肾盂内灌注碱性药物溶石治疗三聚氰胺所致婴儿双肾结石

Direct renal chemolysis with alkaline drug for infantile renal calculus resulted from melamine

目的探讨经输尿管导管或肾造瘘管肾盂内直接灌注碱性药物溶石治疗三聚氰胺所致婴儿双肾结石的有效性和安全性。方法双。肾结石合并急性肾后性肾功能衰竭婴儿15例。年龄5～12个月，平均9个月。结石直径0．4～1．5cm，平均0．8cm。15例患儿均长期食用受三聚氰胺污染的奶粉，经影像学和实验室检查诊断为急性肾后性肾功能衰竭。13例经尿道输尿管镜下通过输尿管导管行肾盂内碱性药物灌洗，20ml5%NaHCO3于10min内缓慢冲洗，然后置入双J管。2例经皮肾穿刺留置肾造瘘管，术后间歇碱性药物灌洗，100ml1．4％NaHCO3于4～6h内持续低压滴注，1次／d，持续2周。结果15例患儿均成功实施碱性药物肾盂内灌洗溶石治疗。术后2～5d尿量恢复正常，2～3dSCr、BUN恢复正常。13例术中经输尿管导管直接肾盂内灌注5％NaHCO3者，术中均观察到大量混浊液体自输尿管口喷涌而出。术后2周复查CT，结石消失13例，结石直径缩小〉50％者2例。结论经输尿管导管或肾造瘘管进行肾盂内直接碱性药物化学溶石治疗三聚氰胺所致婴儿肾结石安全、有效。

Objective To evaluate the efficacy and safety of direct renal chemolysis with alkaline drug through ureteral catheter or nephrostomy tube for the treatment of infantile renal calculus resulted from melamine. Methods Fifteen infants of acute post-renal failure resulted from bilateral renal calculi were treated. The age of the infants was 5-12 months（average, 9 months）. Stone size varied from 0.4 to 1.5 cm （average, 0.8 cm）. They were all fed on milk powder polluted with melamine for a long time and diagnosed with acute post-renal failure based on the imaging and chemical examination. Double-J stents insertion by ureteroscope was performed on 13 infants and direct renal chemolysis with alkaline drug（5 % NaHCO3 , 20 ml）through ureteral catheter was performed during operation. Percutaneous nephrostomy was performed on 2 infants to remove the obstruction of upper urinary tract and di rect renal chemolysis with alkaline drug（1.4 % NaHCO3 , continuous perfusion by gravity） through nephrostomy tube was performed intermittently after operation. Results Direct renal chemolysis was performed successfully on the 15 infants. The urine volume recovered in 2-5 d, blood urea nitrogen and serum creatinine recovered in 2-3 d postoperatively. During the operation of the infants treated by direct renal chemolysis with 5%NaHCO3 throuth ureteral catheter, a large number of limous fluid spurted from ureterostoma. According to CT examination 2 weeks after operation, the stone fragments were removed thoroughly in 13 infants, the diameter of the stone lessened more than 50% in 2 infants. Conclusion Direct renal chemolysis with alkaline drug for eliminating infantile renal calculus resulted from melamine is safe and effective.