小儿微创经皮肾输尿管镜取石术

Minimally invasive percutaneous nephrolithotomy in children

目的总结小儿微创经皮肾输尿管镜取石术的临床疗效和安全性.方法回顾性分析57例(59例次)应用微创经皮肾输尿管镜取石术治疗小儿上尿路结石的患儿资料.男34例,女23例;年龄4～16岁.手术指征包括直径大于2.0 cm或铸型肾结石36例次(其中手术后残留或复发的肾结石9例次),引起梗阻性肾扩张的肾或输尿管上段结石9例次,ESWL术失败的肾或输尿管上段结石7例次,合并远端梗阻的肾结石7例次.结果手术治疗59例次,其中41例次(69.5%)经一次PCNL结石被完全清除.因术中出血需输血4例次,明显尿外渗1例次.PCNL加ESWL或重复PCNL,结石完全清除率达86.4%.结论微创经皮肾输尿管镜取石术是一种治疗小儿肾和输尿管上段结石安全、有效的方法.

Objective To evaluate the efficacy and safety of minimally invasive percutaneous nephrolithotomy in children.Methods Between 1998 and 2004, minimally invasive percutaneous nephrolithotomy was performed in 57 children 4 to 16 years of age (median age 8). The series consisted of 23 girls and 34 boys. Indications for minimally invasive percutaneous nephrolithotomy of 59 renal units included renal stones larger than 2 cm in diameter or staghorn calculus in 36 cases(including residual or recurrent stones after operation in 9 cases, obstructed kidney in 9 cases, failed ESWL in 7 cases,renal calculus with distal obstruction in 7 cases.Results Of the 59 cases 41 ( 69.5%) were stone-free after a single session of percutaneous nephrolithotomy. There were 4 incidences of intraoperative bleeding requiring blood transfusion and one incidence of excessive intraperitoneal extravasation of urine. With subsequent ESWL or repeat mini-PCNL the stone clearance rate was 86.4%.Conclusions Mini-PCNL is an effective procedure for treating renal and upper ureteral stones in children.