy and 5 cases of ureteroscope) were performed ureteroscope or rigid lithotomy. The operation time was 45 (25 ~ 160) min. The amount of irrigating fluid during operation was 1 000 (400 ~ 10 000) ml and the bleeding volume was about 7 (1 ~ 30) ml. All patients were diagnosed by stone composition analysis, pure L-cystine stones in 11 cases, L-cystine phosphorylation of calcium carbonate in 2 cases. Conclusions: Cystine stones in children account for a relatively high proportion of children’s stones, and the treatment has its particularity. Ureteroscopic soft-lens surgery has unique advantages in the treatment of cystine stones in children. For large or multiple cystine stones, Need to use percutaneous nephrolithotomy or ureteroscopic soft lithotripsy.