沧州地区泌尿系结石成分分析及预防建议

发布时间：2018-04-04 12:20

本文选题：泌尿系结石　切入点：结石成分　出处：《河北医科大学》2016年硕士论文

【摘要】：目的:分析沧州地区城乡居住人群的泌尿系结石化学成份,探讨城乡不同居住地的结石成份差异,并结合分析结果提出预防措施。方法:选取2014年1月-2015年6月沧州地区城乡各地的泌尿系结石患者200例做为研究对象,通过体外冲击波碎石、经皮肾镜、输尿管镜、腹腔镜、开放手术等方式共取得结石标本200例,运用红外光谱法和化学分析法分析其化学成分,了解沧州地区城乡居民泌尿系结石成分的特点,并通过分析,找出结石患者性别、年龄、结石部位、居住地点和结石化学成分的关系。结果:1沧州地区泌尿系结石的成分:200例结石标本,含1水草酸钙成分78.50%(157/200),2水草酸钙成分64.00%(128/200),碳酸磷灰石成分52.50%(105/200),没有发现尿酸类、磷酸胺镁和胱氨酸成分。单纯结石占21.50%(43/200),其中单纯草酸钙结石36例,占单纯结石总数的83.72%(36/43),单纯碳酸磷灰石结石7例,占单纯结石总数的16.28%(7/43);草酸钙+碳酸磷灰石复合结石占78.50%(157/2200)。2性别分布男性占65.00%(130/200),女性占35.00%(70/200),男女性别比1.86:1。3年龄分布5~14岁占所有病例的1.00%(2/200),15~24岁占所有病例的3.5%(7/200),25~34岁占所有病例的12.5%(25/200),35~44岁占所有病例的27.5%(55/200),45~54岁占所有病例的22.0%(44/200),55~64岁占所有病例的21.5%(43/200),65~74岁占所有病例的10.5%(21/200),75岁以上占所有病例总数的1.5%(3/200)。4结石部位分布肾结石103例,占结石标本总数的51.50%(103/200),输尿管结石79例,占结石标本总数的39.50%(79/200),膀胱结石9例,占结石标本总数的4.50%(9/200),尿道结石3例,占结石标本总数的1.50%(3/200),肾合并输尿管结石5例,占结石标本总数的2.50%(5/200),尿道结石合并其他1例,占结石标本总数的0.50%(1/200),上路结石明显高于下路结石,比较差异有统计学意义(P0.05)。5治疗方法体外冲击波碎石111例,占所有病例数的55.5%,经皮肾镜手术45例,占所有病例的22.5%,经输尿管镜15例,占所有病例的7.5%,开放手术13例,占所有病例的6.5%,经膀胱镜手术8例,占所有病例的4.0%,药物治疗6例,占所有病例的3.0%,经腹腔镜手术2例,占所有病例的1.0%,微创手术明显高于开放手术和保守药物治疗,比较差异有统计学意义(P0.05)。6城乡分布城市居民结石标本99例,占结石标本的49.50%(99/200),单纯草酸钙结石19例,单纯碳酸磷灰石结石4例,草酸钙+碳酸磷灰石结石复合结石76例;农村居民结石标本111例,占结石标本的50.50%(111/200),单纯草酸钙结石18例,单纯碳酸磷灰石结石3例,草酸钙+碳酸磷灰石复合结石90例,城乡患者结石成分比较,差异无统计学意义(P0.05)。结论:沧州地区泌尿系结石以一水草酸钙、二水草酸钙和碳酸磷灰石构成,红外光谱和化学分析未发现尿酸类、磷酸胺镁和胱氨酸成分;男女性别比例1.86:1,以男性为主,35~44岁年龄组患病率较高,城乡居民结石患者结石成分没有差别,治疗方式以微创手术为主,开放手术和药物治疗为辅。在预防上应以营养平衡,增加水分摄入、控制钠盐、高蛋白、高钙和高磷食品,忌食和少食高草酸食物,合理锻炼为主。
[Abstract]:Objective: urinary calculi chemical composition analysis of Cangzhou urban and rural areas, people live, explore urban and rural residence of different stone composition differences, and with the results of the analysis put forward the preventive measures. Methods: 200 patients with urinary calculi from January 2014 June -2015 Cangzhou urban and rural areas around the cases as the research object, by extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy mirror, ureteroscopy, laparoscopy, open surgery, a total of 200 cases were stone, the chemical compositions were analyzed by infrared spectrometry and chemical analysis, understand the characteristics of composition of urinary stone of urban and rural residents in Cangzhou area, and through the analysis, find out the stone with the gender, age, place of residence and the relationship between the stones, stones of chemistry results: 1. The composition of the Cangzhou area of urinary stone composition: 200 stone samples, containing 1 water calcium oxalate component 78.50% (157/200), 2 water calcium component 64% (128/200), Carbonate apatite component 52.50% (105/200), found no uric acid, magnesium ammonium phosphate and cystine ingredients. Simple stones accounted for 21.50% (43/200), the calcium oxalate stones in 36 cases, accounting for 83.72% of the total number of pure stones (36/43), pure carbonate apatite stones in 7 cases, accounting for 16.28% of the total number of single pure stones (7/43); calcium oxalate + carbonate apatite composite stones accounted for 78.50% (157/2200).2 gender distribution accounted for 65% of men, women accounted for 35% (130/200) (70/200), the sex ratio of 1.86:1.3 age 5~14 years old accounted for 1% of all cases (2/200, 15~) at the age of 24 accounted for 3.5% of all cases (7/200), 25~34 years old accounted for all in 12.5% of cases (25/200), 35~44 years old accounted for 27.5% of all cases (55/200), 45~54 years old accounted for 22% of all cases (44/200), 55~64 years old accounted for 21.5% of all cases (43/200), 65~74 years old accounted for 10.5% of all cases (21/200), 75 years of age accounted for 1.5% of all the total number of cases (3/200.4) Department of stone Distribution of renal calculi in 103 cases, accounting for 51.50% of the total number of stone specimens (103/200), 79 cases of ureteral calculi, accounting for 39.50% of the total stone specimens (79/200), 9 cases of bladder stones, stones were accounted for 4.50% of the total (9/200), 3 cases of urethral calculi, accounting for 1.50% of the total stone specimens (3 /200), 5 cases of renal calculi complicated with ureteral calculi, accounting for 2.50% of the total number of samples (5/200), urethral stone with the other 1 cases, accounting for 0.50% of the total number of stone specimens (1/200), the road was significantly higher than that under the stone road stone, and there was a statistically significant difference (P0.05).5 treatment of external shock wave lithotripsy in 111 cases, accounting for all cases the 55.5%, the 45 cases of percutaneous nephrolithotomy, accounting for 22.5% of all cases, 15 cases with ureteroscopy, accounted for 7.5% of all cases, 13 cases of open surgery, accounting for 6.5% of all cases, 8 cases with bladder surgery, accounting for 4% of all cases, drug treatment in 6 cases, accounted for 3% of all cases laparoscopic surgery, 2 cases In all cases, accounting for 1%, significantly higher than that of open surgery and minimally invasive surgery, conservative treatment, the difference was statistically significant (P0.05).6 city residents of urban and rural distribution stones were 99 cases, accounting for 49.50% of the stone specimens (99/200), calcium oxalate stones in 19 cases, 4 cases of simple carbonate apatite stones, calcium oxalate + carbonate apatite stone composite stones in 76 cases; 111 cases of gallstones were rural residents, accounting for 50.50% of the stone specimens (111/200), calcium oxalate stones in 18 cases, 3 cases of simple carbonate apatite stones, calcium oxalate + carbonate apatite composite stones in 90 cases, a comparison between urban and rural patients with calculi, there was no statistically significant difference (P0.05). Conclusion: the urinary tract stone in Cangzhou area of calcium oxalate monohydrate, two water calcium oxalate and carbonate apatite, IR and chemical analysis found no uric acid, magnesium ammonium phosphate and cystine composition; the sex ratio 1.86:1, male dominated, 35~4 4 year old age group prevalence rate is higher, there is no difference between urban and rural residents stone with the stone composition, treatment is mainly in the form of minimally invasive surgery, supplemented by surgery and drug treatment. In the open prevention should be based on balanced nutrition, increase water intake, control of sodium, high protein, high calcium and high phosphorus diet and food, eat less high acid foods. Reasonable exercise.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R691.4

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