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1、泌尿系结石论文：广西地区泌尿系结石的临床特征分析和防治研究【中文摘要】通过对广西地区1600例泌尿系结石病人的性别、年龄、结石部位、结石成分等临床特征以及治疗方式进行回忆性分析,初步探讨广西地区泌尿系结石的防治策略。方法1.分析2021年1月至2021年2月收治的来自广西生长的1600例患者的性别、年龄、结石部位、治疗方式等,探讨广西地区泌尿系结石的临床特征和主要治疗方法。2.从以上患者收集的结石标本707例进行红外光谱法分析,了解广西地区泌尿系结石成分的特点,并对上尿路结石标本100例同时进行红外光谱法和化学分析法分析,比拟两种分析方法在结石分析上的特点及结石成分构成上的异同点。3.与10年
2、前同时期的764份病例及206结石成分分析相比拟,了解在性别、年龄、结石部位、治疗方法、结石成分的变化。结果1.性别：泌尿系结石病人中男性65%(1042/1600),女性35% (558/1600),男女性别比例为1.87：1(1042/558)；年龄：3-13岁年龄组占所有病例的0.9%,13-23岁年龄组占所有病例的3.3%,23-33岁年龄组占所有病例的12.7%,33-43岁年龄组占所有病例的27%,43-53岁年龄占所有病例的22.5%,53-63岁年龄占所有病例的21.8%,73-83岁年龄组占所有病例的0.7%；部位：肾结石41.7%(667/1600),输尿管结石50.9%(
3、818/1600),膀胱结石4.9%(79/1600),尿道结石0.2%(3/1600),肾合并输尿管结石2.1%(34/1600),尿道结石合并其他占0.1% (2/1600)；治疗方法：体外冲击波碎石55.6%(889/1600),经皮肾镜23.0%(368/1600),输尿管镜7.4%,(118/1600),膀胱镜4.9%(97/1600),腹腔镜0.3%(5/1600),药物治疗3.2%(51/1600),开放手术5.6%(90/1600)。2.707例结石成分构成：单纯性结石占40.7%,其中草酸钙占18.4%,尿酸占19.5%,磷灰石占2.5%,胱氨酸占0.3%；混合性结石占59.
4、3%,其中尿酸+草酸钙占32.8%,草酸钙+碳酸磷灰石占19.9%,草酸钙+碳酸磷灰石+尿酸占4%,磷酸磷灰石+六水磷酸铵镁占2.5%。3.红外光谱法和化学法各有特点,红外光谱法灵敏、快捷,能测得晶体结构,分析结果以单纯性结石所占比例较多,由于取样较少,故结果易受取石方式及取石部位的影响；化学法检出的结果中混合性结石所占比例稍高,但它无法测得晶体的结构,主要以目前所知的成分为分析对象,无法发现新的结石成分,我们还要对实验结果进行相应的组合处理,结果才能较为合理。4.1600例结石病人与十年前同时期764例相比,性别：卡方检验X2=1.341,P=0.247,P0.05,两组性别构成比无统计学差
5、异；30-50岁年龄组病例数：卡方检验X2=1.700,P=0.192,P0.05,构成比例差异无统计学意义；结石发病部位：卡方检验x2=1.367,P=0.85010,P0.05,结石发病部位差异不具有统计学意义；结石处理方式：卡方检验x2=464.985,P=0.000,P0.05,10年前后尿酸与草酸钙构成差异无统计学意义。结论1.广西地区泌尿系结石病以男性比例较大,33-53岁年龄组的患病率比拟高,上尿路结石患病率比下尿路结石的患病率高,治疗方法以微创治疗为主、开放手术为辅。2.结石主要以草酸钙、尿酸结石为主要成分。3.两种分析方法各有优缺点,有条件的医院首选红外光谱法,必要时联合两种
6、方法更能准确地分析结石成分。4.与10年前相比,在性别、年龄上波动不大,仍以中青年男性发病最多,上尿路结石发病仍较高,需要手术干预的病例趋于腔内治疗,结石成分以草酸钙、尿酸为主。5.在预防上保持营养平衡,增加液体及富含枸橼酸水果的摄入,限制钠盐及高嘌呤饮食,并控制草酸的摄入量,尿酸结石应提高尿液的PH值、减少尿酸的形成和排泄。【英文摘要】To study and evaluate the urinary stones treatment and prevention strategies, the clinical characteristics of 1600 cases of urinar
7、y stones and stone components constitute were retrospectively analyzed.Methods 1.Analysis of 1600 cases of patientssex, age, stone location, stone composition, admitted from August 2021 to February 2021 from around the Guangxi Province, Explore the clinical features and treatment of urinary stones i
8、n Guangxi region.2.Calculus specimens collected by patients over the 707 cases analyzed by infrared spectrometry analysis, to understand the characteristics of the composition of urinary calculi in Guangxi region,100 cases of upper urinary tract calculi specimens were compared with infrared spectros
9、copy and chemical analysis to analyze the similarities and differences in the characteristics of the stone analysis and stone composition.3. Characteristics of gender, age, stone location, stone composition, and treatment of 764 cases and 206 urinary stones composition analysis results were analyzed
10、 and compared with 10 years ago to understand the changes. Results 1.Gender:urinary tract stones among men 65%(1042/1600), women 35%(558/1600), the sex ratio of about 1.87:1 (1042/558); Age :3-13-year-old age group accounted for all cases 0.9%, 13-23-year-old age group accounted for 3.3%,23-33-year-
11、old age group in all cases accounted for 12.7%,33-43-year-old age group in all cases accounted for 27%,43-53 years of age in all cases to account for all cases22.5%,53-63 age group accounted for 21.8%,73-83-year-old age group in all cases accounted for 0.7% of all cases; Stone location:kidney stones
12、, accounting for 41.7%(667/1600), ureteral stones 50.9% (818/1600), bladder stones 4.9%(79/1600), urinaiy tract stones 0.2% (3/1600), the kidney with ureteral stones 2.1%(34/1600); urinary tract stones combined with other accounts for 0.1%(2/1600); Methods of treatment:55.6%(889/1600) extracorporeal
13、 shock wave lithotripsy, percutaneous nephrolithotomy 23.0%(368/1600), ureteroscopy 7.4% (118/1600), cystoscopy,4.9%(97/1600), laparoscopic 0.3%(5/1600), medication was 3.2%(51/1600), open surgery was 5.6% (90/1600).2. Stones constitute of 707 calculus specimens:Simple stones accounted for 40.7%:whi
14、ch accounted for 18.4% of calcium oxalate, uric acid accounted for 19.5%,2.5% apatite, cystine 0.3%; accounted for 59.3%of mixed stones:uric acid+calcium oxalate accounted for 32.8%, calcium oxalate+carbonated apatite accounted for 19.9%, Calcium oxalate+carbonated apatite+uric acid (4%),Phosphate a
15、patite+ hexahydrate magnesium ammonium phosphate (2.5%).3. Both the infrared spectroscopy method and the chemical method have the characteristics of their own, The infrared spectroscopy is sensitive, fast, and can measure crystal structure, the simple stone is of more proportion in the results, the
16、proportion of sampling is less, so the results vulnerable to the way of stone and stone parts;Chemical method detected slightly higher proportion of mixed stones, but the crystal structure can not be measured, mainly to the current knowledge of the composition is analyzed, the new composition of the
17、 stones can not be found, in order to arrive at a more reasonable conclusion the experimental results with the combination treatment.4. The result of 1600 cases of urinary stones compared with 764 cases in the same period a decade ago is below, Of gender:chi-square test X2= 1.341, P= 0.247, P 0.05,
18、two groups of sex is no statistical difference; the incidence ratio of 30-50 age group chi-square test:X2=1.700, P= 0.192, P 0.05, constitute no significant difference; Stone incidence areas:the chi-square test x2= 1.367, P =.85010, P 0.05, stones anatomical site differences were statistically signi
19、ficant; Stones treatment:chi-square test%= 464.985, P=0.000, P 0.05, uric acid and calcium oxalate constitute no statistically significant difference.Conclusions 1. Urinary stones with larger proportion of males in Guangxi region; The 33-53 age group the prevalence is relatively high; Upper urinary
20、tract stones prevalence rate than the prevalence of lower urinary tract stones; The treatment approach to the minimally invasive treatment, supplemented by open surgery.2. Stones composed mainly of calcium oxalate, uric acid stones as the main ingredient.3.The two analysis methods have advantages an
21、d disadvantages, Qualified hospitals preferred infrared spectroscopy, comparison of two methods when necessary to do a more accurate analysis of stone composition. 4.Compared with 10 years ago, little fluctuation in gender, age, still young and middle-aged male, highest incidence of upper urinary ca
22、lculi incidence increase in the proportion, the treatment tends to minimally invasive treatment.5.Prevention should be controlled oxalate, uric acid food intake, to maintain nutritional balance, increase fluid intake in the prevention, The calcium salt stones should be added to the rich the citrate
23、fruit intake, restrict sodium and high-purine diet, Uric acid stones should raise the PH value of the urine, to reduce the formation and excretion of uric acid.【关键词】泌尿系结石 临床特征 结石成分 防治【英文关键词】urinary calculi clinical characteristics composition ofurinary calculi prevention and treatment【目录】广西地区泌尿系结石的临床特征分析和防治研究英文縮略语表4-5摘要5-8ABSTRACT8-11前言12-13材料与方法13-16结果16-34讨论34-40结论40-41参考文献41-44综述44-60参考文献57-60致谢60