微创经皮肾镜取石术治疗儿童上尿路结石(附45例报告)

目的 探讨微创经皮肾镜取石术(mini-PCNL)治疗儿童上尿路结石的临床效果.方法 回顾性分析2007年3月-2009年4月被确诊为上尿路结石并接受mini-PCNL治疗的45例患儿的临床资料,患儿的年龄为10个月～15岁,平均年龄为(4.9±3.5)岁.男:女为1.8:1.三聚氰胺所致上尿路结石20例(44.4%),喂养受三聚氰胺污染的奶粉的时间为6～12个月.左肾结石16例,右.肾结石18例,双肾结石7例;左输尿管上段结石2例,左输尿管上段合并右肾结石1例,右输尿管上段合并双肾结石1例.结石直径为10～50 mm,平均直径为(18.6±8.9)mm,其中8例为鹿角形结石.所有患儿术前均经B超、CT平扫+三维重建检查明确诊断,核素肾动态显像检查判断有无输尿管梗阻,以了解分肾功能情况.结果 45例患儿共50侧肾接受mini-PCNL治疗.平均手术时间为(45±12)min,术中平均出血量为(20±5)mL.单次手术成功率为96%(48/50).术后全部留置肾造瘘管,2～5 d后拔除.60%(30/50)的患侧留置双J管,1个月后在膀胱镜下拔除.术后住院时间为4～14 d,从静脉途径给予抗生素治疗3～10 d,出院时尿液检查呈阴性.随访时间为5～30个月,患儿生长发育良好.通过B超检查发现,40例(88.9%)患儿肾和输尿管结石消失,无复发,肾盂积水消失或减轻;4例有肾结石残留;1例复发.结论 mini-PCNL治疗儿童上尿路结石具有结石清除率高、创伤小、恢复快、住院时间短的优点,且手术可多次进行,对肾盂输尿管的影响小,在婴幼儿奶粉结石、鹿角型结石和复杂性结石的处理方面更具有微创的优势.

Minimally invasive percutaneous nephrolithotomy for treatment of upper urinary tract calculi in children:a report of 45 cases

Objective To evaluate the clinical efficacy and safety of minimally invasive percutaneous nephrolithotomy (mini-PCNL) for treatment of upper urinary tract calculi in children. Methods We retrospectively reviewed the clinical data of 45 cases with upper urinary tract calculi from March 2007 to April 2009. The children underwent mini-PCNL at a mean age of (4.9±3.5) years (ranging from 10 months to 15 years); and the male to female ratio was 1. 8 : 1. The calculi in 20 children were caused by taking milk products contaminated with melamine. Left-side renal calculi were found in 16 cases and right-side in 18. Bilateral renal calculi were found in 7 cases. Left-side upper ureteral calculi were found in 2 cases, and left-side upper ureteral calculi combined with right-side renal stone in one. One right-side upper ureteral calculi was combined with bilateral renal stones. The diameter of these stones were about 10- 50 mm (with a mean size of 18.6±8.91 mm), and 8 cases had staghorn stone. All the urinary calculi were confirmed by B-ultrasound examination and spiral CT scanning. DTPA renal dynamic imaging was used to evaluate the extent of ureter obstruction and know about the kidney function separately. Results Forty-five cases(50 sides) underwent mini-PCNL. The mean operative time was (45±12) minutes. The average volume of bleeding was (20±5) mL during the operation. The successful rate of single operation was 96% (48/50). The renal stoma tubes were left in all patients after operation and removed 2 to 5 days later. Double pigtail tubes were left in 60% patients and removed by cystoscope after a month. The postoperative hospital stays were 4 to 14 days. All cases were followed up for 5 to 30 months, and the growth and development of the children were normal. Forty (88.9%) patients had calculi completely disappeared, with no recurrence. Hydronephrosis and hydroureterosis disappeared or were improved. Four cases still had residuals and one case had recurrence. Conclusion Mini-PCNL for the treatment of upper urinary tract calculi is safe and effective in children. The patients recover quickly and the operation can be done repeatedly; moreover, the technique has little influence on ureter and renal pelvis.