三聚氰胺致婴幼儿泌尿系统结石的外科疗效评价

Evaluation of Effect of Surgical Treatment for Melamine-Induced Urolithiasis in Infants

目的评价3种外科方式治疗三聚氰胺致婴幼儿泌尿系统结石的效果。方法对经保守治疗无效的27例三聚氰胺致婴幼儿泌尿系统结石的患儿采用3种外科方式进行治疗,分别为体外冲击波碎石术(ESWL)、输尿管插管置管术(UC)、输尿管切开取石术(ULT)。治疗1a后随访,对其行B超检查,肾功能检查[包括BUN、Cr、尿酸(UA)、α1-微球蛋白、微量清蛋白、β2-微球蛋白]及尿常规测定,进行评价疗效。结果 27例患儿中25例治愈,治愈率达92.6%。采用UC治疗20例,2例残留结石(直径分别为9.0mm、2.3mm);采用ULT治疗4例,均治愈;采用ESWL治疗7例,其中3例治愈,4例无效改用UC治疗后治愈。UC组与ULT组治疗前后BUN、Cr、UA比较差异有统计学意义(Pa<0.01),治疗1a后各治疗组患儿BUN、Cr、UA均恢复正常。肾功能检查与尿常规随访结果显示患儿各指标转归良好。结论三聚氰胺致婴幼儿泌尿系统结石外科治疗方式中ULT效果最好,UC次之,ESWL效果欠佳。

Objective To evaluate the efficacy of three different surgical interventions administered to infants with urolithiasis induced by ingestion of melamine - contaminated infant formula milk powder. Methods A total of 27 infants with severe urolithiasis accepted the urinary catheterization（UC） ,ureterolithotomy （ULT） or cxtracorporeal shock wave lithotripsy （ESWL） after the unavailable conservative treatment. Ultrasonograph,blood and urine biochemistry analysis Ⅰ including blood urea nitrogen （BUN）, serum creatinine （Cr）, serum urea acid （UA）,α1-microglobulin,urine microalbumin,β2 -microglobulinl and urinalysis in these infants were conducted in the one- year follow- up study in order to evaluate the efficacy of treatments. Results Of the 27 infants,20 cases were treated with UC,but 2 cases failed and the size of residual stone in these 2 cases was 9.0 mm and 2.3 mm, respectively;4 cases were successfully treated with ULT and 7 cases were treated with ESWL,but only 3 cases cured,4 cases of these 7 cases then cured by UC. Finally,25 cases（92.6% ） cured. There were significant differences of BUN,Cr and UA between UC group and ULT group before and after treatment. The levels of BUN,Cr and UA recovered to normal level in three different teatment groups after one year intervention. Urine biochemistry analysis and renal function test turned negative basically in the follow - up study. Conclusion The efficacy of ULT is found superior to UC and proved UC to be better than ESWL.