头孢曲松钠致上尿路结石五例诊疗分析

摘要

Objective To investigate characteristics of ceftriaxone sodium - induced upper urinary tract calculi and its treatment. Methods The data of 5 patients with ceftriaxone sodium induced upper urinary tract calculi admitted to the First Af-filiated Hospital of Liaoning Medical University from March 2006 to November 2013 were analyzed retrospectively. This study de-termined the presence of calculi by urinary system color ultrasound or CT,and combined with history of ceftriaxone sodium use to make a preliminary diagnosis. The patients were treated with intra - ureteral cannula or low - level ESWL. Results By CT,bi-lateral renal pelvis dilated slightly,dot density shadow was seen;the upper - and mid - pieces of bilateral ureter dilated,the left ureter wall thickened;quasi - circular high density shadow seen in the right ureter,with a size of 0. 56 cm × 0. 60 cm,CT value were about 146 HU. Color ultrasound showed 1. 5 cm × 0. 6 cm left upper ureteral calculi,0. 8 cm × 0. 6 cm right ureter 3 narrow calculi. After intra - ureteral cannula or low - level ESWL,5 patients' symptom remitted or even disappeared,urine out-put increased,renal function recovered gradually in 1 ~ 5 d. Review color ultrasound after 1 week did not see residual stones, the stone clearance was 100% . The calculi were identified as components of ceftriaxone or ceftriaxone and calcium. Conclusion ceftriaxone sodium induced upper urinary tract calculi can be diagnosed preliminarily by imaging characteristics and medication history. Intra - ureteral cannula or low - level ESWL,which can relieve the obstruction caused by calculi and drain calculi,is effective and reliable.%目的：分析头孢曲松钠所致上尿路结石的特点及诊疗方法。方法回顾性分析2006年3月-2013年11月辽宁医学院附属第一医院收治的头孢曲松钠致尿路结石患者5例，其中男1例，女4例；年龄分别为9、13、25、26、29岁。通过泌尿系彩色超声检查或 CT 确定结石存在，结合头孢曲松钠用药史做出初步诊断。采用输尿管插管或低能级体外冲击波碎石对患者进行治疗。结果双肾 CT 示：双侧肾盂略扩张，可见点状密度增高影；双侧输尿管上、中段亦扩张，左侧输尿管管壁局部增厚；右侧输尿管管腔内见类圆形高密度影（约腰4、5椎间隙水平处），大小为0.56 cm ×0.60 cm，CT 值约146 HU。彩色超声示：左侧输尿管上段结石1.5 cm ×0.6 cm，右侧输尿管第三狭窄处结石0.8 cm ×0.6 cm。通过镜下输尿管插管或低能级体外冲击波碎石处理后，5例患者症状缓解或消失，尿量增多，肾功能1~5 d 内逐渐恢复，1周后复查彩色超声均未见结石残留，清石率为100%。结石成分经结石红外光谱鉴定为头孢曲松钠或头孢曲松钙。结论通过影像学特点及用药史可初步诊断头孢曲松钠所致上尿路结石；通过镜下输尿管插管或低能级体外冲击波碎石即可解除结石所致梗阻，排净结石，疗效可靠，值得临床推广应用。