学龄儿童肾结石经皮肾取石术疗效评估

目的 评价经皮肾取石术(PCNL)治疗学龄儿童肾结石的疗效与安全性.方法 2006年8月至2011年8月对25例7～12岁学龄儿童肾结石患者接受经皮肾取石术治疗.X线定位穿刺,建立16F经皮肾通道,8/9.8F输尿管镜下碎石取石.结果 平均手术时间74 min.20例肾结石患儿I期PCNL取出结石,2例患儿接受Ⅱ期pCNL治疗并取净结石,结石清除率88％(22/25).无严重并发症发生.结论 对有手术指征的学龄儿童肾结石,采用经皮肾取石术治疗是安全有效的.     

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。     

经皮肾镜取石术治疗小儿复杂肾结石合并上尿路梗阻

目的探讨微创经皮肾镜取石术(MPCNL)治疗小儿复杂肾结石合并上尿道梗阻的疗效和临床应用价值。方法回顾性分析我们于2006年6月至2009年6月采用微创经皮肾镜取石术(MPCNL)治疗的20例小儿复杂肾结石合并上尿路梗阻患儿临床资料,其中男14例,女6例,年龄8个月至11岁,平均年龄4.5岁。结果全部患儿平均住院时间6 d,20例中,16例一期全部取净,4例行二期取净,一期结石清除率为80.0%(16/20),术中未见肾盂大穿孔或肾皮质撕裂的并发症,无一例需术中输血,所有患儿术后随访6~12个月,未见输尿管狭窄或闭锁等并发症。结论微创经皮肾镜取石术(MPCNL)治疗小儿复杂肾结石合并上尿路梗阻安全有效,值得在临床上推广。     

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.     

小儿尿路结石的腔内微创治疗

目的探讨小儿尿路结石施行腔内微创治疗的临床价值。方法对79例小儿尿路结石患儿施行腔内微创治疗。男47例，女32例。年龄0．5～14岁，平均7．9岁。肾结石18例；输尿管上段结石14例（阴性结石和多发性结石各1例），输尿管中段结石2例，输尿管下段结石10例，膀胱内型输尿管囊肿内结石1例，肾结石合并输尿管上段结石4例；膀胱结石18例；尿道结石12例（后尿道6例，前尿道6例）。结石横径0．5～2．8cm，长径0．5～1．5cm。上尿路结石中左侧24例，右侧22例，双侧3例。结果30例下尿路结石、13例输尿管中下段结石行经输尿管镜碎石术（URL），1例肾盂结石、4例输尿管上段结石行后腹腔镜肾盂输尿管切开取石术（RPPL／RPUL），31例肾、输尿管上段结石行微创经皮肾镜取石术（MPCNL），手术均获成功。术中、术后无严重不良反应发生。结论综合应用各种腔内治疗技术，小儿尿路结石可以实现现代微创治疗，并可作为一线治疗的选择。     

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.     

经皮输尿管镜治疗小儿上尿路结石(附11例报告)

目的探讨经皮输尿管镜取石治疗小儿上尿路结石的手术方法与临床效果。方法对经皮输尿管镜取石治疗11例小儿上尿路结石的病例进行回顾性分析。结果11例均取得满意取石效果,未出现严重并发症。Ⅰ期取石9例结石取尽;2例结石残余,其中1例经同一通道Ⅱ期取石,结石取尽,另1例结石残余但梗阻解除残余结石对肾个功能无明显影响未进一步处理,结石取尽率91%。结论经皮输尿管镜取石治疗小儿上尿路结石是比较安全和有效的一种手术方法。     

微创手术治疗小儿尿路结石

目的探讨微创手术治疗小儿尿路结石的可行性与临床效果。方法应用输尿管镜经尿道碎石或经皮肾造瘘碎石取出尿路结石。结果52例患儿所有结石均一次取净,无明显并发症。结论微创手术治疗小儿尿路结石安全可行,并发症少。     

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.     

婴儿食用三聚氰胺污染奶粉致急性肾后性肾功能衰竭的治疗

目的 探讨因食用三聚氰胺污染奶粉致急性肾后性肾功能衰竭婴儿的外科急诊处理方法 与疗效.方法 应用半硬性输尿管镜(F6.8)逆行输尿管插管冲洗术11例,开放输尿管切开取石术2例.结果 本组除1例开放输尿管切开取石术后5h患儿又出现无尿且血红蛋白持续下降,再次行切口探查和腹膜透析外,其余12例均顺利恢复.本组13例肾功能均恢复正常,无手术并发症.结论 对婴儿因食用三聚氰胺污染奶粉致上尿路结石引起的急性肾后性肾功能衰竭,在输尿管镜下逆行捕管置入输尿管导管冲洗术是一种微创、安全而又有效的治疗方法 ;对婴儿尿道狭小输尿管镜不能进入者,开放输尿管切开取石术也是一种有效的方法 ,但对有明显出血倾向者需先纠正出血倾向后再考虑开放手术解除梗阻.     

经皮肾穿刺碎石取石术治疗婴幼儿肾结石

目的探讨微创经皮肾穿刺碎石取石术（MPCNL）治疗婴幼儿肾结石的疗效与安全性。方法回顾性分析湖南省儿童医院2008年10月至2011年2月,应用经皮肾穿刺术钬激光治疗婴幼儿肾结石47例的临床资料。结果47例患儿50个肾脏行50次mini—PCNL治疗,其中一期碎石取石成功46个肾脏,二期碎石取石成功3个。肾脏,结石残留1例。单通道取石49个肾脏,双通道取石1个。肾脏。3例肾盂输尿管交界处狭窄（UPJO）患儿经钬激光内切开,8例息肉切除。术中通道迷失1例,经再穿刺成功。术后血红蛋白浓度平均下降2．5g／dL。2例肾功能异常者术后1—3d恢复正常。术后拔出DJ管后4周复查B超或X线平片,结石排尽率94％（47／50）,术后3个月复查,除1例结石残余外,其余均排尽。手术肾脏未见缩小,IVU检查提示8例双肾显影正常。38例肾积水患儿中,30例肾积水消失,8例由中重度肾积水转为轻度肾积水。47例术后随访2个月至1年6个月,无其他并发症。结论在明确掌握适应证和操作熟练的情况下,经皮肾穿刺碎石取石术治疗婴幼儿肾结石安全、有效,是一种较为理想的方法。     

微创经皮肾穿刺取石治疗儿童复杂肾结石

目的 探讨微创经皮肾穿刺取石治疗儿童复杂肾结石的疗效和安全性.方法 回顾性分析我院收治儿童复杂肾结石33例,男21例,女12例,年龄5～14岁,平均8.5岁.结石位于右侧16例,左侧13例,双侧4例.结石单发11例,多发19例,铸形结石3例,结石大小2.1 cm×3.2 cm-3.7 cmx6.7 cm.均采用B超定位经皮肾气压道碎石系统治疗,并观察结石清除情况.结果 本组33例均经一次穿刺即成功建立通道,其中4例行两通道碎石,4例同时行双侧碎石.31例I期行经皮肾微创造瘘术(MPCNL),2例Ⅱ期.手术时间80～130 min,平均92 min,术中出血30-80 ml,平均(61.5±12.3)ml,均无输血.1例有较大结石残留辅以体外震波碎石治疗.Ⅰ期结石清除率90.9%(30/33),Ⅱ期碎石后总清除率为96.9%(32/33).无气胸、腹腔脏器损伤、大出血等严重并发症.术后发热4例.术后24 h血红蛋白及血肌酐值与术前相比差异无统计学意义.术后住院时间4～8 d,平均5.4 d.术后随访3～18个月,平均9个月,结石无复发.结论 微创经皮肾取石治疗儿童复杂肾结石安全可行,疗效确切,具有创伤小、恢复快等优点,可成为本病首选治疗.     

微创经皮肾镜取石术治疗婴幼儿肾结石

目的 探讨微创经皮肾镜取石术(MPCNL)治疗婴幼儿肾结石的临床效果和安全性.方法 2008年12月至2009年10月行MPCNL治疗婴幼儿肾结石24例.男18例,女6例.年龄10～42个月,平均23个月.左侧10例,右侧8例,双侧6例,共30侧.结石最长径11～22 mm,平均14.2mm.通过B超、螺旋CT薄层平扫予以诊断.结果 24例患儿,共30侧肾行MPCNL治疗.手术时间25～90min,平均40min.术中出血5～40ml,平均15ml.建立经皮通道成功率为1(00%.术后全部留置肾造瘘管,3～5d后拔除.60%(18/30)的病例留置双J管,1个月后膀胱镜下拔除.所有病例未输血,未发生严重并发症.静脉应用抗生素3～7 d,术后住院4～10 d,出院时尿检阴性.患儿随访6～18个月,生长发育良好,经B超和尿检,22例肾结石消失,并无复发,肾盂积水消失或减轻,尿检阴性.2例患儿有肾结石残留.结石清除率91.7%(22/24).结论 采用MPCNL术治疗婴幼儿肾结石安全有效,术后恢复快、住院时间短,具有微创的优势.     

Treatment of paediatric urolithiasis by extracorporeal shock-wave lithotripsy

Non-surgical removal of renal and ureteral stones has proven successful in adults. In this study, 21 paediatric patients have been treated with the first generation extracorporeal shock-wave lithotriptor and an additional 13 children with a second generation local shock-wave lithotriptor. A total of 47 stones was treated. Treatment-related complications such as colics (17%/18.8%) or fever (8.3%/6.2%) were minimal. Stone passage occurred in 93% and 100%, respectively of each group. Open surgery is still the treatment of choice for large staghorn calculi. Extracorporeal shock-wave lithotripsy can be performed successfully in paediatric nephrolithiasis with stones of limited size.Abbreviations PNL percutaneous nephrolithotomy - ESWL extracorporeal shock-wave lithotripsy - LS local shock-wave lithotripsy     

Outcome of ureteroscopy for treatment of pediatric ureteral stones

PurposeWe assess the efficacy and safety of semirigid ureteroscopy for treatment of ureteral stones in children.Materials and methodsThe records of 18 non-consecutive children with symptomatic ureteral stones treated with ureteroscopy in 2008–2010 were reviewed. Mean age was 7.6 years (range 15 months–14 years). A semirigid (8F) ureteroscope was used in all cases. A 0.038-inch floppy-tipped guidewire was passed through the selected ureteric orifice, advanced under direct vision, and monitored fluoroscopically. Dilatation of the ureteral orifice was necessary in 7 cases. Either direct extraction or disintegration using a pneumatic lithotripter was performed. The follow-up period was 6 months.ResultsUreteroscopic procedures were successfully completed in 16 children (89%). Stones were located at the middle ureter in 3 (19%) cases and various levels of the lower third ureter in 13 (81%) cases. Stone size was 4–10 mm (mean 7 mm). Stones were fragmented with pneumatic lithotripsy in 9 (56%) cases and removed by forceps without fragmentation in 7 (44%). Stent was left in place for 3 days to 3 weeks in 12 (75%) cases. Early postoperative complications were insignificant hematuria in 2 patients and renal colic and fever in 3 patients. No complications were observed during the period of follow up.ConclusionUreteroscopy is a feasible treatment option for ureteral stones in children, when in skilled hands and with the aid of experience gained in the adult population.     

Minimally invasive percutaneous nephrolithotomy in preschool age children with kidney calculi (including stones induced by melamine-contaminated milk powder)

Purpose

This study was undertaken to assess the safety and efficacy of minimally invasive percutaneous nephrolithotomy (mini-PCNL) using ureteroscope and pneumatic intracorporeal lithotripsy in preschool age children with kidney calculi.

Methods

We studied 27 renal units in 20 patients of preschool age (≤6?years) who underwent mini-PCNL at our institute. The mean age was 42.6?months (range 14–68?months). The average stone burden was 1.85?cm (range 0.9–2.8?cm). Eight patients aged 14 to 58?months had been exposed to melamine-tainted powdered formula. The mini-PCNL was performed with an X-ray-guided peripheral puncture. Minimal tract dilatation was undertaken to fit a 14–16?Fr peel-away sheath. Ureteroscope and pneumatic intracorporeal lithotripsy were used to fragment the stones.

Results

Complete clearance was achieved in 23 renal units (85.2?%) with mini-PCNL monotherapy. This has increased to 92.6?% after adjunctive ESWL. The average fall in hemoglobin was 1.28?g/dL. None of the patients required blood transfusion. The median length of hospital stay was 8.2?days. Patients were followed up every 6?months for 2?years. There has been only one recurrence of stone and no long-term complications.

Conclusion

Mini-PCNL is a effective treatment for pediatric kidney stones refractory to extracorporeal shock wave lithotripsy, including stones induced by melamine-contaminated milk powder. The “mini-PCNL” technique, which uses ureteroscope and pneumatic intracorporeal lithotripsy, is a safe and feasible modality for treating renal calculi in preschool age children.     

小儿尿路结石的ESWL及腔道处理

探讨ＥＳＷＬ及腔道处理治疗小儿尿路结石的疗效及治疗方式。对肾、输尿管上段结石，首选ＥＳＷＬ；输尿管中、下段结石，经尿道输尿管镜，用ＡＰＬ弹道碎石机击碎结石，碎片推回肾内，停留支架再行ＥＳＷＬ。结果，单次ＥＳＷＬ后Ｘ线片示结石完全粉碎者１９例，停留支架管再行ＥＳＷＬ者３例，本组无严重的并发症。因此，通过选用合适的腔道设备，配合规范的ＥＳＷＬ，可减少结石治疗过程中对小儿的伤害。     

An uncommon cause of acute kidney injury in young children: Cystinuria

Bilateral obstructive nephrolithiasis is a rare cause of acute kidney injury (AKI) in early childhood. As soon as the identification of AKI secondary to ureteral stone is made, it will necessitate an emergency treatment.PatientsWe report three infants with AKI caused by bilateral obstructive ureteral cystine stones. They were diagnosed with acute post-renal injury due to obstructive bilateral ureteral stones based on ultrasound scan findings. Immediately, bilateral ureteral stents were inserted for urinary drainage. Once renal function recovered to normal, each patient underwent ureteroscopy and percutaneous nephrolithotomy at the same session. Cystinuria was diagnosed by stone analysis and increased urinary excretion of cystine. Patients were advised to maintain a high fluid intake and were treated with potassium citrate in addition to tiopronin.ConclusionsWith these three cases we would like to emphasize the importance of urolithiasis in the differential diagnosis of acute renal failure in young children, since urolithiasis may only cause nonspecific symptoms in this population. An early diagnosis with prompt treatment and a close follow-up are the key for achieving the best long-term outcome in cystinuria.