无管化组合式输尿管软镜超微经皮肾通道治疗小儿输尿管上段结石的疗效观察

Tubeless of modular flexible ureteroscope combined with ultramini nephrostomy tract for the treatment of upper ureteral calculi in paediatric patients

目的 观察组合式输尿管软镜超微通道碎石术治疗小儿输尿管上段结石的效果及安全性。方法 20例学龄前输尿管上段结石患儿（年龄≤7岁）,于该院住院行组合式输尿管软镜超微皮肾通道碎石术,其中位于左侧12例,右侧8例。平均患儿年龄在4岁（2~7岁）,结石平均直径为1.0 cm（0.7~1.5 cm）,多发9例（其中3例为双侧多发,6例为单侧多发）,单发结石11例。超声引导下行经皮肾穿刺建立超微通道（F11）,应用组合式输尿管软镜及钬激光碎石系统进行碎石。结果 采用超微通道输尿管软镜碎石Ⅰ期结石清除率达91%（21/23）,另2侧结石Ⅰ期碎石后残余结石再次手术处理,分期手术后结石清除率为100%（23/23）。术后血红蛋白下降率无明显变化。无需输血患儿,手术前后肌酐、尿素氮及C反应蛋白变化均无差异,术后不放置DJ管及肾造瘘管（无管化）。术后平均住院时间2 d,随访6个月~1年,所有患儿均无远期并发症。结论 无管化组合式输尿管软镜超微通道治疗婴幼儿输尿管上段结石安全、有效,住院时间短。

Objective To evaluate the efficacy and safety of tubeless of modular flexible ureteroscope combined with uhramini nepbrostomy tract for the treatment of upper ureteral calculi in paediatric patients. Methods 20 cases of children with upper ureteral calculi （age ~〈 7 years old）, in our hospital underline of modular flexible ureteroscope combined with ultramini nephrostomy tract lithotripsy, the stones located on the left side in 12 cases, 8 cases on the right. The average age of children in the 4 years （2 to 7 years）, the average diameter of stones 1.0 cm （0.7 - 1.5 cm）, multiple 9 （including 3 cases of multiple bilateral, 6 cases of unilateral multiple） single stones 11 cases. Ultrasound- guided percutaneous nephrolithotomy establish supermiero channel （F11）, application modular and flexible uretero- scope holmium laser lithotripsy systems. Results Tubeless of modular flexible ureteroscope combined with ultramini nephrostomy tract calculi Clear Phase 91% （21/23）, 2 cases of bilateral stones with phased surgical treatment, surgi- cal staging stone clearance rate was 100 % （23/23）. Postoperative hemoglobin decline was no significant change. Children do not need a blood transfusion, creatinine, blood urea nitrogen and CRP were no significant differences in change, not placed before and after surgery and renal fistula DJ tube （no tube-based）. The mean postoperative hospital stay was two days, followed up for 6 months to 1 year, all patients had no long-term complications. Conclusion Tubeless of modular flexible ureteroscope combined with uhramini nephrostomy tract for the treatment of Upper ureteral calculi in paediatric patients is an effective and safety method, can shorten hospital stay.