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.

Minimally invasive percutaneous nephrolithotomy for the treatment of renal calculi in infants and young children

Objective To evaluate the clinical efficacy and safety of minimally invasive percutaneous nephrolithotomy(MPCNL)for the treatment of renal calculi in infants and young children.Methods Between December 2008 and October 2009,clinical data of 24 patients with renal calculi was retrospectively analyzed.The mean age of these patients at the time of MPCNL was 23 months (Ranged from 10 to 42 months).The male to female ratio was 3 to1.Among the patients,left-side renal calculi were found in 10 patients,right-side calculi in 8,and bilateral calculi in 6.The lengths of these stones ranged from 11 to 22 rain(mean length,14.2 mm).The renal calculi were imaged and confirmed by B-ultrasound examination and spiral CT scan.Results Twenty-Four patients with 30 renal calculi underwent MPCNL The operative time ranged from 25 to 90 minutes(mean time,40min).Blood loss during surgery ranged from 5 to 40 ml(mean,15 ml).Percutaneous accesses to the calculi were achieved on all patients.The renal stoma tubes were left in all patients and removed 3 to 5 days later after surgery.Double pigtail tubes were left in 60% patients and removed by cystoscope a month later. No blood transfusion was performed.No major complications such as hemorrhage,perforation and organic injury were noted.The postoperative hospital stays ranged from 4 to 10 days.All patients were followed up for 6 to 18 months.Their growths and developments were good.All calculi were removed in 22 patients.No calculi recurrence was noted.Hydronephrosis and hydroureterosis disappeared or alleviated.Residual calculi were found in two patients.The Stone free rate after MPCNL was 91.7%(22/24).Conclusions MPCNL was a safe and effective treatment for renal calculi in infants and young children.