输尿管软镜钬激光碎石术治疗婴幼儿上尿路结石

目的探讨输尿管软镜联合钬激光治疗婴幼儿（<2岁）上尿路结石的可行性与有效性。 方法回顾性分析我科自2016年1月至2018年2月应用输尿管软镜治疗婴幼儿上尿路结石62例（77侧）。其中男37例，女25例，均为维吾尔族，年龄8～24个月，单侧上尿路结石47例，双侧上尿路结石15例。输尿管上段结石19侧，肾盂结石31侧，肾上盏结石18侧，下盏结石9侧，结石最大径8～25 mm。所有患儿均Ⅰ期置入双J管被动扩张输尿管2周，Ⅱ期采用导丝引导下直接置入输尿管软镜，配合200 μm钬激光光纤碎石，激光功率为20～30 W，术后留置双J管2～3周。 结果62例均入镜成功，51例行一次碎石手术（双侧上尿路结石6例），9例双侧上尿路结石行两次碎石手术，2例下盏结石未能寻及继续观察。术后住院3～5 d，术后8周复查67侧结石排尽，结石清除率87.0%（67/77），平均手术时间为35 min（20～55 min）。 结论输尿管软镜联合钬激光碎石治疗婴幼儿上尿路结石，有较高的清石率和临床安全性。

Flexible ureteroscope combined with holmium laser lithotripsy for infants with upper urinary tract calculi

ObjectiveTo investigate the feasibility and efficacy of flexible ureteroscope combined with holmium laser lithotripsy in the treatment of the upper urinary tract calculi in infants aged <2 years old. MethodsClinical data of 62 infants diagnosed with the upper urinary tract calculi (77 sides) receiving flexible ureteroscope in our department from January 2016 to February 2018 were retrospectively analyzed. Among them, 37 cases were male and 25 female. All patients were Uyghur nationality, aged 8-24 months. Forty-seven cases had unilateral and 15 patients suffered from bilateral upper urinary tract calculi. The upper urinary tract calculi were detected on 19 sides, renal pelvic calculi on 31 sides, upper renal caliceal calculi on 18 sides and lower renal caliceal calculi on 9 sides. The maximum diameter of calculi was ranged from 8 to 25 mm. During the Stage I operation, double J stent was placed in all children for passive ureteral dilatation for 2 weeks. In the Stage II surgery, wire-guided flexible ureteroscope insertion combined with 200 μm holmium laser lithotripsy at a laser power of 20-30 W was performed. Double J stent was retained for 2-3 weeks after operation. ResultsFlexible ureteroscope was successfully inserted in 62 cases. Fifty-one patients underwent lithotripsy for one time (6 cases of bilateral upper urinary tract calculi), 9 patients with bilateral upper urinary tract calculi underwent lithotripsy twice, and 2 patients were still under observation because the lower caliceal calculi were not detected. The patients were hospitalized for 3-5 d after operation. At postoperative 8 weeks, the calculi on 67 sides were thoroughly removed with a removal rate of 87.0% (67/77). The average operation time was 35 min (20-55 min). ConclusionFlexible ureteroscopy combined with holmium laser lithotripsy is an efficacious and safe treatment of the infantile upper urinary tract calculi, which yields a high removal rate.