山西地区肾结石复发特点及危险因素分析

发布时间：2018-07-17 04:15

【摘要】：目的:通过260例山西地区初发肾结石患者的术后随访及对复发肾结石成分分析,总结山西地区肾结石复发特点及影响复发的危险因素,为预防山西地区肾结石复发提供依据。方法:从2014年9月到2016年9月就诊于中国人民解放军264医院的肾结石患者中筛选出符合标准的260例患者定期随访,随访资料包括术后相关影像学检查及血、尿生化。根据结果将260例肾结石术后患者分为肾结石复发组与肾结石未复发组,同时对复发性患者结石性质进行结石成分分析,并回顾性分析二组患者临床资料及随访结果,对资料进行统计分析,总结出山西地区肾结石复发的复发特点及影响复发危险因素。结果:260例初发性肾结石患者中,超重组5人,肥胖组29人,正常组226人;轻度肾脏积水者18人(先天性输尿管狭窄者7人,前列腺增生患者10人,后尿道狭窄患者1人),共复发8人,无肾积水者242人,复发16人;血清高血钙者10人,其中肿瘤患者6人(肺部肿瘤患者1人,膀胱肿瘤患者4人,前列腺肿瘤患者1人)、代谢综合症患者2人,不明原因患者2人,共复发3人,正常血钙者250人,复发21人;男性和女性患者分别为182、78例,比例约为2.3:1;男性、女性平均肾结石初发年龄分别为42.5±12.4岁、40.8±13.2岁;左肾、右肾及双肾结石分别为121例、115例、24例;非鹿角形、鹿角形结石分别为237例、23例;结石长轴2cm、2~3cm、3cm者分别有153人、92人、15人,结石长轴平均为1.9cm;最长随访30个月,最短随访7个月,平均随访16.9个月;肾结石共复发24例,1年复发率、2年复发率分别为7.8%、9.2%;复发患者复发时间最短7个月,最长25个月,平均为13.5个月;20~40岁、40~60岁、60岁以上分别有50例、190例、20例,复发人数人别为6例、10例、8例;男性复发18例,女性6例;超重组、肥胖组、正常体质组分别复发3、6、15例;初发单侧、双侧肾结石患者中分别复发13例、11例;鹿角形结石23例,复发8例,非鹿角形结石237例,复发16例;初发肾脏结石小于2cm组、2~3cm组、大于3cm组复发人数分别为8人、12人、4人;高尿酸血症者2人,2人术后2年全部复发;复查两次及以上尿路感染者9人,复发4人;复发结石全部为单侧复发,结石成分主要以草酸钙结石、磷酸铵镁结石及磷灰石多见。结论:1、山西地区肾脏结石患者复发率较高,1年、2年复发率分别为7.8%、9.2%;2、年龄与肾结石复发有相关性,60岁以上老年人更易复发;性别因素对复发率影响无统计学意义;3、初发肾结石患者之中,双侧肾结石及鹿角形肾结石更易复发;初发患者结石长轴大小与复发有相关性,大于2cm结石患者更易复发;4、BMI指数与肾结石复发相关,BMI指数25者更易复发;5、高血清Ca2+水平、长期肾脏积水、肾脏结石术后慢性尿路感染为肾结石复发的重要因素;6、山西地区复发结石成分以草酸钙结石和感染性结石(磷酸铵镁结石、磷灰石)为主。
[Abstract]:Objective: to summarize the characteristics of renal calculi recurrence and the risk factors affecting the recurrence of renal calculi in Shanxi area through the follow-up of 260 cases of primary renal calculi in Shanxi area and to provide evidence for preventing the recurrence of renal calculi in Shanxi area. Methods: from September 2014 to September 2016, 260 patients with renal calculi were selected from 264 Hospital of the Chinese people's Liberation Army (PLA) to follow up regularly. The follow-up data included postoperative imaging examination, blood and urine biochemistry. According to the results, 260 patients were divided into two groups: the recurrent group and the non-recurrent group. The stone components of the recurrent patients were analyzed, and the clinical data and follow-up results of the two groups were analyzed retrospectively. The recurrence characteristics and risk factors of renal calculi recurrence in Shanxi area were summarized by statistical analysis. Results among 260 patients with primary renal calculi, 5 were superrecombinant, 29 were obese, 226 were normal, 18 were mild hydronephrosis (7 patients with congenital ureteral stricture and 10 patients with benign prostatic hyperplasia). There were 8 patients with posterior urethral stricture, 242 patients without hydronephrosis, 16 patients with recurrence, 10 patients with high serum calcium, including 6 patients with tumor (1 patient with lung tumor and 4 patients with bladder tumor). (1 patient with prostate cancer), 2 patients with metabolic syndrome, 2 patients with unknown cause, 3 patients with recurrence, 250 patients with normal blood calcium and 21 patients with recurrence. The mean initial age of renal calculi in females was 42.5 卤12.4 years old and 40.8 卤13.2 years old respectively; there were 121 cases of renal calculi in the left kidney, 115 cases in the right kidney and 24 cases in both kidneys; 237 cases were non-staghorn stones and 23 cases were staghorn stones; The mean long axis of stone was 1.9 cm, the longest follow-up was 30 months, the shortest follow-up was 7 months, the average follow-up was 16.9 months, the recurrence rate of renal calculi in 24 cases, the recurrence rate of 1 year and the recurrence rate of 2 years were 7.8 and 9.2.The recurrence time of recurrent patients was 7 months and the longest was 25 months. The average age was 13.5 months, 20 / 40 years, 40 / 40 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60, 20 / 50 / 50 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 50 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / 60 / Among the patients with bilateral renal calculi, there were 13 cases of recurrence, 23 cases of staghorn calculi, 8 cases of recurrence, 237 cases of non-staghorn calculi, 16 cases of recurrence, the number of recurrence of primary renal calculi was less than 2cm in 2cm group and 4 cases were higher than that of 3cm group. In 2 patients with hyperuricemia, 2 patients all recurred 2 years after operation; 9 patients with urinary tract infection were re-examined twice or more, 4 patients recurred. All the recurrent stones were unilateral recurrence, the main components of the stones were calcium oxalate stones, magnesium ammonium phosphate stones and apatite. Conclusion the recurrence rate of renal calculi in Shanxi area is high, the recurrence rate in 1 year and 2 years is 7.8% and 9.2%, respectively. The age is related to the recurrence of renal calculi. The elderly over 60 years old are more likely to relapse. Sex factors had no significant effect on the recurrence rate. Among the patients with primary renal calculi, bilateral renal calculi and staghorn renal calculi were more likely to recur, and the long axis size of the stones was correlated with the recurrence of primary renal calculi. Patients with 2cm were more likely to recur than those with 2cm. The patients with high serum Ca 2 2 level and long term hydronephrosis were more likely to recur than 25 patients with renal calculi associated with renal calculi recurrence. Chronic urinary tract infection was an important factor for the recurrence of renal calculi. Calcium oxalate stones and infectious stones (ammonium magnesium phosphate stone, apatite) were the main components of the recurrent stones in Shanxi.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.4

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