儿童头孢曲松相关尿路及胆囊假性结石一例报告并文献复习

Ceftriaxone-associated urinary tract and biliary pseudolithiasis in children： a case report and litera-ture review

目的探讨儿童头孢曲松相关尿路及胆囊假性结石的发病机制、临床特点、诊断及治疗。方法2011年3月收治头孢曲松相关尿路及胆囊假性结石患儿1例，男，6岁。人院前9d诊断为急性化脓性扁桃体炎，予头孢曲松钠3g／d[117mg／（kg·d）]治疗，用药3d出现双侧腹痛、恶心、呕吐，遂停药。停药后2d腹部B超检查示右肾盂扩张，其内可见0．7cm×0．4cm强回声团，后伴弱声影。停药后4d复查B超示胆囊内数个强回声光点，未见声影；右肾盂扩张加重，。肾盂输尿管交界处见1．6cm较强回声，声影不明显，右侧输尿管扩张；左肾盂扩张1．1cm，左侧输尿管扩张。SCr313μmol／L。结果行膀胱镜下双侧输尿管插管并冲洗，冲出较多胶冻样沉淀物。停药后6d复查SCr正常，复查B超示胆囊内强回声光团体积较前增大；右肾盂扩张减轻；左肾盂扩张无明显改变，左输尿管扩张稍缓解。再次行膀胱镜下输尿管插管并冲洗，仍冲出较多胶冻状沉淀物。此后双侧腹痛间断发作，但较前有所缓解。停药后7d复查血、尿常规和肝肾功能未见明显异常。停药后10d尿液变清亮、腹痛消失，复查CT未见尿路结石，双侧‘肾盂及输尿管无扩张，胆囊内可见较强回声团。停药后22d复查B超示胆囊、双侧肾及输尿管均未见异常。随诊1个月，尿道及胆囊结石无复发。结论头孢曲松相关尿路合并胆囊假性结石病例较少见。应用头孢曲松后出现尿路及胆道系统结石症状，应想到头孢曲松相关假结石病。

Objective To investigate the pathogenesis, clinical characteristics, diagnosis and treat- ment of Ceftriaxone-associated urinary tract and biliary pseudolithiasis in children. Methods A 6-year- old boy was treated in our hospital in March 2011. The initial diagnosis was acute suppurative tonsillitis. Ceftriaxone was administered intravenously at a dose of 3 g/d [ 117 mg/（ kg· d） ] for three days. After that the boy complained of bilateral abdominal pain and nausea. Abdominal sonogram obtained after cessation of ceftriaxone treatment revealed urinary tract and gallbladder stone and hydronephrosis. After cessation of ceftriaxone treatment and intubation tube into the ureters by cystoscope, symptoms gradually disappeared and renal function recovered. Results After cessation of ceftriaxone treatment, symptoms gradually disap- peared, with urinary tract CT scan normal after 10 days. Urinary tract and gallbladder sonograms were found to be normal 22 days after diagnosis without specific treatment. Followed up for 1 month, no recurrence of stone was observed. Conclusions Ceftriaxone-associated urinary tract and biliary pseudolithiasis in children is rare. These complications generally resolve spontaneously with cessation of the ceftriaxone therapy. Physicians should be aware of these complications so as to avoid unnecessary therapeutic procedures.