输尿管镜下碎石术治疗儿童输尿管结石的疗效和安全性探讨

Ureteroscopic lithotripsy for treatment of ureteral calculi in children:efficacy and safety

目的:探讨输尿管镜下碎石术在儿童输尿管结石中的疗效和安全性。方法:2008年3月至2009年5月收住我院的输尿管结石患儿13例,男性6例,女性7例,年龄23个月至11岁;输尿管下段结石6例,中段4例,上段2例,肾盂输尿管连接部合并下段结石1例;结石直径0.6～2.0(1.1±0.47)cm。全麻或静脉麻醉下,截石位,使用WOLF Fr 7.5/6输尿管半硬镜,找到输尿管开口,插入斑马导丝,沿导丝用输尿管扩张管常规扩张输尿管下段至Fr 10～12,顺利进境后用钬激光(1.5 J,10Hz)或气压弹道粉碎结石至3 mm以下,留置Fr 4.7双J管及导尿管。术后4周拔除双J管。结果:13例患儿中有11例顺利碎石,平均碎石时间8 min,平均手术时间21 min,术中出血很少,无明显输尿管损伤穿孔、术后发热等情况,术后复查B超或摄片未见3 mm以上结石残留,单次碎石成功率84.6%。另有1例输尿管上段结石和1例合并肾盂输尿管连接部结石在肾盂内部分碎石,结合体外冲击波碎石后结石排净。结论:输尿管镜下碎石术处理儿童输尿管结石安全、高效,有望成为儿童输尿管结石的一线治疗方法之一。

Objective：To assess the efficacy and safety of the ureteroscopic lithotripsy in treatment of ureteral calculi in children.Methods： From March 2008 to May 2009,thirteen pediatric patients with ureteral stones were admitted to our department.There were six males and seven females,with an age range of 23 months to 11 years old.Six patients with stones located at the lower segments of the ureter,four at the middle segments,two at the upper segments,and one at pyelo-ureteral junction and lower ureter.The average diameter of the stones was（1.1±0.47） cm（range 0.6-2.0 cm）.The patients were placed in a lithotomy position;under general or venous anesthesia,ureteroscopy was performed using a semirigid ureteroscope（WOLF Fr 7.5/6）,and the ureteral orifice was dilated to 10-12 Fr.Then holmium laser（1.5 J,10 Hz） or pneumatic lithotripter was employed to fragment the stones（diameter of fragment less than 3 mm）.Fr4.7 double-J stent was placed after operation and was removed 4 weeks later.Results： Eleven of the 13 patient underwent successful lithotripsy,with the first time successful rate being 84.6%.The mean lithotripsy time was 8 min and the mean operation time was 21 min.There was slight bleeding during operation,but with no noticeable perforation of ureter or post operation fever,etc.Post-operation B ultrasound examination and X ray image revealed no residual stones with diameter 〉 3 mm in the 11 cases.Partial fragmentation was achieved in one patient with stone at upper ureter segment and one patient with stone at pyelo-ureteral junction and lower ureter,and the stones were excreted after extracorporreal shock wave lithotripy.Conclusion： Ureteroscopic lithotripsy is safe and effective in treatment of children with ureteral stones,which might become one of the first line treatment for children.