输尿管镜气压弹道碎石术治疗小儿输尿管结石

目的探讨输尿管镜气压弹道碎石术治疗小儿输尿管结石的临床效果。方法回顾性分析应用输尿管镜气压弹道碎石术治疗小儿输尿管结石32例临床资料。结果一次性治疗成功29例，成功率90．6％，手术时间为30～120min，术后无明显血尿、感染及输尿管、尿道狭窄等并发症。结论输尿管镜气压弹道碎石术治疗小儿输尿管结石效果确切、创伤小，是治疗小儿输尿管结石的理想方法。     

经输尿管镜钬激光碎石术治疗婴幼儿输尿管结石

目的 探讨经输尿管镜钬激光碎石术治疗婴幼儿输尿管结石的可行性和疗效.方法 回顾性分析2008年12月至2010年10月36例41侧婴幼儿输尿管结石采用经输尿管镜钬激光碎石术治疗的临床资料.结果 36例41侧输尿管结石,其中32侧一次入镜碎石成功;8侧采用导丝、输尿管导管、双J管扩张后碎石成功;1侧改经皮肾穿刺钬激光碎石术.所有病例术后均留置双J管1～4周,拔管后2周内复查B超或KUB结石全部排尽,清石率97.6％.7侧合并有输尿管息肉者,息肉切除.发生输尿管口撕裂1例,黏膜下假道2例,留置双J管4周,无输尿管反流和狭窄并发症.1例出现术后发热,经抗感染后体温正常.所有病例术后随访3～24个月未见输尿管狭窄和结石复发.结论 选择合适的输尿管镜,熟炼掌握操作技术,采用经输尿管肾镜钬激光碎石术治疗婴幼儿输尿管结石安全有效.     

经输尿管软镜钬激光碎石术治疗儿童上尿路结石

随着腔镜技术的发展,泌尿系结石的微创手术逐渐取代了传统的开放手术,对于儿童泌尿系结石的微创治疗大部分是从成人的技术发展过来,但是因为儿童泌尿系结石的临床表现以及身体结构与成人大相径庭,故儿童结石的微创治疗的方式也有所不同,我科开展多种腔镜手术,比如输尿管硬镜,经皮肾镜以及输尿管软镜,尤其是对儿童上尿路结石输尿管软镜的治疗,亦从中总结出一些方法和经验。     

经输尿管软镜钬激光碎石术治疗儿童肾结石和输尿管上段结石

目的 探讨经输尿管软镜钬激光技术治疗儿童肾结石和输尿管上段结石的疗效.方法 回顾性分析47例（52侧）采用经输尿管软镜钬激光技术治疗的上尿路结石患儿临床资料.结果 47例52侧上尿路结石,单用输尿管软镜碎石取石术35例、硬镜＋软镜12例.其中2侧一次入鞘置镜碎石成功;其余采用双J管扩张输尿管后,45侧置入软镜导引鞘成功.45侧置入导引鞘者,39侧一次碎石成功;另外3侧进行了第二次碎石手术;其他3侧未寻及结石,2侧改由MPCNL,1侧观察.5侧导引鞘置入不成功者,其中2侧在斑马导丝引导下置入软镜到肾盂进行碎石成功;另外2例改由微创经皮肾穿刺碎石取石术（MPCNL）,1例失访.共49侧入镜成功并碎石.术后1个月复查B超或CT,46侧结石全部排尽,清石率88.5%（46/52）,3例残留下盏结石,术后2～4周再行软镜碎石取石术,术后1个月复查,结石全部排尽.术后2个月总清石率92.3%（49/52）.本组平均手术时间为 45 min（25~115 min）.术后平均住院时间3 d（2~5 d）,术后出血少,发生输尿管口撕裂1例,无输尿管反流和狭窄.3例出现术后发热.43例术后随访2～24个月,未见输尿管狭窄,1例术后1年结石复发.结论 选择合适的输尿管软镜,熟炼掌握操作技术,采用经输尿管软镜钬激光碎石术,是治疗儿童肾和输尿管上段结石安全有效的方法.     

间歇通气呼吸暂停麻醉法在儿童输尿管软镜钬激光碎石术中的应用

目的 评价间歇通气呼吸暂停麻醉法在儿童输尿管软镜钬激光碎石术中的安全性与有效性.方法 选择气管内插管全身麻醉下输尿管软镜钬激光碎石术患儿30例.采用间歇通气呼吸麻醉法,呼吸暂停时间为2 min,呼吸暂停次数为5次,根据手术需要行呼吸暂停.观察记录患儿手术开始前（Ta）、第1次呼吸暂停2 min后（T1）、第2次呼吸暂停2 min后（T2）、第3次呼吸暂停2 min后（T3）、第4次呼吸暂停2 min后（T4）、第5次呼吸暂停2 min后（T5）,手术结束后15 min（Tb）各个时间点的心率、血压、pH、PaCO2、PaO2.结果 患儿Ta、T1～T5各时间点的心率、血压均无明显差异（P〉0.05）;T1 ～T5各时间点pH值较Ta比较有所下降（P〈0.05）,至Tb时间点时pH回升恢复至正常水平;T1～T5各时间点PaCO2值较Ta比较升高（P〈0.05）,至Tb时间点下降恢复至正常水平.Ta、Tb PO2值比较比较无明显差异（P〉0.05）,T1～T5各时间点PaO2值较Ta有所下降（P〈0.05）,但最低值〉380 mmHg.结论 间歇通气呼吸暂停麻醉法可安全、有效地应用于儿童输尿管软镜钬激光碎石术.     

气压弹道碎石术治疗小儿输尿管中下段结石的体会

目的 探讨气压弹道碎石术治疗小儿输尿管中下段结石的临床效果及手术技巧.方法 回顾性分析2009年11月至2012年1月间应用输尿管镜气压弹道碎石术治疗小儿输尿管中下段结石42例44侧的临床资料.结果 本组有10例经筋膜扩张器扩张输尿管后方顺利置入输尿管镜,除1例Ⅱ期手术,均一次性成功,无1例中转开腹手术.手术时间为20～100 min.所有病例随访1～18个月,未发现大出血、感染、输尿管、尿道狭窄等并发症.结论 适度的筋膜扩张,合适的灌注压等均有利于提高输尿管镜气压弹道碎石术成功率,气压弹道碎石术是小儿输尿管中下段结石的理想治疗方法.     

经皮肾微造瘘输尿管镜下钬激光碎石术治疗儿童上尿路结石

目的 探讨经皮肾微造瘘输尿管镜下钬激光碎石术治疗儿童上尿路结石的疗效与安全性.方法 上尿路结石患儿51例,平均年龄5.6岁,均为14岁以下.其中肾结石41例,结石平均大小16.8 mm（11～28 mm）,输尿管结石10例,结石平均大小11.5 mm（10～16 mm）.全部病例使用全身麻醉下经皮肾微造瘘输尿管镜下钬激光碎石术治疗.术后行超声或X线摄片观察疗效,术后随访2～20个月.结果 51例患儿中,单通道取石49例（96%）,双通道取石2例（3%）.一期取石46例（90%）,二期取石5例（9%）.结石排尽率96%（49/51）.平均手术时间85.5 min.一期取净结石者住院时间7～10 d,平均8 d.术中操作鞘脱出腹膜后渗液1例,置腹膜后引流管后渗液消失.术后发热4例（7%）;1例（2%）术后大出血予输血及超选择性肾动脉栓塞后治愈.4例残石患儿,2例二期行原窦道或再次穿刺取石取净;1例一期取石术后ESWL治疗仍有残石,1例一期取石术后出血放弃再次取石.全部病例术后半年复查彩超,49例肾积水消失,2例重度肾积水转为轻度肾积水,手术肾脏未见缩小.结论 经皮肾微造瘘输尿管镜下钬激光碎石术并发症少,净石率高,可重复取石,是治疗儿童上尿路结石安全有效的手段.     

输尿管镜下气压弹道碎石治疗尿道结石

目的 探讨输尿管镜下气压弹道碎石治疗儿童尿道结石的效果。方法 回顾分析本院在基础麻醉＋黏膜表面麻醉或静脉麻醉下，应用输尿管镜气压弹道碎石治疗儿童尿道结石16例的治疗结果，术后随访3～12个月。结果病例均1次碎石成功，后尿道结石多返回膀胱，碎石时间10～40min，术后10例留置尿管1～3d，术后无尿道损伤、尿道狭窄、明显出血等并发症。结论 输尿管镜下气压弹道碎石治疗儿童尿道结石疗效确切、安全、手术时间短、损伤小、并发症少。     

小儿输尿管结石体外震波碎石:十年经验

目的报告小儿结石ESWL治疗的10年经验，探讨ESWL治疗的效果和策略。方法回顾性研究67例小儿输尿管结石行ESWL治疗的结果，检测及记录患儿的代谢情况、生理解剖、结石的大小、位置以及各种并发症；其中术前置人输尿管导管52例；术后随访3～9个月。结果67例输尿管结石，首次碎石后，43例（64．2％）结石完全排空；7例（10．4％）经2次ESWL结石完全排空；2例（2．9％）经3次碎石结石完全排空；总结石完全排空率为77．6％。小于10mm结石首次碎石后的完全排空率为100％，37例大于10mm的结石患儿中，23例（62．2％）首次碎石后完全排空。上段结石的完全排空率为92．0％，而中下段结石的完全排空率仅为69．0％。其中11例输尿管中、下段结石和1例上段嵌顿结石ESWL失败者进行了输尿管镜治疗，用APL弹道碎石机击碎结石并取出；3例改行开放手术。结论ESWL是小儿输尿管结石的安全有效的治疗方法；对输尿管中、下段结石应用输尿管镜是ESWL的有效补充治疗；部分结石采用输尿管镜联合ESWL可获得较好的效果。     

小儿胃石症的胃镜下钬激光碎石治疗

目的寻求小儿胃石症的有效治疗手段。方法采用钬激光对１２例胃石症患儿进行了胃镜下激光碎石治疗。结果胃石最大者为１２ｃｍ、最小者为２ｃｍ，经１～２次激光碎石治疗，全部患儿均获得治愈，未发生任何术中及术后并发症。结论胃镜下钬激光碎石术是目前治疗小儿胃石症的一种安全、有效的理想技术。     

Experience with ureteroscopic holmium laser lithotripsy in children

The purpose of the study was to evaluate the outcome of ureteroscopic holmium laser lithotripsy (UHLL) in children, taking into consideration different stone locations. Records of 15 children with ureteral calculi managed with UHLL were reviewed. All patients were evaluated with history, clinical, radiological and laboratory assessment prior to treatment. All patients were managed on an outpatient basis. After stone disintegration, if sizable fragments remained, they were retrieved using grasping forceps or stone basket extraction. Patient records were reviewed for age, sex, stone laterality, location, number and size, need for ureteral dilation, stenting and residual fragment extraction. Of the 15 children, 11 were female and 4 were male. Mean age was 8.5 years (age range 2–15 years). There was no significant difference in stone laterality (eight left and seven right ureteral stones). Main presenting symptoms were renal colic, hematuria and urinary tract infection or a combination of these symptoms. The 15 children harbored 15 ureteral stones (range 5–11 mm, mean 7.8 mm) and underwent 15 UHLL procedures. Ureteral dilation was performed in 14 patients using balloon dilators. Stone retrieval was done in all patients. DJ stents were placed at the conclusion of the procedure in 11 patients. Complete stone clearance was achieved at the end of the procedure in all patients (success rate 100%). No complications were encountered during or after the procedure. This study confirms the effectiveness and safety of ureteroscopy and holmium laser in the treatment of ureteral stones in children regardless of stone location.     

输尿管镜气压弹道碎石术治疗小儿下尿路结石疗效观察

目的 探讨经输尿管镜气压弹道碎石术在治疗小儿下尿路结石中的应用效果.方法 收集我科2012年1月至2015年1月33例小儿下尿路结石患儿,其中男32例,女1例,年龄6个月至12岁,平均年龄29个月,年龄小于3岁的患儿有27例.膀胱结石17例,尿道结石16例,其中前尿道结石6例,后尿道结石10例,结石大小8 mm～25 mm,平均13 mm.所有患儿经B型超声、泌尿系CT等检查,均无尿道狭窄、神经源性膀胱、先天性畸形.全身麻醉、电视监视系统下应用Wolf输尿管镜(Wolf 6～7.5F,工作通道F4.0)气压弹道碎石术(碎石杆直径1.0 mm)治疗,观察碎石成功率、术后有无尿道损伤、膀胱穿孔、有无发热等并发症发生情况及结石复发情况.结果 33例患儿均1次碎石成功,碎石时间15～60 min,平均(26±9)min,术后2d～7d内结石清除率100％,4例患儿术后第一天体温超过38.0℃、无“石街”、无尿道狭窄、无尿道损伤、无膀胱穿孔和排尿异常等并发症发生,术后住院时间2～3 d,平均2.4d.随访2～24个月,无结石复发.结论 经输尿管镜气压弹道碎石术治疗小儿尿路结石安全简便、效果确切、结石清除率高,且损伤小,术后恢复快,可作为小儿下尿路结石治疗的首选方法之一.     

Management of urinary calculi using endourology and extracorporeal shock wave lithotripsy (ESWL)

Childhood urolithiasis is uncommon, comprising 2% – 3% of urinary calculi. This paper presents our initial experience in the endourological (EU) treatment of 23 children with urinary calculi presenting to the Royal Childrens' Hospital. Twenty-seven renal, ureteric, and vesical calculi were treated. Three strictures were divided endoscopically synchronously with calculus removal. Twenty-three calculi were renal (6 staghorn, 3 cystine), 2 ureteric, and 2 vesical. In 12 patients (mean age 17.5 years, range 5–24), the underlying cause was a neuropathic bladder secondary to spina bifida. Ten of these had ileal conduits, 1 was successfully undiverted, and 1 previously undiagnosed (all infected). The second group of 11 patients (mean age 10.1 years, range 5–16) had normal renal anatomy. Seventeen (63%) were treated by percutaneous nephrolithotomy (PCNL) or endoscopic lithotripsy via their conduit (n = 1) or bladder (n = 2). Three (11%) underwent combined extracorporeal shock wave lithotripsy (ESWL) and PCNL and 7 (26%) were treated by ESWL alone. Twenty-one (77%) were cleared of stone by their primary procedure. Four patients with residual calculi following ESWL have a decreased volume of stone and 2 patients with staghorn calculi treated by PCNL have peripheral fragments only (1 bilateral). There was no mortality or significant morbidity except sepsis in 4 patients, which was treated medically. This series demonstrates that EU and ESWL techniques are safe and effective in children and patients with spina bifida, who often have marked scoliosis, urinary diversion, and difficulties in access. In our experience, paediatric calculi were associated with infection, metabolic disorders, urinary diversion, and patient deformities, and so the majority were more appropriately treated by endourological techniques. ESWL was effective for small stones and in combination with EU for complex stones. By using EU and ESWL alone or in combination, we have avoided open surgery in all patients with urinary calculi treated so far. Offprint requests to: H. L. Tan     

Efficacy of extracorporeal shock wave lithotripsy for ureteral stones in children

Purpose  

In this study, we retrospectively analyzed our experience with extracorporeal shock wave lithotripsy (ESWL) in children with ureteric stones.     

体外冲击波碎石术治疗小儿鹿角状结石

目的 评价体外冲击波碎石术治疗小儿鹿角状结石的安全性和疗效。方法 从1997年3月至2002年3月，共收治8例小儿鹿角状结石患儿，年龄1．5—14岁，平均7．8岁，结石直径均大于20mm，完全鹿角状结石3例，部分鹿角状结石5例，Donier Compact S碎石机治疗。3例低龄患儿行氯胺酮麻醉，全部患儿碎石1—5次，无需置D-J管，随访6个月以上。结果 6例无结石残留(75．0％)，2例残留结石，需经皮肾取石术治疗。2例形成输尿管石街，轰击石街1—2次后结石排出。随访6个月以上，肾功能恢复正常，无高血压发生。结论 体外冲击波碎石是小儿鹿角状结石的首选治疗方法，安全性好，疗效高。应重视代谢障碍、解剖异常问题及并发症的防治。     

急诊冲击波碎石术治疗小儿绞痛性输尿管结石的临床研究

目的 评价急诊体外冲击波碎石术(ESWL)治疗小儿绞痛性输尿管结石之效果.方法 回顾1997年1月至2007年12月32例小儿输尿管结石伴急性肾绞痛的急诊ESWL的治疗资料.结果 1次ESWL 25例;2次ESWL 5例;1例3次ESWL治疗失败后改其他治疗,总结石排净率为96.8%(30/31).首次ESWL治疗后,28例肾绞痛完全缓解(90.3%).ESWL术中,静脉全麻19例,镇静加止痛剂者12例.术后无严重并发症.结论 急诊ESWL治疗小儿绞痛性输尿管结石安全快捷、疗效肯定.