经皮肾输尿管镜下气压弹道碎石术治疗儿童肾结石

Using of percutaneous nephrolithotomy in pediatric urolithiasis

目的探讨经皮肾输尿管镜下气压弹道碎石术治疗儿童肾结石的疗效与安全性。方法肾结石患儿15例，均为14岁以下，其中单侧8例，双侧7例，共22个肾脏。全部病例使用全身麻醉下经皮肾输尿管镜下气压弹道碎石术治疗。术后行X线摄片观察疗效，术后48h查血红蛋白。所有病例均行代谢评估，术后使用枸橼酸钾预防结石复发。术后随访2～3年。结果20个肾脏（91％）的结石完全清除。2个有残石的肾脏经体外冲击波碎石术治疗，结石完全清除。14例患儿术后有轻、中度发热（〈39℃，〈2d），1例术后高热（〉39℃，〉2d）。患儿术后血红蛋白较术前平均下降10．0g／L。无输血病例。平均住院5．2d。全部病例术后半年行静脉肾盂造影检查，肾功能均平稳或有改善。无远期并发症。结论对儿童肾结石行经皮肾输尿管镜下气压弹道碎石术安全、有效。

Objective To assess the safety and efficacy of percutaneous nephrolithotomy （PCNL） using ureteroscope and pneumatic intracorporeal lithotripsy in the pediatric age group. Methods Twenty-two renal units in 15 patients underwent PCNL at our institute. The patients were all under 14 years old. The average age was 9 years（ range 5-14 years）. There were 7 bilateral, 8 multiple, and 5 staghorn calculi. The average calculus size was 2. 0 （ 0. 9-4. 5 ） era. The PCNL was done with an X ray-guided peripheral puncture, a planned staged approach in some cases, and minimal tract dilatation with the use of an ureteroscope and pneumatic intracorporeal lithotripsy. Results Complete stone clearance was achieved in 20 renal units, giving an overall clearance rate of 91%. Minor pyrexia（ 〈 39℃, 〈 2 days）was seen in 14 patients, whereas serious pyrexia was seen in 1. The average fall in hemoglobin was 10 g/L, but none of the patients required blood transfusion. Conclusions It is safe and effective to cure pediatric urolithiasis with percutaneous nephrolithotomy using ureteroscope and pneumatic intracorporeal and pneumatic intracorporeal lithotripsy.