老年人2型糖尿病合并输尿管结石34例诊治分析

Analysis of diagnosis and treatment of ureteral calculi in elderly patients with type 2 diabetes mellitus

目的探讨老年人2型糖尿病合并输尿管结石的临床特点,提高对其诊治水平。方法回顾性分析2014年10月至2018年12月连云港市第二人民医院收治的老年人2型糖尿病合并输尿管结石患者34例的临床资料。口服降糖药物或皮下注射胰岛素控制血糖,输尿管结石的治疗根据我国输尿管结石指南选择方案,如继发重度感染,给予分期治疗,一期给予抗感染+经尿道膀胱镜下输尿管双J管置入内引流,二期根据指南手术治疗。结果男性15例,女性19例,男女比例为1∶1.3。继发感染5例,均为女性患者,且病程长,其中1例轻度感染,给予抗感染治疗后一期手术治疗;3例重度感染,其中1例拒绝治疗并出院,其他2例采取分期治疗;1例为经尿道输尿管镜碎石术(URL)后继发感染。药物排石治疗12例,9例成功排石,3例治疗失败;体外冲击波碎石术(ESWL)9例,URL7例,经皮肾镜碎石术(PCNL)5例,接受外科治疗患者中,1例URL术后继发败血症,其余均无明显并发症出现,术后结石无残留。结论老年人2型糖尿病合并输尿管结石女性发病率较高;女性及长病程为感染发生的危险因素;通过积极控制血糖、加强抗感染,药物排石及外科治疗安全有效。

Objective To analyze the clinical features of ureteral calculi in elderly patients with type 2 diabetes mellitus in order to improve the diagnosis and treatment level.Methods The clinical data of 34 ureteral calculi elderly patients with type 2 diabetes mellitus in the Second People's Hospital of Lianyungang from October 2014 to December 2018 were studied retrospectively.Insulin therapy or oral glucose-lowering drugs was accepted.The patients received one-stage treatment according to the guidelines,while the patients with severe infection received two-stage treatment.In the stage I,cystoscopic retrograde double J tube was accomplished.In the stage II,the patients received surgical treatment according to the guidelines.Results Of the 34 cases,15 cases were male and 19 cases were female,and the female to male ratio was 1.3.Five cases with infection were female and had long disease duration.One case with mild infection received one-stage treatment through strictly controlling the infection,1 case with severe infection refused treatment and requested discharge from the hospital,2 cases with severe infection received two-stage treatment,1 case suffered infection after ureteroscopic lithotripsy(URL).Of the 12 patients received medical expulsive therapy,9 cases were cured,while 3 cases failed.Nine patients were successfully cured by extracorporeal shock-wave lithotripsy(ESWL),7 patients with middle-lower ureteral calculi by URL,5 patients with upper ureteral calculi by percutaneous nephrolithotripsy(PCNL).Septicemia occurred in 1 case after URL,the others had no serious complications.Conclusion The incidence of ureteral calculi in elderly patients with type 2 diabetes mellitus in female is gradually rising.Female and long disease duration are the risk factors for urinary tract infection.Medical expulsive therapy and surgery are safe and effective for the treatment of ureteral calculi in elderly patients with type 2 diabetes mellitus through strictly controlling the infection and blood glucose.