输尿管硬镜治疗小儿输尿管远端结石

目的：探讨输尿管镜处理小儿输尿管远端结石的可行性和疗效。方法：采用F6．5／8．5WOLF输尿管硬镜结合钬激光治疗13例8个月～14岁小儿输尿管远端结石。输尿管口径较粗者直接入镜或主动扩张后一期入镜并碎石；口径较小者采用先输尿管置管（被动扩张）1～4周后再二期手术入镜碎石。结果：6例一期手术成功入镜并碎石，7例行输尿管置管后二期手术入镜成功并碎石。术中无输尿管穿孔、黏膜撕裂等并发症发生。拔除内支架管后1周结石排净率为100％。所有病例术后随访6～24个月未见输尿管狭窄。结论：输尿管镜处理小儿输尿管远端结石安全可行，疗效好；可作为一线治疗方法。

Ureteroscopy for the Treatment of Distal Ureteral Calculi in Children

Objective： To explore the feasibility and effect of ureteroscopy for the treatment of in children. Methods： 13 patients（ range 8 months to 14years） of distal ureteral calculi were treated by ureteroscopy combined with Holmium：YAG laser. When the ureteral orifice is wide,a direct ureteroscopy or with active dilation of ureteral orifice （by balloon or serial uretral facial dilators） was done. And when the orifice is tight,a ureteral stent was placed for 1 to 4 weeks and then a second-stage ureteroscopy was performed. Results： Tile urcteroscopy procedure was successful in 6 patients （3 patients required active dilation, 1 with balloon and 2 with facial dilators） at initial stage and in 7 patients at second stage. No intraoperative complications such as Ureteral perforation and extravasation were identified and stone purge rate were 100%. At follow-up 6 to 24 months, no ureteral stricture was detected and no incidence of vesicoureteral reflux detected in 2 who underwent postoperative cystography. Conclusion： Ureteroscopy for the treatment of distal ureteral calculi in children is safe and feasible, and of good effect. When the ureteral orifice is ultraminiature, passive dilation of the ureter with a stent can make ureteroscope accessible.