微创经皮肾镜取石术治疗婴幼儿上尿路结石

Mini-percutaneous nephrolithotomy for upper urinary tract calculi in early children

目的探讨微创经皮肾镜取石术（MPCNL）治疗婴幼儿上尿路结石的安全性和适应证。方法婴幼儿上尿路结石患儿56例。男34例，女22例。平均年龄24（7～36）个月。无症状筛查发现28例、肉眼血尿20例、尿路刺激症状6例、无尿2例。有药物排石治疗史49例（87．5％），有ESWI．治疗史8例。平均病史4．8个月，保守治疗时间平均4．5个月。56例均经B超、KUB、CT检查确诊。左侧20例、右侧25例、双侧11例，共67侧。结石最长径线平均19（10～32）mm。透X线结石44侧（65．7％），合并肾积水54侧（80．6％）。结果56例患儿应用实时彩色多普勒超声定位，一期成功建立12～16F微造瘘皮肾通道，并应用气压弹道、超声、激光碎石或套石篮取石。双侧结石患儿分期手术完成。通道建立时间（2．9±0．6）min，结石处理时间（13．9±3．2）min。术后71．6％（48／67）的患儿出现血红蛋白和血细胞比容下降，血红蛋白平均下降8．7g／L，血细胞比容平均下降2．6％。术后患儿出现持续性或反复发热3例（4．5％）。结石排净率92．5％（62／67）。无输血病例，未发生外科并发症。平均住院时间（15±4）d。结论婴幼儿上尿路结石MPCNL治疗安全有效。直径〉1．5cm、多发性及鹿角形肾结石以及引起明显梗阻的输尿管上段结石为婴幼儿MPCNL的手术适应证。

Objective To review the experience with mini-percutaneous nephrolithotomy （MPC- NL） in early children and discuss its safety and indications. Methods Between Dec 2005 and Apt 2009, 34 boys and 22 girls aged 7 months to 36 months underwent MPCNL for upper urinary tract calculi. Clinical data were analyzed retrospectively. Results The mini-percutaneous renal access of 12-16 F was successfully established in 56 patients under realtime colour ultrasound guidance and immediate lithotripsy was performed. Average accessing time was 2.9!0.6 rain, and stone management time was 13.9±3.2 min. No severe complication occurred. Stone free rate was 92.5%. Conclusions MPCNL was highly effective to treat stone disease in this population. The indications for MPCNL in early children include large upper tract stone burden （ greater than 1.5 cm ）, multiple renal calculi, staghorn calculi, stones with high-grade obstruction, and those could not be cleared by EWSL or other treatment conservatively.