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中華民國泌尿科醫學會雜誌

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篇名 小兒尿路結石與高尿鈣症
卷期 6:4
並列篇名 Pediatric Urolithiasis and Hypercalciuria
作者 鄭鴻琳林信男邱元佑
頁次 219-223
關鍵字 高尿鈣症小兒尿路結石體外震波碎石術輸尿管鏡碎石術hypercalciuriapediatric urolithiasisextracorporeal shock wave lithotripsyureteroscopic lithotripsyTSCI
出刊日期 199512

中文摘要

小兒尿路結石並不是一種常見的疾病:盛行率根據國外統計大約是成人的五十至七十五分之一,相當於每一千位小兒住院病例中,佔0.13至0.94位。常見的分類有:代謝異常,解剖結構異常,與感染相關,及不明原因等四種,各個地區佔的比例各有不同,本文中共有3位患者,1男2女;年齡分別是4,5,6歲;2位以腰痛表現,1位意外發現;1位是腎臟結石,2 位是輸尿管結石。3位尿中鈣離子含量分別是6.0,5.1,10.0 mg/kg/day。普通飲食時尿中鈣離子和肌酸肝離子的比(UCa/UCr)分別是0.47,0.32,0.29;限制飲食後比值分別是0.26,0.22,0.17:都符合高尿鈣症(Hypercalciuria)的診斷,而且其中2 位是腎性高尿鈣症,2位尿路結石以體外震波碎石術處理,而1位下段輸尿管結石則以染料雷射經由輸尿管鏡處理。術後以超音波及核子醫學腎臟掃描追蹤,沒有腎水腫,腎功能也沒有改變。經由3,12,12個月的追蹤,沒有殘存結石,結石也沒有再生現象。現有的經驗中,不管是體外震波碎石術或輸尿管鏡雷射碎石術,都能有效的達到碎石目的,不會影響到上泌尿道功能。但邊如果發現小兒尿路結石病例時,必須詳細評估結石的可能原因,高尿鈣症是其中一種不能忽略的重要因素。

英文摘要

Pediatric urolithiasis is not a common disease. The prevalence rate in children has been estimated to be 1/50 to 1/75 that of adults. In the past year three children with urolithiasis were treated in National Cheng-Kung University Hospital. The one boy and two girls were aged four, five, and six years respectively. Locations were one in renal pelvis and two in the ureter. Calcium excretion in twenty-four hour urine was 6.0, 5.1 and 10.0 mg/kg/day, individually. And the ratio of urinary calcium to creatinine (Uca/Ucr) in ordinary diet was 0, 47, 0.32 and 0.29; Uca/Ucr in calcium and sodium restricted diet 0.26, 0.22 and 0.17. The two cases were considered to have renal leak hypercalciuria and one absorptive hypercalciuria. One child with the stone in the lower third ureter underwent ureteroscopic stone manipulation under general endotracheal tube anesthesia and two children underwent extracorporeal shock wave lithotripsy (ESWL) under general intravenous sedation. The courses were smooth. After two months of periods followup, the patients were free of stones. In the periods 3, 12, 12 month followup renal growth was normal and renal function, preserved best. According to limited experience ureteroscopic lithotripsy or ESWL is an effective and safe procedure for pediatric urolithiasis. Investigation of any underlying disorders is recommended for all pediatric stone patients, since hypercalciuria is the major metabolic disorder.

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