微创经皮肾穿刺取石治疗儿童复杂肾结石

Minimally invusive percutaneous nephrolithotomy for complex renal calculi in children

目的探讨微创经皮肾穿刺取石治疗儿童复杂肾结石的疗效和安全性。方法回顾性分析我院收治儿童复杂肾结石33例，男21例，女12例，年龄5～14岁，平均8．5岁。结石位于右侧16例，左侧13例，双侧4例。结石单发11例，多发19例，铸形结石3例，结石大小2．1cm×3．2cm～3．7cm×6．7cm。均采用B超定位经皮。埒气压道碎石系统治疗，并观察结石清除情况。结果本组33例均经一次穿刺即成功建立通道，其中4例行两通道碎石，4例同时行双侧碎石。31例I期行经皮肾微创造瘘术（MPCNI。），2例Ⅱ期。手术时间80～130min，平均92min，术中出血30～80ml，平均（61．5±12．3）ml，均无输血。1例有较大结石残留辅以体外震波碎石治疗。I期结石清除率90．9％（30／33），II期碎石后总清除率为96．9％（32／33）。无气胸、腹腔脏器损伤、大出血等严重并发症。术后发热4例。术后24h血红蛋白及血肌酐值与术前相比差异无统计学意义。术后住院时间4～8d，平均5．4d。术后随访3～18个月，平均9个月，结石无复发。结论微创经皮肾取石治疗儿童复杂肾结石安全可行，疗效确切，具有创伤小、恢复快等优点，可成为本病首选治疗。

Objective To retrospectively analyze the safety and efficacy of minimally invasive pereutaneous nephrolithotomy （MPCNL） for complex pediatric renal calculi. Methods Thirty-three patients including 21 boys and 11 girls, who underwent MPNCL for complex renal stones, were recruited in this study. Their ages ranged from 5 to 14 years （mean： 8. 5 ± 2. 3 years）. Of the 33 patients, 16 had calculi in right kidneys and 13 in left kidneys, and 4 had bilateral renal calculi. Eleven patients had single calculus, 19 had multiple calculi, and 3 had staghorn stones. The stones＂ size ranged from 2. 1 cm × 3. 2 cm to 3. 7 cm× 6. 7 cm. The calculi were positioned by uhrasonography and treated with MPCNL. Operating time, stone free rate and complications were recorded and analyzed retrospectively. Results The pelvicaliceal system was successfully approached on all patients. Of the 33 patients, 29 required a single tract, the other 4 required multiple tracts. Four eases underwent simultaneous bilateral MPCNL. Thirty one patients underwent lithotripsy in one stage, and the other 2 patients underwent lithotripsy in 2 stages. The operative time ranged from 80 to 130 rain with an average of 92 min. The mean operative blood loss was 61.5 ± 12. 3 ml （range, 30-80 ml）. No blood transfusion was performed. No severe complications were noted after MPNLC. The overall stone-free rate was 96. 90/40 （32/33）. Rosidual stone fragments were found in 1 patient who underwent adjuvant extracorporeal shock wave lithotripsy. The postoperative hemoglobin and creatine stayed at the same level with the preoperative measurements. Average hospital stay was S. 4 days （range, 4-8 days）. Mean follow-up period was 9 months （range, 3-18 months）. No calculi recurrence was noted. Conclusions MPNCL is a safe and effective management for complex pediatric renal calculi. It deserves the first choice for complex pediatric renal calculi.