输尿管镜术治疗学龄前儿童输尿管中下段结石

Ureteroscopy treatment of mid and distal ureteric calculi in preschool children

目的评价输尿管镜取石术治疗学龄前儿童输尿管中下段结石的疗效与安全性。方法2001年2月～2006年4月,13例学龄前儿童输尿管中下段结石患儿接受不同方式输尿管镜术治疗,回顾性分析其临床资料。结果13例患儿中,1例输尿管末端结石患儿逆行人镜及置入导丝失败改开放手术,2例行Ⅰ期6.5/8.5 Fr输尿管半硬镜下钬激光碎石,2例行Ⅰ期硬性扩张后8/9.8 Fr输尿管硬镜取石,1例行Ⅰ期气囊扩张后8/9.8 Fr输尿管硬镜下取石,7例Ⅰ期输尿管置管被动扩张1～3周后,Ⅱ期8/9.8 Fr输尿管硬镜下取石。12例患儿共接受19次输尿管镜术,结石全部取出,无输尿管穿孔等严重并发症。随访3～12个月,4例(1例Ⅰ期硬性扩张,3例置管被动扩张)患儿接受排尿性膀胱造影未见膀胱输尿管反流,5例(2例Ⅰ期6.5/8.5 Fr输尿管半硬镜下钬激光碎石术,3例Ⅰ期置管被动扩张)行静脉肾盂造影未见输尿管开口狭窄及肾积水。结论输尿管镜术治疗学龄前儿童输尿管中下段结石直接明了,安全有效,作为ESWL的有益补充。

Objective To evaluate the feasibility of ureteroscopy treatment mid and distal ureteric calculi of preschool children. Methods From February 2001 to April 2006,13 preschool children with a mid or distal ureteric calculi were treated by ureteroscopy. The clinical data was reviewed. Resuits Of 13 cases, 1 case with a distal ureteric calculi underwent open surgery because of failure of ureteroscopy insertion of a 0. 035 inch guide-wire, 2 cases had a successful ureteroscopy in the first session with 6. 5Fr semirigid ureteroscope and Ho.. YAG laser lithotripsy, 2 patients had a successful ureteroscopy with a 8/9. 8Fr rigid ureteroscope after a dilation of the ureteric orifice by rigid dilators, 1 case had a successful ureteroscopy with a 8/9. 8Fr rigid ureteroscope after a dilation of the ureteric orifice with balloon dilator, the remaining 7 cases received passive dilation by indwelling of ureteric stents for 1 to 3 weeks and underwent successful ureteroscopy with a 8/9. 8Fr rigid ureteroscope. 12 cases received 19 ureteroscopic procedures in all, and all the cases were rendered stone free without any severe complication. In a follow up of 3 to 12 months, 4 children had a voiding cystourethrography and no cases had a vesicoureteral reflux and 5 cases had a intravenous pyelography and no ureteric stricture was founded. Conclusions Our study shows that ureteroscopic treatment of mid and distal ureteric calculi was feasible in preschool children.