尿石症Urolithiasis(PPT-99).ppt

尿 石 症Urolithiasis 陈 斌 仁济医院 泌尿外科 概 述 有史以来折磨人类最久的疾病之一 最常见的泌尿科疾病之一，男女比约3：1 人们对于该病治疗方法的进展远超越对于病因的了解 90%尿路结石不再采用传统的开放手术 发病有地区性，江南多于江北 概 况 形成机制未完全阐明，有多种学说 多数结石无十分理想的预防方法 近年来，肾、输尿管上尿路结石发病率明显提高 如果没有随访及医学干预，尿石症5年内的复发率高达50% Components of stones 晶体+基质(crystal + matrix) 草酸钙、磷酸钙、磷酸镁铵、尿酸、胱氨酸 上尿路（肾、输尿管）结石多为草酸钙结石、草酸钙与磷酸钙混合性结石 下尿路结石磷酸镁铵、尿酸铵结石多见 尿石成分及其性质 Etiology Aspects Extrinsic Factors Intrinsic Factors Heredity Age and Sex Abnormal metaboly Local factors Extrinsic Factors Climatic and seasonal factors Water intake Diet Medication Water intake the volume of water ingested as opposed to that lost by perspiration and respiration the mineral or trace element content of the water supply of the region Diet Protein Increasing the acid in urine Hyperuricosuria Calcium Hypercalciuria Hyperoxaluria Diet Sodium Hypercalciuria Magnesium Inhibit crystallization of Calcium Phosphate reduce calcium oxalate crystalloiduria Vitamins Medications Steroids Vitamins Sulfanilamide Abnormal metaboly Calcium Oxalate Stone Calcium Phosphate Stone Uric Acid Stone Cystine Stone Calcium Oxalate Stone Hypercalciuria (excessive calcium in the urine and kidneys) Absorptive Hypercalciuria Resorptive Hypercaiciuria Renal Hypercalciuria Calcium Oxalate Stone Hyperoxaluria Hyperuricosuria Citrate Calcium Phosphate Stone Pure calcium phosphate stone is quite rare More common in women and are often associated with tubular acidification defects Showing pure calcium phosphate Distal renal tubular acidosis Primary hyperparathyroidism sarcoidosis Uric Acid Stones By-product of purine Typically radiolucent in nature and may not be identified on plain abdominal films Visible on noncontrast CT images Associated calcium deposits, may be partially radiopaque Cystine Stones Cystine can be found in nerves, muscles, and other body tissues Cystinuria cause excessive cystine build up in the urine, lead to cystine stones Occurs in about 1% to 2% of patients with kidney stone disease The conditi