输尿管镜下U100倍频双波长脉冲激光治疗婴幼儿尿路结石39例

Treatment of Urolithiasis in 39 Children with Age Less than 3 Years by Ureteroscopic U100 Laser Lithotriptor

目的探讨小儿输尿管镜U100激光治疗婴幼儿尿路结石的安全性、效果及并发症。方法小儿尿路结石39例(肾盂结石1例,输尿管结石22例,膀胱尿道结石16例),男性29例,女性10例,年龄5～36月龄,平均13月龄。结石最大直径6～30mm,膀胱结石直径10～30mm,输尿管结石直径6～15mm。B超、肾输尿管膀胱镜(KUB)及静脉尿路造影(IVU)或CT尿路造影(CTU)检查均无先天畸形。B超检查患侧肾积水20例。X线胸片检查肺部感染12例。尿路感染16例。全麻、电视监视系统下进行小儿输尿管镜U100激光碎石治疗,光纤芯径200μm,输出能量密度为120mJ/cm2,脉冲频率为10Hz。结果39例患儿均成功碎石并排出结石,输尿管单侧碎石时间平均为5min,尿道结石、膀胱结石平均碎石时间21min;无"石街"及残石等并发症,血尿一般持续1～2d;所有患儿均无输尿管损伤和穿孔。随访3～6个月,肾积水均得到减轻,无双J管上移或脱落等,无尿道狭窄和排尿异常等并发症发生,无结石复发。结论在明确掌握适应证和操作熟练的情况下,小儿输尿管镜U100激光碎石是治疗小儿尿路结石的理想方法。

Objective To evaluate the clinical efficacy and complications by ureteroscopic frequency-doubled-double pulse neodymium ∶YAG laser on the treatment of urolithiasis in children. Methods Ureteroscopic U100 laser lithotripsy was used in 39 children patients with stones （1 case with pelvic calculi, 22 cases with ureteral calculi and 16 cases with bladder calculi ）, there were 29 boys and 10 girls with a mean age of 13 months （5 to 36 months）. The diameters of the stone were from 6 mm to 30 mm （10-30 mm in the bladder and 6-15 mm in the ureter）.All children were examed by B-ultrasound, intravenous urography or computed tomography urography, there were 20 cases with hydronephrosis, 12 cases had pulmonary infection by X-ray and 16 cases had urinary tract infection.Ureteroscopic U100 laser lithotripsy was taken after the tracheal anesthesia,setting the fiber diameter of U100 laser to 200 μm, with the output energy 120 mJ/cm2 and pulse frequency 10 Hz.Results Stones were fragmented and discharged out of body in all 39 children in one treatment course,the average time of surgical operation was 5 min in one-side ureter calculi and 21 min for urethral and bladder calculi. There was no excessive intraperitoneal extravasation of urine case, no patients were converted to open surgery, and the hematuria was persisted 1-2 days after operation. In the 3-6 months follow-up, the urine test, renal function test and ultrasonography were went through, the hydronephrosis had been reduced, no double J tube removal or drop was found, no complications such as urethral stricture and abnormal urination happened and without stone recurrence. Conclusions The ureteroscopic U100 laser lithotriptor is an effective and ideal means in pediatric urolithiasis under the conditon of proper indications and perfect operation.