小儿肾窦内肾结石的诊治分析

目的 探讨小儿肾窦内肾结石的诊断与处理方法 .方法 同顾性分析2001～2007年间收治小儿肾窦内肾结石25例的临床资料.男18例.女7例.年龄3个月～13岁.平均3.5岁.左肾结石13例.右肾结石9例,双肾结石3例;多发结石左侧3例.右侧4例,双侧1例;规则状结石17例(20侧).鹿角犁结石5例,铸状结石3例;全部病例均合并轻至重度肾积水.结果 复杂肾窦内肾结石中5例鹿角型结石、3例铸状结石和5例6侧偏大(直径>1.0cm)的规则多发结石.均未阻断.肾蒂血管,肾实质最薄处或肾后下段切开取石,1例合并肾盂输尿管交界处梗阻,Ⅱ期手术治愈;单纯肾窦内肾结石中9例11侧规则肾结石和3例3侧直径小于1.0cm的多发结石均采用类似Anderson-hynes术式行肾内肾盂切开取石.术中发现3例合并肾盂输尿管交界处梗阻.同期行肾盂输尿管成形术.结石最大3.0 cm× 2.0 cm×1.0 cm,数目多达6枚.术中C臂检查无结石残留,术后3～6个月复查B超、KUB平片未见结石复发.结论小儿肾窦内肾结石发病率逐年增高.腹部B超、IVU或逆行造影检查是有效的辅助检查手段.治疗应根据结石类型、数目、大小以及合并肾积水的情况而定,如鹿角型、铸状结石以及多发结石采用肾实质切开取石;合并肾积水者尽量采用肾内肾盂切开取石,有助于术巾探查是否合并肾盂输尿管交界处狭窄,以便同期施行肾盂输尿管成形术.

Diagnosis and treatment of intrasinusal calculi in children

Objective To investigate the diagnosis and treatment of intrasinusal calculi in chil- dren. Methods Between 2001 to 2007, 25 children with intrasinusal calculi, including 18 males and 7 females, were treated in this institute. Their ages ranged from 3 month to 13 years with a mean age of 3. 5 years. Left kidneys were affected in 13 patients, fight kidneys in 9 patients and bilateral kidneys in 3 patients. Multiple stones were found in 8 patients, including 3 cases in left kidneys, 4 cases in fight kidneys, and 1 case in bilateral kidneys. Regular renal calculi were found in 20 affected kidneys of 17 patients, staghorn calculi were found in 5 patients and cast calculi in 3 patients. Hydronephrosis was identified in all of the cases. Results The patients were divided into 2 groups: complicated intrasi- nusal calculi group included 5 staghom calculi, 3 cast calculi and 5 multiple renal calculi patients with the diameter more than 1.0cm; and simple intrasinusal calculi included 9 regular patients and 3 multi- ple renal calculi patients with the diameter less than 1.0cm. In complicated calculus group, the renal parenchyma incision was performed at position where the parenchyma was the thinnest, or at the infe- rior posterior segment of kidney to remove calculi without clamping renal pedicle. One patient with ureteropelvic junction obstruction (UPJO) underwent pyeloureteroplasty at 2 years after nephrolithot- omy. In simple calculus group, patients underwent Anderson-Hynes pyeloplasty with some modifica- tions to remove intrasinusal calculi, 3 of them with UPJO underwent pyeloureteroplasty simultaneously. The size of the biggest calculus was 3.0 × 2. 0 × 1.0 cm3 and 6 such big calculi were found. No calculus was found via intraoperative X-ray examinations. All patients had been followed up for 3-6 months, kidney, ureter and bladder photograph(KUB) and B ultrasound examination were carried out to detect reoccurred calculus, and no calculus was found. Conclusions The incidences of intrasinusal calculi in children are increased every year. B-utrasonography, intravenous urography (IVU) and retrograde contrast examination are helpful for the diagnosis of this disease. The strategy to remove calculi should be based on the shape, quantity and size of renal calculi and renal function.