经皮肾镜气压弹道联合超声碎石术治疗儿童肾结石

Percutaneous nephrolithotripsy with pneumatic and ultrasonic power for treatment of pediatric renal calcull

目的探讨经皮肾镜气压弹道联合超声碎石术治疗儿童肾结石的安全性和疗效。方法肾结石患儿44例。男28例，女16例。年龄7～14岁，平均11岁。单侧肾结石39例，双侧肾结石5例。右侧26例、左侧23例，共49侧。44例患儿中有代谢异常者19例（43．2％）、尿路解剖异常15例（34．1％）、尿路感染14例（31．8％）。输尿管镜下患侧输尿管逆行留置4～6F输尿管导管，生理盐水充盈肾盂，B超引导下穿刺目标肾盏建立经皮肾通道，气压弹道联合超声碎石。术后x线摄片和B超检查结石排出情况。结果44例均一期成功建立皮肾通道。一次取净结石36侧（73．5％），经2次取净结石9侧，结石清除率91．8％（45／49）。经2次取石仍有结石残留者经体外冲击波碎石治疗清除结石2例2侧，因出血较多改开放手术取石2侧。手术时间52～132min，平均79min。2例术中分别输血400和800ml。无气胸、腹腔脏器损伤等严重并发症发生。37例随访3～18个月，患儿肾功能平稳或较术前改善，肾积水均未加重，未发生远期并发症。结论经皮肾镜气压弹道联合超声碎石术处理小儿肾结石创伤小、安全高效。

Objective To assess the safety and efficacy of percutaneous nephrolithotripsy with pneumatic and ultrasonic power in pediatric renal calculi. Methods The clinical data of 44 patients treated with combination of pneumatic and ultrasonic power during percutaneous nephrolithotripsy were retrospectively analyzed. The 44 patients had 49 renal calculi. The patients were all under 14 years old. The average age was 11 years （range 7--14 years）. There were 39 unilateral and 5 bilateral calculi. Among the 44 patients, metabolic disturbance occurred in 19 cases （43.2%）, anatomical dys- function occurred in 15 cases （34.1%）, urinary tract infection occurred in 14 cases （31.8%）. Antegrade percutaneous access was established under ultrasound guidance, a combination of pneumatic and ultrasonic lithotripsy were used. The effect was evaluated by postoperative KUB and ultrasonic. Resuits The access was successfully established in all patients. Complete stone clearance was achieved in 36 kidneys in phase I , stones from 9 kidneys were completely removed with second lithotripsy. Leftover stone in 2 kidneys were treated by ESWL. Open surgery was performed in 2 kidneys due to excessive bleeding. The operative time ranged from 52--132 rain, average time was 79 min. Two pa- tients needed blood transfusion. No severe complications occurred in all patients. Thirty-seven patients were followed up for 3-- 18 months. The renal function was not worsened and hydronephrosis was not aggravated in these patients. Conclusion The percutaneous nephrolithotripsy with pneu-matic and ultrasonic power is a safe, effective treatment for pediatric renal calculi.