微创经皮肾镜取石术治疗小儿上尿路结石(附149例报告)

The mini-percutaneous nephrolithotomy for the treatment of upper urinary tract calculi in children (Report of 149 cases)

目的:评价微创经皮肾镜取石术(MPCNL)治疗小儿上尿路结石的临床价值.方法:收治上尿路结石患儿149例,男85例,女64例,年龄1~16岁,平均8.7岁.左侧80例,右侧58例,双侧11例.结石大小平均1.3 cm×0.9 cm.均行MPCNL治疗;合并输尿管下段结石及膀胱结石者,术中均先予输尿管镜取石术及经皮膀胱穿刺取石术处理.术中结石寻找困难者联合软性输尿管镜治疗.结果:149例160侧手术均成功.无Ⅲb级以上并发症发生.单侧手术时间20~65 min,平均50 min.一期结石清除率为87.9% (131/149),二期结石清除率为93.9% (140/149),总清除率为95.3% (142/149).本组11例行双侧同期MPCNL;13例行'无管化'MPCNL,其中1例行'完全无管化'MPCNL.术后住院3~15 d,平均7.2 d.结论:运用MPCNL治疗小儿上尿路结石安全、可行,具有高效、损伤小、痛苦少、恢复快等优点.符合条件者可不留置肾造瘘管,恢复更快.配合软性输尿管镜技术可提高结石清除率.

Objective:To evaluate the clinical value of mini-percutaneous nephrolithotomy(MPCNL)for the treatment of upper urinary tract calculi in children.Methods:A total of 149cases with upper urinary tract calculi were treated by MPCNL.The mean age was 8.7yearsold(ranging from 1to 16).The calculi were found on left side in 80cases,right side in 58,and both side in 11.The smallest size of the calculus was 0.6cm×0.6cm,the largest was 2.6cm ×1.8cm(mean 1.3cm×0.9cm).The children with lower ureteral stones and with bladder stones underwent ureteroscopic lithotomy(URL)and minimally invasive percutaneous cystolithotripsy(PCCL).Some stones which were not detected by rigid ureteroscopy were treated by flexible ureteroscopy.Results:All the procedures were successful.The mean operative time for unilateral MPCNL was 50(range 20to 65)mins.Stones were cleared using one MPCNL session in 131(87.9%),two sessions in 9(6.04%).One hundred and fourty two of 149children(95.3%)were cleared of their stones in all.Simultaneous bilateral MPCNLs were performed in 11children.Thirteen children underwent tubeless-MPCNL.One child underwent totally tubeless-MPCNL.The mean length of hospital stay was 7.2(range 3to 15)days.Conclusions:MPCNL appears to be a safe,minimally invasive,and quick recovery procedure for upper urinary tract calculi in children.In some selective patients tubeless-MPCNL could be performed. Flexible ureteroscopy could improve the stone clearance rate of MPCNL.