手术治疗三聚氰胺污染奶粉致泌尿系统结石22例

Surgical Treatment of Urinary Calculi in 22 Children Fed by Melamine-Contaminated Milk Powder

目的探讨三聚氰胺污染奶粉致小儿泌尿系统结石的特点及手术治疗效果,为临床诊疗提供参考。方法收集2008年9月-2010年2月在本院行手术治疗的三聚氰胺奶粉致泌尿系统结石22例患儿的临床资料,并进行临床分析。其中肾盂切开取石12例,输尿管切开取石3例,膀胱切开取石、B超引导下经皮肾镜取石各2例,肾盂切开取石并离断式肾盂成型、肾盂及输尿管下段联合切开取石、经前尿道取石各1例。术前常规行腹部平片、B超及CT检查。结果本组男17例,女5例;3岁以下婴幼儿16例(72.72%)。上尿路结石19例(86.36%),下尿路结石3例(13.64%)。其中并肾积水17例(77.27%)。腹部X线结石检出率为13.64%,B超为95.49%,CT为100.00%。开放性手术取石19例,B超引导下经皮肾镜取石术2例,经前尿道直接取石1例,均取石彻底,且无相关手术并发症发生。结论三聚氰胺污染奶粉致小儿泌尿系统结石以上尿路结石为主,3岁以下男童多见,B超及CT检出率高。经内科保守治疗无效患儿可采用手术治疗,手术效果较好,有条件可采用微创手术治疗。

Objective To explore the clinical feature of urinary calculi in children fed by melamine - contaminated milk powder and the effects of surgical treatment,which provide a reference for clinical diagnosis and treatment. Methods The clinical data of 22 hospitalized children with urolithiasis in the First Affiliated Hospital of Guangxi Medical University from Sep. 2008 to Feb. 2010 were collected. All the children undergone operation, including 12 cases of pyelolithotomy,3 cases of ureterolithotomy,2 cases of cystotomy,2 cases of B uhrasound - guided percutaneous nephrolithotomy, 1 case of pyelolithotomy combining dismembered pyeloplasty, 1 case of pyelolithotomy combining lower ureterolithotomy,and 1 case of fetched stone form anterior urethral. Most of the patients were accepted abdominal X ray, B ultrasound and CT before operation. Results There were 17 boys and 5 girls,of them 16 cases under 3 years old. Nineteen patients had calculi in the upper uri- nary tract and 3 cases in the lower urina~ tract, 17 cases of them were hydronephrosis. Abdominal X ray, B ultrasound and CT had c.omflrmed the diagnosis of calculi in 13.64% ,95.49% , 100.00% ,respectively. All the patients suffered from surgical treatment had good effects without complication,and 19 cases of them were open surgical,2 cases were B- ultrasound guide of percutaneous nephrolithotomy and 1 case was fetched stone from anterior urethral. Conclusions The urinary calculi in children fed by melamine - contaminated milk powder are mainly in upper urinary tract and children below 3 years old are predominant. B - ultrasound and CT had a high relevance ratio. Surgical treatment can be adopted when medical treatment is invalid. Minimally invasive treatment is optional. The surgical treatment is eutherapeutic.