小儿下尿路结石的诊治分析

目的　探讨小儿下尿路结石不同影像学检查的价值及其对治疗结果的影响。方法　回顾性分析2014年1月至2017年8月在伽师县人民医院和喀什地区第一人民医院就诊的105例下尿路结石患儿的临床资料。105例患儿按照是否做非增强螺旋计算机断层扫描（NCCT）进行分组，A组行超声（US）+尿路平片（KUB）检查，B组行US + KUB + NCCT检查，两组患儿均行经尿道膀胱结石碎石术。A组50例，均为男性患儿，年龄（2.09±1.37）岁；B组55例，其中男54例、女1例，年龄（2.61±1.56）岁。比较两组患儿的结石检出率和围术期指标。统计学方法采用独立样本t检验和χ²检验。结果　105例患儿均确诊为下尿路结石；100例患儿做US检查，检出率为98.00%（98/100）；99例做KUB检查，检出率为74.75%（74/99）；55例做NCCT检查，检出率为98.18%（54/55）。其中A组患儿US+KUB合并检出率为100.00%（50/50）；B组患儿US+KUB+NCCT合并检出率为100.00%（55/55）。NCCT检查发现了1例US + KUB均未发现的尿道结石，1例发现左肾结石（均未改变手术方案）。手术均成功，术后均无严重并发症。两组患儿的术后留置尿管时间（P=0.363）、住院时间（P=0.077）及并发症发生率（P=0.627）比较差异均无统计学意义。B组手术时间比A组短［（19.63±11.82）min比（28.20±13.49）min］，两组比较差异有统计学意义（t=3.469，P<0.001）。结论　临床疑为小儿下尿路结石时，均应以US和/或KUB作为初查方法，足够诊断和制定治疗方案，还可以避免CT检查带来的辐射和经济压力。此方案值得在我国新疆南部的喀什等贫困地区进一步推广和使用。

Diagnosis and treatment of pediatric lower urinary tract stones

Objective　To evaluate the values of different imaging examinations for pediatric lower urinary stones and their effects on treatment outcomes. Methods　The clinical data of 105 children with lower urinary tract stones in The People's Hospital of Jiashi County and The First People's Hospital of Kashgar Prefecture from January 2014 to August 2017 were analyzed retrospectively. The 105 children were divided into two groups according to whether they underwent non-contrast computed tomography (NCCT) or not. Group A underwent ultrasound (US) + plain film of kidney-ureter-bladder (KUB), group B underwent US + KUB + NCCT, and transurethral lithotripsy of bladder stones was performed in both groups. Group A included 50 cases, all males, aged (2.09±1.37) years; there were 55 children in group B, including 54 males and 1 female, aged (2.61±1.56) years. The detection rates of stones and perioperative indexes of the two groups were compared. Independent sample t test and χ² test were used. Results　All the 105 children were diagnosed with lower urinary stones; 100 children underwent US, with a detection rate of 98.00% (98/100); 99 children underwent KUB examination, with a detection rate of 74.75% (74/99); 55 children underwent NCCT, with a detection rate of 98.18% (54/55). The combined detection rate of US + KUB in group A was 100.00% (50/50), and the combined detection rate of US + KUB + NCCT in group B was 100.00% (55/55). NCCT detected 1 case of urethral calculi not detected by US + KUB, and 1 case of left renal calculi (the surgical scheme was not changed). All operations were successful and there were no serious complications in both groups. There were no statistically significant differences in the postoperative indwelling catheter time (P=0.363), length of hospital stay (P=0.077), and incidence of complications (P=0.627) between the two groups. The operation time of group B was shorter than that of group A (19.63±11.82) min vs. (28.20±13.49) min], with a statistically significant difference between the two groups (t=3.469, P<0.001). Conclusions　When suspected to be pediatric lower urinary tract stones, US and/or KUB should be used as the initial examination method, which is sufficient for diagnosis and treatment and can also avoid the radiation and economic stress of CT examination. This program is worthy of further promotion and application in the poor areas such as Kashgar in southern Xinjiang of China.