單個輸尿管結(jié)石自然排出的預(yù)測性研究

邱光槐 蔡娟 鄭愛樺 郭訓(xùn)偉 鐘赟 奚晶 鐘陽縣

【摘要】 目的：分析單個輸尿管結(jié)石自然排出的預(yù)測性。方法：選取2017年6月-2019年6月本院泌尿外科接收的單個輸尿管結(jié)石患者186例作為研究對象，所有患者均經(jīng)CT掃描、彩超檢查確診為單個輸尿管結(jié)石，觀察分析影像學(xué)、實驗室檢查、流行病學(xué)等情況，1個月后復(fù)診，對所有患者的尿液、血液標(biāo)本進(jìn)行收集，輸尿管結(jié)石變化情況通過彩超予以了解，通過檢查結(jié)果將患者分成結(jié)石排出組、結(jié)石未排出組。結(jié)果：輸尿管結(jié)石排出者有109例、未排出者77例，結(jié)石排出率為58.60%。相比結(jié)石未排出組，結(jié)石排出組患者的結(jié)石直徑明顯更小，差異有統(tǒng)計學(xué)意義（P<0.05）;結(jié)石排出組患者上段、中段、下段結(jié)石位置比較，差異無統(tǒng)計學(xué)意義（P>0.05）。結(jié)石排出組患者的白細(xì)胞、C反應(yīng)蛋白降低明顯，分析認(rèn)為血白細(xì)胞、C反應(yīng)蛋白亦是對輸尿管結(jié)石排出產(chǎn)生影響的重要因素，僅次于結(jié)石大小。結(jié)論：結(jié)石大小是影響單個輸尿管結(jié)石自然排出最重要因素，除此之外也會受到血白細(xì)胞、C反應(yīng)蛋白指標(biāo)變化的影響。

【關(guān)鍵詞】 單個輸尿管結(jié)石 自然排出 結(jié)石大小 血白細(xì)胞變化

[Abstract] Objective： To analyze the predictability of natural discharge of single ureteral calculi. Method：A total of 186 patients with single ureteral calculi received by urology department from June 2017 to June 2019 in our hospital were selected as the research objects. All patients were diagnosed as single ureteral calculi by CT scan and color Doppler ultrasound. The imaging， laboratory examination and epidemiology were observed and analyzed. After one month， all patients were re-examined. Urine and blood samples were collected. The changes of ductal calculi were understood by color Doppler ultrasonography， and the patients were divided into two groups： the stone discharge group and the non-stone discharge group. Result： There were 109 cases of ureteral calculi discharged and 77 cases of non-discharged， with a stone discharging rate of 58.60%. Compared with the non-stone group， the stone diameter in the stone-discharging group was significantly smaller， with the difference was statistically significant （P<0.05）; the stone location in the upper， middle and lower segments of the stone-discharging group had no statistical difference （P>0.05）. Leukocyte and C-reactive protein decreased significantly in patients with calculus discharge. The analysis showed that leukocyte and C-reactive protein were also important factors affecting the discharge of ureteral calculi， second only to the size of calculus. Conclusion： Stone size is the most important factor affecting the natural discharge of single ureteral calculi. In addition， it is also affected by the changes of blood white blood cells and C-reactive protein.[Key words] Single ureteral calculi Natural discharge Stone size White blood cell changesFirst-authors address： Ganzhou Nankang District First Peoples Hospital， Ganzhou 341400， China

輸尿管結(jié)石是泌尿外科一種常見病，以血尿、腹部絞痛等為典型癥狀表現(xiàn)，會對患者的腎功能造成損害，誘發(fā)尿路感染等并發(fā)癥[1]。輸尿管結(jié)石患者若能夠得到及時有效治療，絕大多數(shù)均可自行排出（自行排出率可占60%～80%），若方法錯誤有可能會錯過最佳治療時機(jī)，引起膿毒血癥、急性腎功能衰竭、阻塞性腎盂腎炎等并發(fā)癥，嚴(yán)重時會危及患者的生命安全[2-4]，所以臨床上應(yīng)對結(jié)石是否可自然排出的準(zhǔn)確判斷加以重視，分析結(jié)石自然排出的影響因素，及時對應(yīng)處理，以減少治療費用、防止手術(shù)治療對身體造成損傷[5]。……