小儿尿石症：一家三级护理儿童医院的经验
Pediatric urolithiasis: experience at a tertiary care pediatric hospital.
作者信息
Kit Laura Chang, Filler Guido, Pike John, Leonard Michael P
机构信息
Pediatric Urology.
出版信息
Can Urol Assoc J. 2008 Aug;2(4):381-6. doi: 10.5489/cuaj.804.
OBJECTIVE
We aimed to determine the epidemiology, risk factors, clinical characteristics, evaluation and course of patients with urolithiasis at the Children's Hospital of Eastern Ontario to improve current diagnostic and management strategies.
METHODS
This was a retrospective study of children with newly identified urolithiasis between Jan. 1, 1999, and July 31, 2004. Cases were reviewed for demographics, presentation, family history, diagnostic methods and findings, metabolic and anatomic abnormalities, management, stone analysis and stone recurrence.
RESULTS
Seventy-two patients (40 male, 32 female; mean age 11.3 yr) were assessed. Mean follow-up was at 1.5 years. Eighteen patients (25%) had a family history of stones. Flank pain (63%) was the most common presentation. Eighty-two percent of urinalyses showed microscopic hematuria. Imaging comprised abdominal plain film radiography (56%) and (or) abdominal ultrasonography (74%). The mean stone size was 5 mm. Forty-one percent (28/69) of patients who underwent metabolic investigation had an abnormality. Fourteen percent of patients (10/72) had a genitourinary anatomical abnormality. Thirty-four patients (47%) passed their stones spontaneously, 25 patients (35%) required surgical intervention and 13 patients (18%) had yet to pass their stone. The mean size of spontaneously passed stones was 4 mm. Of 42 stones analyzed, 39 (93%) were composed of calcium oxalate or phosphate. Seventeen (24%) patients had stone recurrence during follow-up.
CONCLUSION
Pediatric patients with stones present in a manner similar to adults. Abdominal plain film radiography and ultrasonography are the preferred initial radiological investigations in children as they limit radiation exposure. Metabolic abnormalities are common and may coexist with anatomic abnormalities, therefore investigations must rule these out. One-half of patients will pass their stones spontaneously. Recurrence rates are high and long-term follow-up is recommended.
目的
我们旨在确定安大略东部儿童医院尿路结石患者的流行病学、危险因素、临床特征、评估及病程，以改进当前的诊断和管理策略。
方法
这是一项对1999年1月1日至2004年7月31日期间新确诊尿路结石患儿的回顾性研究。对病例进行人口统计学、临床表现、家族史、诊断方法及结果、代谢和解剖异常、治疗、结石分析及结石复发情况的审查。
结果
共评估了72例患者（40例男性，32例女性；平均年龄11.3岁）。平均随访时间为1.5年。18例患者（25%）有结石家族史。胁腹痛（63%）是最常见的表现。82%的尿液分析显示镜下血尿。影像学检查包括腹部平片（56%）和（或）腹部超声（74%）。结石平均大小为5毫米。接受代谢检查的患者中有41%（28/69）存在异常。14%的患者（10/72）有泌尿生殖系统解剖异常。34例患者（47%）结石自行排出，25例患者（35%）需要手术干预，13例患者（18%）结石尚未排出。自行排出结石的平均大小为4毫米。在分析的42颗结石中，39颗（93%）由草酸钙或磷酸盐组成。17例（24%）患者在随访期间结石复发。
结论
小儿结石患者临床表现与成人相似。腹部平片和超声是儿童首选的初始影像学检查，因为它们可减少辐射暴露。代谢异常常见，可能与解剖异常并存，因此检查必须排除这些情况。一半的患者结石会自行排出。复发率高，建议进行长期随访。
Zotero 插件