胸腔镜手术与开胸手术治疗先天性支气管囊肿的对比分析

目的总结传统开胸手术与胸腔镜手术治疗先天性支气管囊肿的经验,分析两种手术的可行性及优劣。方法回顾性分析本院自2013年1月至2叭5年11月收治的先天性支气管囊肿患儿临床资料。患儿均经产前超声检查获得初步诊断,经产前评估及出生后增强CT检查明确诊断,最后经手术确诊。手术方式分为传统开胸手术及胸腔镜手术,比较两组手术时间、术中出血量、住院时间及胸腔引流管留置情况,探讨小儿胸腔镜手术治疗支气管囊肿的可行性及风险。结果共13例确诊,12例手术,1例家属决定暂不手术。手术病例中,女性6例,男性6例,男:女=1:1。左右侧比为1:1,其中6例手术诊断为支气管囊肿,3例合并肺囊腺瘤,3例合并肺隔离症。5例术前准确诊断为支气管囊肿,7例诊断为肺囊腺瘤或肺隔离症。手术年龄最小5 d,最大1岁,平均手术年龄4.8个月。5例采取传统开胸手术;7例采取胸腔镜手术,其中1例2月龄患儿因术中须行肺叶切除而增加辅助切口。所有手术病例均治愈。结论先天性支气管囊肿属于少见疾病,由于存在感染以及占位的风险,建议早期手术。胸腔镜下操作,对于婴幼儿病例,不会增加手术风险,是一种可行的手术方式。     

Recent management of urinary stone disease in a pediatric population

The incidence of stone disease has been increasing and the risk of recurrent stone formation is high in a pediatric population. It is crucial to use the most effective method with the primary goal of complete stone removal to prevent recurrence from residual fragments. While extracorporeal shock wave lithotripsy (ESWL) is still considered first line therapy in many clinics for urinary tract stones in children, endoscopic techniques are widely preferred due to miniaturization of instruments and evolution of surgical techniques. The standard procedures to treat urinary stone disease in children are the same as those used in an adult population. These include ESWL, ureterorenoscopy, percutaneous nephrolithotomy (standard PCNL or mini-perc), laparoscopic and open surgery. ESWL is currently the procedure of choice for treating most upper urinary tract calculi in a pediatric population. In recent years, endourological management of pediatric urinary stone disease is preferred in many centers with increasing experience in endourological techniques and decreasing sizes of surgical equipment. The management of pediatric stone disease has evolved with improvements in the technique and a decrease in the size of surgical instruments. Recently, endoscopic methods have been safely and effectively used in children with minor complications. In this review, we aim to summarize the recent management of urolithiasis in children.     

Tubeless percutaneous nephrolithotomy in children

ObjectiveTo assess the effectiveness of tubeless percutaneous nephrolithotomy (PCNL) as an alternative to extracorporeal shock-wave lithotripsy (ESWL) in the management of urolithiasis in children.Materials and methodsIn 2003–2005 we operated on 20 cases that met the inclusion criteria. Extensive follow-up tests were performed in all patients; stone clearance was defined as the absence of residual fragments on plain abdominal X-ray and renal ultrasound. Pain-scale ruler (0–10) was used to evaluate pain postoperatively. Comparison was made with a group of 10 patients with very similar criteria operated upon with PCN tube.ResultsMean follow-up period was 9 months (3–18 months) and mean age 7.5 years (4–15 years). Mean operative time was 115 min (45–180) with no significant bleeding intra- or postoperatively. Conversion to open surgery was necessary in one case. There were no major perioperative complications. In the tubeless group the pain score was 3–6 (mean 4.6), there was no need for IV analgesia, and median hospital stay was 1.7 days (1–4 days); urine leakage occurred in one patient. In the group with PCN tube the pain score was 5–8 (mean 5.5), IV analgesia was mandatory in four patients, and median hospital stay was 2.8 days (3–4 days); urine leakage occurred in five patients and a small residual stone was detected in one child.ConclusionTubeless PCNL in children has the advantages of being less painful, less troublesome and shortening the hospital stay of the child. The decision to use this procedure is best made intraoperatively and depends on the experience of the surgeon.     

小儿微创经皮肾输尿管镜取石术

目的总结小儿微创经皮。肾输尿管镜取石术的临床疗效和安全性。方法回顾性分析57例(59例次)应用微创经皮肾输尿管镜取石术治疗小儿上尿路结石的患儿资料。男34例，女23例；年龄4～16岁。手术指征包括直径大于2．0cm或铸型肾结石36例次(其中手术后残留或复发的肾结石9例次)，引起梗阻性肾扩张的肾或输尿管上段结石9例次，ESWL术失败的肾或输尿管上段结石7例次，合并远端梗阻的肾结石7例次。结果手术治疗59例次，其中41例次(69．5％)经一次PCNL结石被完全清除。因术中出血需输血4例次，明显尿外渗1例次。PCNL加ESWL或重复PCNL，结石完全清除率达86．4％。结论微创经皮肾输尿管镜取石术是一种治疗小儿肾和输尿管上段结石安全、有效的方法。     

Duration of urinary leakage after open non-stented dismembered pyeloplasty in pediatric patients

ObjectiveWe aimed to determine the duration and associated complications of postoperative urinary leakage in pediatric patients undergoing open, non-stented dismembered pyeloplasty for ureteropelvic junction obstruction.MethodsA retrospective review of 100 patients who underwent an open non-stented dismembered pyeloplasty between 2003 and 2008 was performed. Duration of urinary leakage and postoperative complications were tabulated. Patients were considered to have a dry anastomosis if the Penrose drain was removed within one week of surgery.ResultsDuration of leakage ranged from 0 to 27 days. 86% had Penrose drain removal within 7 days of surgery and were considered dry.14 patients demonstrated a persistent urinary leakage (PUL) ranging from 7 to 27 days. Complications of any type were significantly more likely in the group with prolonged drainage (p = .0126). UTI and obstruction were not significantly more likely to occur in patients with PUL (p = .0931 and p = .2616 respectively). Only one patient with PUL required placement of a ureteral stent.ConclusionWe demonstrate that stentless dismembered pyeloplasty is feasible with a low rate of urinary drainage beyond one week. The character and quality of the slightly increased complications in those that demonstrated PUL were not great and not bothersome enough to warrant routine stenting.     

微造瘘经皮肾镜碎石术治疗学龄前儿童上尿路结石

目的 评价微造瘘经皮肾镜碎石术在治疗学龄前儿童上尿路结石的安全性和有效性.方法 应用B超引导穿刺的微造瘘(16F)经皮肾镜碎石术治疗平均年龄46个月的学龄前患儿35例共42侧上尿路结石,其中肾结石34侧,上段输尿管结石8侧,结石平均长径(16.9±9.2)mm.结果 所有病例均I期成功建立通道并处理结石,手术时间平均为(35.4±14.9)min.手术清除率分别为92.9%,术后血红蛋白含量下降了12.7%,术后感染率5.0%,没有需要输血.毗邻脏器损伤或循环超负荷的病例.结论 微创经皮肾镜碎石术治疗学龄前儿童上尿路结石是安全、有效的.     

Heminephroureterectomy for duplex kidney: Laparoscopy versus open surgery

ObjectiveTo report our experience of laparoscopic heminephroureterectomy (Hnu) in pediatric patients with duplex anomalies, in comparison to open surgery.Patients and methodsRetrospective review of data from patients who underwent Hnu from 2005 to 2008 was performed. The patients were divided into two groups: laparoscopic (LHnu) and open surgery (OHnu). Laparoscopic surgery was performed by transperitoneal approach in majority of cases. Open surgery was performed by retroperitoneal approach in all cases.ResultsGroup LHnu: nine patients (8 females, 1 male) with median age of 14 months (range 3–205). Transperitoneal approach was performed in eight patients. Mean operative time was 182 min (CI 95% 146–217). No conversion to open surgery was necessary and there were no complications. Mean hospital stay was 2.44 days (CI 95% 1.37–3.52). Group OHnu: eight patients (3 females, 5 males) underwent nine heminephrectomies at median age of 6.9 months (range 1–12). Mean operating time was 152 min (CI 95% 121–183). There were no complications and mean hospital stay was 4.38 (CI 95% 2.59–6.16) days. Statistical analysis showed no statistically significant difference (P > 0.05) in operating time between groups while mean hospital stay was significant (P = 0.021).ConclusionThe laparoscopic approach is feasible, safe, reduces hospital stay, does not increase operating time and has better cosmetic results. We believe this should be the first option for heminephrectomy.     

小儿无管化经皮肾镜取石术的安全性和效果分析

目的 探讨小儿无管化经皮肾镜取石术( tubeless PCNL)的安全性和有效性.方法 回顾性分析6例应用留置输尿管外支架的tubeless PCNL治疗肾或输尿管上段结石的患儿资料.男4例,女2例.年龄2～12岁,平均6.5岁.其中肾盂结石3例,输尿管上段结石2例,肾多发性结石1例.结石平均大小为(2.5±2.1)cm2.合并患肾中度积液4例,轻度积液2例.6例在经皮肾镜取石术结束时,通过B超和C臂X线证实结石已经完全清除,然后把逆行插入的输尿管导管的头端调整至肾盂的中央,让扩张鞘退至肾造瘘通道以外,证实瘘道无活动性出血,最后拔除扩张鞘,并用丝线缝合皮肤伤口.结果 6例患儿通过单一通道完全清除结石,其中4例经肾上盏入路,2例经肾中盏人路.手术时间30～75 min,平均35 min.手术引起血红蛋白下降3～10g/L,平均6.5 g/L.术后住院2d.无出现严重出血、尿外渗、发热和邻近器官损伤等并发症.结论 在严格掌握手术适应证的前提下,在小儿施行留置输尿管外支架的tubeless PCNL是安全和有效的.     

Transumbilical open laparoscopy: a simple method of avoiding complications in pediatric surgery

The author reports his experience with a new procedure, transumbilical open laparoscopy (TUOL), to obtain the pneumoperitoneum in children operated upon laparoscopically. TUOL was designed to avoid complications related to closed introduction of the first trocar, and consists in the visually-guided introduction of the first trocar transumbilically without any need for a pursestring suture, with an operative time of about 1 min. The author recommends TUOL as it is easier, less expensive, and less timeconsuming compared to other techniques.     

小儿泌尿系统疾病诊断治疗进展

20 0 2年第八届亚洲儿科肾脏病学术大会 (9月 9～ 11日 )在韩国济州岛召开 ,我国有 13名代表参加交流。第 11届全国儿科肾脏病学术大会 (10月 16～ 2 0日 )在海南省海口市召开。上述两届学术会议除重视IgA肾病、局灶节段性硬化症 (FSGS)、紫癜性肾炎 (PN)等常见肾小球疾病诊治外 ,关注小儿肾脏疾病的遗传学研究和肾脏病慢性进展因素分析 ;进一步深入探讨一些机制 ,如蛋白尿、肾病综合征激素抵抗以及肾素 血管紧张素系统 (RAS)对肾脏影响等 ,这些成为大会的特点和热点 ,也反映出国内外小儿肾脏病的研究水平和研究方向。全年国内核心期…     

经皮肾穿刺微造瘘取石术治疗儿童肾结石

目的探讨经皮肾穿刺微造瘘取石术（mini—PCNL）治疗儿童肾结石的手术技巧及临床应用价值。方法回顾性分析总结35例儿童肾结石患儿采用mini—PCNL术治疗的临床资料。结果22例I期取净结石，12例经二次取石，9例取净，另有1例经三次取石仍未取净。4例有残石者术后配合ESWL治疗，2例排净。随访2～32个月，患儿肾积水明显好转，结石无复发，7例肾盏颈部扩张者狭窄消失。1例有少许残石患儿结石体积有增大。结论mini—PCNL治疗儿童肾结石创伤小，安全、有效。结合术后ESWL治疗可以代替开放手术而成为儿童肾复杂结石、鹿角形结石以及合并肾内狭窄的首选治疗方法。