输尿管镜术治疗婴幼儿急性梗阻性双侧输尿管结石的评价

目的：探讨输尿管镜腔内治疗婴幼儿急性梗阻性双侧输尿管结石的有效性及安全性。方法回顾性分析2011年9月至2013年9月新疆维吾尔自治区人民医院收治的16例双侧输尿管结石婴幼儿，行一期U-100激光碎石或逆行置管引流治疗。输尿管上段结石9侧，输尿管下段结石23侧，合并肾结石5例，结石直径6～14 mm，平均（7．4±1．9） mm。术前检查血尿素氮25～49 mmol/L，血肌酐270～835μmol/L，血尿酸623．7～1640．5μmol/L，血钾4．5～6．8 mmol/L。观察手术前后尿量、血尿素氮、血肌酐、血尿酸、血钾变化。结果输尿管镜下U-100一期双侧输尿管成功碎石8例，7例逆行置入输尿管支架管引流，双侧置管4例，单侧置管3例，1例逆行置管失败改开放手术。6例二期手术碎石，治愈15例，死亡1例。平均手术时间（45±7）min，平均住院时间（9．1±2．3）d。术后第3天血尿素氮1．9～5．9 mmol/L，血肌酐45～76μmol/L，血尿酸125．6～296．7μmol/L，血钾3．2～4．8 mmol/L。结论输尿管镜联合U-100激光碎石或逆行置入输尿管支架管引流治疗婴幼儿急性梗阻性双侧输尿管结石临床有效，创伤小，治疗效果理想。

Ureteroscopy treatment of acute obstructed bilateral ureteral calculi in infants

Objective To evaluate the efficacy and safety of ureteroscopic intracavitary treatment for in-fants with acute obstructed bilateral ureteral calculi .Methods The 16 cases with acute obstruction caused by ure-ter calculi were treated by one stage ureteroscopic FREDDY laser lithotripsy or retrograde ureteral stent drainage . 12 cases were male and 4 cases were female.The age was 6-24 months with an average （11 ±6）months.7 cases were infants and 9 cases were toddlers .9 cases were upper ureteral calculi , 23 cases were lower ureteral calculi , 5 cases had kidney stones.The diameter of the calculi was 6-14 mm with an average（7.4 ±1.9） mm.Preopera-tive blood urea nitrogen was 25-49 mmol/L; serum creatinine was 270-835 μmol/L; blood uric acid was 623 .7-1 640.5 μmol/L and serum potassium was 4.5-6.8 mmol/L.Urine volume, blood urea nitrogen , serum creati-nine, blood uric acid and serum potassium levels before and after operation were measured .Results Of all the cases, 8 patients suffering from bilateral calculi successfully underwent one stage ureteroscopic FREDDY laser lith -otripsy;7 patients underwent retrograde ureteral stent drainage under ureteroscopy ;4 cases were bilateral;3 cases were unilateral and 1 case of retrograde insertion failure went to open surgery .6 cases underwent reoperation;15 cases were cured and 1 case died.The average operation time was （45 ±7） min and the mean hospital stay was （9.1 ±2.3） days.Three days after surgery , blood urea nitrogen was 1.9-5.9 mmol/L;serum creatinine was 45-76 μmol/L;blood uric acid was 125.6-296.7μmol/L and serum potassium was 3.2-4.8 mmol/L.Conclusion Uret-eroscopy combined FREDDY laser lithotripsy or retrograde ureteral stent drainage is an effective and minimally in -vasive treatment for infants with acute obstructed bilateral ureteral calculi .