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.

Flexible ureteroscope holmium laser lithotripsy for the treatment of children with kidney stones and upper ureteral calculus

Objetive To explore the flexible ureteroscope holmium laser treatment of pediatric renal and upper ureteral ealculu. Methods A retrospective analysis of 47 cases （ 52 sides ） with flexible ureteroscope holmium laser technology treatment of upper urinary tract stones in children. Results In the 47 cases （52 side） , There are 35 cases by flexible ureteroscope, and the other 12 cases with hard and flexible ureteroscope. 2 sides were successed through placement sheath by once, 45 sides were succssed after expanding ureter with double J tube. 39 sides among the 45 were successful gravel by once, the other 3 sides were lithotripsied by sec- ond. It has 3 side can not find the stones ,2 sides were changed to MPCNL（ Microinvasive percutaneous nephro- lithotomy with Lithotomy）, 1 sides was observed. 2 sides were successful gravel with placing flexible uretero- scope into the pelvis by the guide of the Zebra guide silk. 2 sides change to MPCNL, 1 side was lost. So, there were 49 sides succssed. After one month, they reviewed by B ultrasound or CT showed： 46 sides calculus were all drained, Stone clearance rate was 88.5% , （46/52） , 3 cases were remained calculus of lower calyx, After 2 -4 weeks again do flexible ureteroscope lithotripsy, then reviewed after 1 month, the stones were all cleaned. The total stone clearance rate was 92.3% （49/52） after 2 months. And the average operative time were 45 min （25 - 115 min） ,the average time were 3 days of be in hospital after operation （2 -5 d） with less bleeding. 1 case has happened ureteral orifice split, no ureteral reflux and narrow. 3 case have occurred fever heat. The 43 cases don＇ t appear ureteral stricture after the operation with 2 - 24 months, and 1 case was recrudescence one year later. Conclusions The choice of fexible ureteroscope suitable and mastering the technique, then adop- tion flexible ureteroscope holmium laser lithotrispsy is a safe and effective method to treating children who were with renal and upper ureteral calculus.