Yong Jiang,Zhao Yaowang,Wang Zhi,et al.Clinical features and treatments of lower urinary tract calculi in children[J].Journal of Clinical Pediatric Surgery,2025,(09):858-863.[doi:10.3760/cma.j.cn101785-202506006-010]
小儿泌尿系下尿路结石的临床特征及疗效分析
- Title:
- Clinical features and treatments of lower urinary tract calculi in children
- Keywords:
- Urinary Calculi; Symptoms and Signs; Postoperative Complications; Surgical Procedures; Operative; Child
- 摘要:
- 目的 分析小儿泌尿系下尿路结石患者的临床特征及治疗效果，为临床诊疗提供参考。方法 回顾性分析湖南省儿童医院泌尿外科2017年1月至2023年12月收治的72例下尿路结石患儿临床资料，收集患儿主诉、症状、体征、实验室检查结果、影像学结果、手术方法、结石成分类型、术后随访、复发情况等数据；根据结石位置不同分为膀胱结石组(53例)和尿道结石组(19例)；根据症状出现至就诊时间的不同，分为症状出现至就诊时间≤7天组(29例)、症状出现至就诊时间7~14(含14)天组(7例)、症状出现至就诊时间14~30(含30)天组(8例)、症状出现至就诊时间＞30天组(28例)；对各组数据进行统计分析。结果 72例下尿路结石患儿中，男性63例、女性9例；结石长径(12.0±7.4)mm；年龄38(25，65)个月；尿培养阳性19例(26.4%)；症状出现至就诊时间14(3, 112)d。术后结石成分：草酸钙结石34例，尿酸结石16例，鸟粪石15例，胱氨酸结石4例，黄嘌呤结石1例，磷酸氢钙结石2例。膀胱结石组结石长径[(13.7±7.8)mm]较尿道结石组[(7.1±2.2)mm]更大；膀胱结石组症状出现至就诊时间[30(4, 167)d]较尿道结石组[5(1, 17)d]更长；膀胱结石组术后尿常规pH值[6.5(6.0, 7.0)]较尿道结石组[6.0(6.0, 6.5)]更高；膀胱结石组术后C反应蛋白[2.8(1.0, 14.0)mg/L]较尿道结石组[1.1(0.8, 2.0)mg/L]更高；上述指标差异均有统计学意义(P＜0.05)。不同症状出现至就诊时间的4组间比较，术前、术后的血常规白细胞、中性粒细胞、C反应蛋白比较差异均无统计学意义(P＞0.05)。使用直线回归分析“症状出现至就诊时间”与“结石长径”在数量上的依存关系，回归系数为0.015，截距为10.196；回归系数假设检验：t=5.569，P＜0.001；回归系数方差分析：F=31.018，P＜0.001；直线回归方程：?=10.196+0.015x。结论 小儿泌尿系下尿路结石典型症状为尿痛、排尿困难、血尿；结石成分以草酸钙和尿酸为主；膀胱结石术后需注意围手术期抗感染治疗方案和抗生素的选择。症状出现至就诊时间会在一定程度上影响结石长径，应尽早就诊。
- Abstract:
- Objective To explore the clinical characteristics and treatments of children with lower urinary tract calculi in urinary system and provide practical references for clinical diagnosis and treatment. Methods Retrospective analysis was conducted for the relevant clinical data of 72 children hospitalized with lower urinary tract calculi from January 2017 to December 2023.Chief complaints, symptoms, signs, laboratory test results, imaging findings, surgical approaches, calculus composition types, postoperative follow-ups and recurrence status were collected.Based upon the location of calculi, they were divided into two groups of bladder and urethral calculi.Also they were assigned into four groups of time from symptom onset to hospital visit of ≤7 day (n=29), >7 day & ≤14 day (n=7), >14 day & ≤30 day (n=8) and >30 day (n=28).Statistical processing was performed. Results Among them, there were bladder calculi (n=53) and urethral calculi (n=19).There were 63 boys and 6 girls with a long diameter of calculi (12.0±7.4) mm and an average age of 38(25, 65) month; 19 cases (26.4%) had positive urine culture; time from symptom onset to visit 14(3, 112) day.Postoperative stone composition: 34 cases of calcium oxalate calculi (n=34), uric acid calculi (n=16), struvite (n=15), cystine calculi (n=4), xanthine calculi (n=1) and calcium hydrogen phosphate calculi (n=2).Long diameter of bladder calculi was larger than that of urethral calculi [(13.7±7.8) vs. (7.1±2.2)]; time from symptom onset to visit longer in bladder calculi group than that in urethral calculi group [30(4, 167) vs. 5(1, 17)]; postoperative urine pH value higher in bladder calculi group than that in urethral calculi group [6.5(6.0, 7.0) vs. 6.0(6.0, 6.5)]; postoperative C-reactive protein 2.8(1.0, 14.0) in bladder calculi group higher than that in urethral calculi group 1.1(0.8, 2.0); the differences were statistically significant (P < 0.05).No statistically significant differences existed in preoperative and postoperative blood routine leucocytes, neutrophils and C-reactive protein among four groups (P>0.05).Linear regression analysis was performed for examining the quantitative dependence relationship between time from symptom onset to visit and long diameter of calculi.The regression coefficient was 0.015 with an intercept of 10.196; regression coefficient hypothesis test: t=5.569, P < 0.001; regression coefficient variance analysis: F=31.018, P < 0.001; linear regression equation: ?=10.196+0.015x. Conclusions The typical symptoms of lower urinary tract calculi in children are urinary pain, difficulty urinating and hematuria.And the major components of calculi are calcium oxalate and uric acid.Greater attention should be paid to postoperative selecting perioperative antibiotic protocols.The onset of symptoms and the time of seeking medical attention may somewhat affect the length and diameter of calculus and early medical attention should be sought.
参考文献/References:
[1] Magni G, Unwin RJ, Moochhala SH. Renal tubular acidosis (RTA) and kidney stones: diagnosis and management[J]. Arch Esp Urol, 2021, 74(1): 123-128.
[2] Davis NF, Donaldson JF, Shepherd R, et al. Treatment outcomes of bladder stones in children with intact bladders in developing countries: a systematic review of >1000 cases on behalf of the European Association of Urology Bladder Stones Guideline panel[J]. J Pediatr Urol, 2022, 18(2): 132-140. DOI:10.1016/j.jpurol.2022.01.007.
[3] Papatsoris A, Alba AB, Galán Llopis JA, et al. Management of urinary stones: state of the art and future perspectives by experts in stone disease[J]. Arch Ital Urol Androl, 2024, 96(2): 12703. DOI:10.4081/aiua.2024.12703.
[4] Kovacevic L. Diagnosis and management of nephrolithiasis in children[J]. Pediatr Clin North Am, 2022, 69(6): 1149-1164. DOI:10.1016/j.pcl.2022.07.008.
[5] Fu YQ, Wu H, Bao JS, et al. Research advances on risk factors related to urinary tract calculi in children[J]. Int J Urol Nephrol, 2022, 42(5): 927-930. DOI:10.3760/cma.j.cn431460-20201225-00249. 付宇强, 吴晃, 包军胜, 等. 儿童泌尿系结石相关危险因素的研究进展[J]. 国际泌尿系统杂志, 2022, 42(5): 927-930. DOI:10.3760/cma.j.cn431460-20201225-00249.
[6] Gadelkareem RA, Shalaby MM, Faddan AA. Predictors of clinical and surgical characteristics of giant stones of the urinary bladder: a retrospective study[J]. BMC Urol, 2023, 23(1): 83. DOI:10.1186/s12894-023-01261-2.
[7] Marra G, Taroni F, Berrettini A, et al. Pediatric nephrolithiasis: a systematic approach from diagnosis to treatment[J]. J Nephrol, 2019, 32(2): 199-210. DOI:10.1007/s40620-018-0487-1.
[8] Soliman NA, Rizvi SAH. Endemic bladder calculi in children[J]. Pediatr Nephrol, 2017, 32(9): 1489-1499. DOI:10.1007/s00467-016-3492-4.
[9] Group of Calculi, Branch of Urology, Chinese Medical Association; China Alliance of Urolithiasis. Chinese Expert Consensus on Diagnosing and Treating Paediatric Urolithiasis[J]. Chin J Urol, 2021, 42(2): 81-88. DOI:10.3760/cma.j.cn112330-20210111-00017. 中华医学会泌尿外科学分会结石学组, 中国泌尿系结石联盟. 儿童泌尿系结石诊疗中国专家共识[J]. 中华泌尿外科杂志, 2021, 42(2): 81-88. DOI:10.3760/cma.j.cn112330-20210111-00017.
[10] Liu L, Li CY, Zhao YW, et al. Efficacy and safety of flexible ureteroscopic lithotripsy for upper urinary tract calculi in children[J]. J Clin Ped Sur, 2022, 21(9): 866-870. DOI:10.3760/cma.j.cn101785-202205066-013. 刘李, 李创业, 赵夭望, 等. 逆行输尿管软镜碎石术治疗儿童肾及输尿管上段结石的疗效与安全性探讨[J]. 临床小儿外科杂志, 2022, 21(9): 866-870. DOI:10.3760/cma.j.cn101785-202205066-013.
[11] Tekgül S, Stein R, Bogaert G, et al. European Association of Urology and European Society for Paediatric Urology Guidelines on Paediatric Urinary Disease[J]. Eur Urol Focus, 2022, 8(3): 833-839. DOI:10.1016/j.euf.2021.05.006.
[12] Qin F, He TQ, Zhao YW, et al. Application of computed tomography Hounsfield unit in the determination of urinary calculus composition in children[J]. J Clin Ped Sur, 2024, 23(1): 40-45. DOI:10.3760/cma.j.cn101785-202304043-008. 覃锋, 何天衢, 赵夭望, 等. CT HU值判断小儿泌尿系结石成分的应用探讨[J]. 临床小儿外科杂志, 2024, 23(1): 40-45. DOI:10.3760/cma.j.cn101785-202304043-008.
[13] Expert Opinion Composing Group of Perioperative Infection Control and Antibiotic Application in Patients with Upper Urinary Tract Calculi. Expert Opinions on Perioperative Infection Control and Antibiotic Application in Patients with Upper Urinary Tract Calculi (Edition 2023)[J]. Chin J Urol, 2023, 44(7): 481-485. DOI:10.3760/cma.j.cn112330-20230620-00224. 上尿路结石围手术期感染控制及抗菌药物应用专家意见编写组. 上尿路结石患者围手术期感染控制及抗菌药物应用专家意见(2023版)[J]. 中华泌尿外科杂志, 2023, 44(7): 481-485. DOI:10.3760/cma.j.cn112330-20230620-00224.
[14] Abd ZH, Muter SA. Comparison of the safety and efficacy of laser versus pneumatic intracorporeal lithotripsy for treatment of bladder stones in children[J]. J Clin Med, 2022, 11(3): 513. DOI:10.3390/jcm11030513.
[15] Giri?gen I, Yüksel S, Karc?l? K, et al. Evaluation of the composition of urinary tract stones in children from the Inner Western Anatolian Region in Turkey[J]. Turk J Urol, 2020, 46(2): 152-158. DOI:10.5152/tud.2019.19170.
[16] Liu L, Peng LC, Li CY, et al. Analysis of pediatric urinary stone composition in 592 cases at a single center[J]. Chin J Urol, 2022, 43(9): 701-706. DOI:10.3760/cma.j.cn112330-20201125-00788. 刘李, 彭柳成, 李创业, 等. 单中心592例儿童泌尿系结石成分分析[J]. 中华泌尿外科杂志, 2022, 43(9): 701-706. DOI:10.3760/cma.j.cn112330-20201125-00788.
[17] Barreto L, Jung JH, Abdelrahim A, et al. Medical and surgical interventions for the treatment of urinary stones in children[J]. Cochrane Database Syst Rev, 2019, 10(10): CD010784. DOI:10.1002/14651858.CD010784.pub3.
[18] Zhang Y, Han CH, Zhao Y, et al. Extracorporeal shock wave lithotripsy in children[J]. J Clin Surg, 2022, 30(2): 101-105. DOI:10.3969/j.issn.1005-6483.2022.02.001. 张弋, 韩从辉, 赵岩, 等. 小儿体外冲击波碎石术[J]. 临床外科杂志, 2022, 30(2): 101-105. DOI:10.3969/j.issn.1005-6483.2022.02.001.
[19] Ward JB, Feinstein L, Pierce C, et al. Pediatric urinary stone disease in the United States: the urologic diseases in America project[J]. Urology, 2019, 129: 180-187. DOI:10.1016/j.urology.2019.04.012.
[20] Eisner BH, Goldfarb DS, Baum MA, et al. Evaluation and medical management of patients with cystine nephrolithiasis: a consensus statement[J]. J Endourol, 2020, 34(11): 1103-1110. DOI:10.1089/end.2019.0703.
相似文献/References:
[1]刘国庆 王剑锋 朵永福 李杰荣 陈一平 黄振强 叶章群. 妊娠期尿结石对胎儿早产流产的影响[J].临床小儿外科杂志,2011,10(02):115.
Urolithiasis influence to develop of fetus in gestation period[J].Journal of Clinical Pediatric Surgery,2011,10(09):115.
[2]丛小明,孙西钊.儿童泌尿系统结石的代谢评估[J].临床小儿外科杂志,2020,19(08):661.[doi:10.3969/j.issn.1671-6353.2020.08.001]
Cong Xiaoming,Sun Xizhao.Metabolic evaluations of pediatric nephrolithiasis[J].Journal of Clinical Pediatric Surgery,2020,19(09):661.[doi:10.3969/j.issn.1671-6353.2020.08.001]
[3]钟量,邹翔宇,侯艳萍,等.输尿管软镜与小通道经皮肾镜治疗儿童1~2厘米肾结石的对比研究[J].临床小儿外科杂志,2025,(01):13.[doi:10.3760/cma.j.cn101785-202410032-003]
Zhong Liang,Zou Xiangyu,Hou Yanping,et al.Comparative study of flexible ureteroscopy and mini-percutaneous nephrolithotomy for treating 1-2 cm pediatric renal stones[J].Journal of Clinical Pediatric Surgery,2025,(09):13.[doi:10.3760/cma.j.cn101785-202410032-003]
[4]张毅,薛萍,廖煜君,等.儿童脑动静脉瘘的临床表现、血管构筑特征及治疗结局分析[J].临床小儿外科杂志,2025,(02):109.[doi:10.3760/cma.j.cn101785-202412015-002]
Zhang Yi,Xue Ping,Liao Yujun,et al.Clinical manifestations,vascular architecture characteristics and treatment outcomes of pediatric cerebral arteriovenous fistula[J].Journal of Clinical Pediatric Surgery,2025,(09):109.[doi:10.3760/cma.j.cn101785-202412015-002]
[5]车瑜,阿布都赛米·阿布都热衣木,李凯,等.可视针状肾镜联合钬激光治疗婴幼儿上尿路结石的疗效分析[J].临床小儿外科杂志,2025,(09):864.[doi:10.3760/cma.j.cn101785-202410063-011]
Che Yu,Abudusaimi Abudureyimu,Li Kai,et al.Efficacy analysis of visual needle nephroscopy combined with holmium laser lithotripsy for upper urinary tract stones in infants and young children[J].Journal of Clinical Pediatric Surgery,2025,(09):864.[doi:10.3760/cma.j.cn101785-202410063-011]
[6]黄明杰,张新陶,高子川,等.婴儿肠造瘘手术后胃肠功能障碍的临床特点及危险因素分析[J].临床小儿外科杂志,2025,(12):1140.[doi:10.3760/cma.j.cn101785-202509008-009]
Huang Mingjie,Zhang Xintao,Gao Zichuan,et al.Clinical characteristics and risk factors of gastrointestinal dysfunction after infant enterostomy[J].Journal of Clinical Pediatric Surgery,2025,(09):1140.[doi:10.3760/cma.j.cn101785-202509008-009]
[7]赵慧敏,杨博宇,周厚宇,等.儿童经皮肾镜碎石术研究进展[J].临床小儿外科杂志,2026,(03):296.[doi:10.3760/cma.j.cn101785-202404059]
Zhao Huimin,Yang Boyu,Zhou Houyu,et al.Research progress of percutaneous nephrolithotripsy in children[J].Journal of Clinical Pediatric Surgery,2026,(09):296.[doi:10.3760/cma.j.cn101785-202404059]
[8]梁海燕,刘沛,温煦,等.卵睾型性发育异常的再认识——单中心10年诊治经验[J].临床小儿外科杂志,2026,(06):520.[doi:10.3760/cma.j.cn101785-20260212-00069]
Liang Haiyan,Liu Pei,Wen Xu,et al.Clinical characteristics and management of ovotesticular disorder of sex development:a single-center experience[J].Journal of Clinical Pediatric Surgery,2026,(09):520.[doi:10.3760/cma.j.cn101785-20260212-00069]
备注/Memo
收稿日期:2025-6-4。
基金项目:湖南省儿童泌尿生殖疾病临床医学研究中心(2021SK4017)
通讯作者:赵夭望，Email: yw508@sina.com