120例山西地区鹿角形肾结石成分分析及临床意义

发布时间：2018-09-10 09:03

【摘要】：目的:通过对山西地区鹿角形肾结石进行成分分析,探讨山西地区鹿角形肾结石成分特点,为本地区鹿角形肾结石的防治提供依据。方法:收集中国人民解放军264医院泌尿外科2014年1月-2016年2月份诊断为鹿角形肾结石的住院和门诊患者68例,通过经皮肾镜弹道碎石术、逆行输尿管软镜钬激光碎石术、肾切除术、体外冲击波碎石术获取结石标本,采用(天津蓝莫德科学仪器公司生产,型号为LIIR-20)红外光谱自动结石成分分析仪对结石标本进行成分分析。同时将收集的每份新鲜结石标本取部分用纯洁水洗净后研碎成末并进行一般细菌培养。并回顾分析2012年1月-2013年12月间在中国人民解放军264医院泌尿外科接受外科治疗的52例鹿角形肾结石患者结石成分分析结果及一般资料。结果:本组120例鹿角形肾结石中,男性82例,女性38例,男女比约为2.2:1;男性平均年龄38.1士12.3岁,女性平均年龄39.4士13.2岁;部分性鹿角形肾结石98例,完全性鹿角形肾结石22例,比例为4.5:1;结石位于左侧72例,右侧44例,双侧4例;结石成分有一水草酸钙、六水碳酸磷灰石、二水草酸钙、六水磷酸铵镁、二水磷酸氢钙和无水尿酸六类,无胱氨酸结石。结石含一水草酸钙101例,二水草酸钙33例,六水碳酸磷灰石86例,六水磷酸铵镁结石36例,二水磷酸氢钙11例,无水尿酸8例。单一成分结石即纯结石23例,其中一水草酸钙17例,无水尿酸结石3例,六水磷酸铵镁结石2例,六水碳酸磷灰石1例,无二水草酸钙及二水磷酸氢钙结石。混合结石共97例,一水草酸钙+碳酸磷灰石在男性中常见,一水草酸钙+磷酸铵镁结石在女性中常见,部分性鹿角形肾结石主要以一水草酸钙+碳酸磷灰石为主,完全性鹿角形肾结石主要以一水草酸钙+磷酸铵镁+碳酸磷灰石为主。结石细菌培养,完全性鹿角形肾结石患者中阳性18例,阴性4例,部分性鹿角形肾结石阳性27例,阴性71例,女性阳性21例,阴性17例,男性阳性24例,阴性58例。结石细菌培养阳性结石中,大肠埃希菌为主要细菌,其中含一水草酸钙31例,六水磷酸铵镁26例,六水碳酸磷灰石27例,二水草酸钙7例,二水磷酸氢钙3例;结石细菌培养阴性结石中,含一水草酸钙70例,六水磷酸铵镁10例,六水碳酸磷灰石59例,二水草酸钙26例,二水磷酸氢钙3例;无水尿酸8例。结论:1、山西地区鹿角形肾结石多发于男性,好发年龄为30一50岁,部分性鹿角形肾结石较常见。2、结石的主要成分依次为一水草酸钙、六水碳酸磷灰石、六水磷酸铵镁、二水草酸钙、二水磷酸氢钙和尿酸结石,无胱氨酸类结石。结石多以混合结石为主,一水草酸钙+碳酸磷灰石在男性中常见,一水草酸钙+磷酸铵镁结石在女性中常见,部分性鹿角形肾结石主要以一水草酸钙+碳酸磷灰石为主,完全性鹿角形肾结石主要以一水草酸钙+磷酸铵镁+碳酸磷灰石为主。山西地区鹿角形肾结石与我国其它地方及国外报道鹿角形肾结石的主要成分不同。3、约30%结石患者结石细菌培养阳性,多为完全性鹿角形肾结石,好发于女性,细菌主要为大肠埃希菌,磷酸铵镁为感染性结石成分。
[Abstract]:Objective: To analyze the composition of staghorn kidney stones in Shanxi and to explore the characteristics of staghorn kidney stones in Shanxi, and to provide evidence for the prevention and treatment of staghorn kidney stones in Shanxi.Methods: The data of inpatients and outpatients with staghorn kidney stones diagnosed by urology department of 264 Hospital of Chinese People's Liberation Army from January 2014 to February 2016 were collected. In 8 cases, stones were obtained by percutaneous nephrolithotomy, retrograde ureteroscopic holmium laser lithotripsy, nephrectomy and extracorporeal shock wave lithotripsy. The stones were analyzed by infrared spectroscopic automatic lithotripsy analyzer (LIIR-20) produced by Tianjin Lamode Scientific Instrument Company. Fresh stone specimens were washed with pure water and ground to pieces and cultured with bacteria. The results and general data of 52 patients with staghorn calculi who received surgical treatment in urology department of 264 Hospital of Chinese People's Liberation Army from January 2012 to December 2013 were analyzed retrospectively. There were 82 males and 38 females, the ratio of male to female was about 2.2:1; the average age of males was 38.1 to 12.3 years, and the average age of females was 39.4 to 13.2 years; 98 cases of partial staghorn calculi, 22 cases of complete staghorn calculi, the ratio was 4.5:1; 72 cases were located on the left side, 44 cases on the right side, and 4 cases on both sides; the calculi components were calcium oxalate hydrate, hexahydrate carbonate apatite, and dihydrate. Calcium oxalate hydrate, magnesium ammonium phosphate hexahydrate, calcium hydrogen phosphate dihydrate and anhydrous uric acid, cystine calculi. Calcium oxalate monohydrate was found in 101 cases, calcium oxalate dihydrate in 33 cases, apatite hexahydrate in 86 cases, magnesium ammonium phosphate hexahydrate in 36 cases, calcium hydrogen phosphate dihydrate in 11 cases, anhydrous uric acid in 8 cases. 7 cases, anhydrous uric acid calculus 3 cases, ammonium magnesium phosphate hexahydrate calculus 2 cases, hexahydrate carbonate apatite 1 case, anhydrous calcium oxalate and dihydrate calcium phosphate calculus. 97 cases of mixed calculus, calcium oxalate monohydrate + carbonate apatite common in men, calcium oxalate monohydrate + magnesium ammonium phosphate calculus common in women, some staghorn kidney stones mainly with a hydrochlor Calcium oxalate + carbonate apatite was the main component of complete staghorn calculi, and calcium oxalate hydrate + magnesium ammonium phosphate + carbonate apatite was the main component of complete staghorn calculi. Escherichia coli was the main bacteria in 58 cases with positive bacterial culture of calculi, including 31 cases of calcium oxalate monohydrate, 26 cases of magnesium ammonium phosphate hexahydrate, 27 cases of apatite hexahydrate, 7 cases of calcium oxalate dihydrate, 3 cases of calcium hydrogen phosphate dihydrate, 70 cases of calcium oxalate monohydrate, 10 cases of magnesium ammonium phosphate hexahydrate, 5 cases of apatite hexahydrate carbonate. 9 cases, 26 cases of calcium oxalate dihydrate, 3 cases of calcium hydrogen phosphate dihydrate, 8 cases of anhydrous uric acid. Conclusion: 1, staghorn kidney stones in Shanxi are more common in men, the predilection age is 30-50 years old, and some staghorn kidney stones are more common. 2. The main components of the stones are calcium oxalate hydrate, hexahydrate carbonate apatite, magnesium ammonium phosphate hexahydrate, calcium oxalate dihydrate, phosphorus dihydrate. Calcium hydroxide and uric acid calculi, cysteine-free calculi. Calcium oxalate monohydrate + carbonate apatite is common in men. Calcium oxalate monohydrate + magnesium ammonium phosphate calculi is common in women. Cervical antler calculi are mainly calcium oxalate hydrate + carbonate apatite. Complete staghorn calculi is mainly water. Calcium oxalate+magnesium ammonium phosphate+apatite carbonate is the main component of staghorn kidney stones in Shanxi area,which is different from other parts of China and foreign reports.3.About 30% of the patients with staghorn kidney stones have positive bacterial culture,most of them are complete staghorn kidney stones,predominantly in women,the bacteria are Escherichia coli,magnesium ammonium phosphate is the infection. The composition of sexual calculus.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R692.4

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