微创经皮肾镜取石术治疗幼儿肾结石

目的 探讨微创经皮肾镜取石术(MPCNL)治疗幼儿肾结石的手术技巧. 方法 12例肾结石患儿行MPCNL.男8例,女4例.平均年龄32(18～53)个月.12例均经KUB、IVU、B超和CT检查确诊.结石直径平均1.3(1.0～1.8)cm.单纯肾盂结石7例,合并多发性肾盏结石5例.无合并肾盂输尿管连接处狭窄者.均实施全麻,B超引导下穿刺目标肾盏,成功建立12～16 F皮肾通道并用气压弹道碎石机碎石. 结果 12例平均手术时间74 min.均Ⅰ期完成碎石,Ⅰ期结石清除率67%(8/12).1例残留结石直径>6 mm者行二次MPCNL后结石完全清除,总结石清除率75%(9/12).3例残留结石直径2～4 mm,其中1例术后2周行ESWL.术后平均住院时间14(10～42)d.随访1～7个月,结石清除率100%. 结论 MPCNL具有出血少、结石清除率高、住院时间短等优点,可作为治疗幼儿肾结石安全、有效的方法.

Treatment of renal calculi in pediatric patients with minimally invasive percutaneous nephrolithotomy

Objective To evaluate the technique and efficacy of minimally invasive percutaneous nephrolithotomy (MPCNL) for renal calculi in pediatric patients. Methods From April 2009 to December 2009, 12 pediatric patients (8 males and 4 females) with renal calculi were treated by MPCNL. The age ranged from 18 to 53 months (mean 32 months). All the 12 cases were diagnosed by KUB+IVU, ultrasonography and CT. The stone had average diameter of 1. 3 cm (ranged from 1. 0 to 1. 8 cm). Seven cases had simple renal pelvis stone and 5 cases had multiple renal calyx stone. UPJ stricture was not found in this series. General anaesthesia was applied. Renal transfixion pin was punctured to select renal calices by monitoring with ultrasonography. 12 - 16 F percutaneous renal access was successfully established in all cases and calculi were fragmented by pneumatic lithotripter. Results The average operative time of MPCNL was 74 min. Phase Ⅰ lithotripsy was underwent in all patients. The phase Ⅰ stone-free rate was 67%(8/12). One cases accepted second MPCNL. The calculus clearance rate reached 75%(9/12). Three cases had residual calculi ranged from 2 to 4 mm. One of whom had ESWL 2 weeks postoperatively. All cases were followed up for 1 - 7 months, all cases were in stone free status. Conclusion Regarding the advantages of less bleeding, high clearance rate, and shorter hospital stay, MPCNL is an effective and safe treatment option for renal calculi in pediatric patients.