儿童和成人头孢曲松结石致上尿路梗阻的外科治疗

Surgical treatment of upper urinary tract obstruction caused by ceftriaxone calculi in children and adults

目的:探讨儿童及成人头孢曲松结石致上尿路梗阻的外科治疗方法。方法:回顾性分析2017年7月-2020年2月于我院诊治的4例儿童和成人头孢曲松结石致上尿路梗阻的临床资料,探讨其临床表现、影像学特征及外科治疗方法。结果:4例患者中,有3例的临床表现为肾绞痛或腹部疼痛,1例的临床表现为无尿。B超和CT检查发现肾结石和(或)输尿管结石,患侧肾、输尿管积水经外科治疗均已痊愈,结石成分分析为头孢曲松,术后随访3-6个月肾功能均正常,无结石残留或复发。结论:长期和(或)超量使用CTRX、脱水、长期卧床、补钙、输尿管狭窄是形成头孢曲松结石的高危因素。头孢曲松结石致上尿路梗阻时通过及时留置输尿管支架解除梗阻,并通过口服枸橼酸氢钾钠和适当喝水促进结石排出,达到较好地治疗效果。

Objective: To investigate the surgical treatment of upper urinary tract obstruction caused by ceftriaxone(CTRX) calculi in children and adults. Method: The data of 4 children and adults with upper urinary tract obstruction caused by CTRX calculi in the Department of Urology, First Hospital of Lanzhou University from July 2017 to February 2020 were retrospectively analyzed, and the clinical manifestations, imaging features and surgical treatment methods were discussed. Result: Among the 4 cases, 3 cases had renal colic or abdominal pain, and 1 case had anuria. Renal and/or ureteral calculi were found by B-ultrasound and CT examination. The hydronephrosis of the affected side was cured by surgical treatment. The composition of the stone was analyzed as CTRX. The renal function was normal after 3-6 months of follow-up, and there was no residual or recurrence of stones. Conclusion: Long term and/or excessive use of CTRX, dehydration, long-term bed rest, calcium supplement and ureteral stricture are the high risk factors for CTRX calculi. When upper urinary tract obstruction caused by CTRX calculi, ureteral stent should be placed in time to relieve the obstruction, and potassium sodium hydrogen citrate and appropriate drinking water should be taken orally to promote the excretion of stones, so as to achieve better therapeutic effect.