PCNL治疗儿童与成人上尿路结石对比研究

Children versus adults undergoing percutaneous nephrolithotomy: aprospective comparative study

目的:对比研究儿童及成人肾结石采用经皮肾镜取石术(PCNL)治疗的手术风险及疗效.方法:回顾性分析比较2000～2012年经PCNL治疗的331例儿童及7 089例(8 537侧)成人的临床资料.结果:儿童相比成人结石较小(2.3 cm∶3.1 cm),但结石数量和肾内的位置分布相似.儿童所需的经皮通道数量较少、通道大小较小、手术时间较短及血红蛋白(Hb)下降较少.经单次PCNL后儿童结石清除率为80.4％,成人为78.6％ (P＜0.05),经辅助手术治疗后,两组总结石清除率无明显差异(94.7％∶93.5％,P＞0.05),而总并发症(15.6％∶16.3％)及总输血率(3.1％∶2.9％)均差异无统计学意义(P＞0.05).相比成人,多通道的PCNL的儿童输血率更高(18.8％∶4.5％,P =0.007).结论:PCNL治疗儿童和成人肾结石一样安全有效.儿童采用多通道时仍需谨慎出血的风险.

Objective:As almost any version of percutaneous nephrolithotomy(PCNL)has been proven to be safe and efficacious in treating both pediatric and adult patients without age being a limiting risk factor,the aim of the study was to compare the differences of the operation parameters,the safety and efficacy of PCNL between children and adults.Methods:The data of 331renal units in children and 8537renal units in adults that had undergone MPCNL for upper urinary tract stones between the years of 2000-2012were compared and reviewed.Results:The children had a smaller stone size but a similar stone type(number and locations)compared to adults.Usage of multiple tracts,sheath size,mean operative time and hemoglobin drop was significantly lower or shorter in children(P<0.05 for all).Stone clearance after a single session of MPCNL was 80.4%in the children and 78.6%in adults(P= 0.001),which increased to 94.7%and 93.5%after auxiliary procedures(P=0.44).Overall complications(15.6% vs.16.3%),and blood transfusion rate(3.1%∶2.9%)were similar in both groups(P>0.05for all).Both groups had low rate of high grade Clavien complications.There was no gradeⅢ,Ⅳ,Ⅴ complications in pediatric group. For patients requiring multiple tracts,the blood transfusion was significant increase in children than adults(P= 0.007).Conclusions:This contemporary largest-scale analysis confirms that the stone-free rate in pediatric patients is at least as good as in adults without an increase of complication rates.However,multiple percutaneous nephrostomy tracts should be practiced with caution in children.