小儿上尿路多发结石的微创手术处理

Preliminary experience with minimally invasive endourological management of multiple upper urinary tract calculi in children

目的探讨经皮肾镜、腹腔镜、输尿管镜等微创手术方法治疗小儿上尿路多发结石的效果。方法回顾分析2003年5月至2009年12月采用3种微创技术治疗12例小儿上尿路多发结石的临床资料。年龄中位数3.5岁（6个月到15岁）,结石最大径6~40mm（平均15mm）。结果 12个小儿经过15次手术成功取尽结石。I期手术：经皮肾镜5例,输尿管镜钬激光碎石4例,腹腔镜输尿管切开取石3例,I期结石清除率为75%,3例经二次手术取净结石,术中无并发症发生。住院时间中位数9d（3~21d）。手术前后血红蛋白、血肌酐差异无统计学意义（P〉0.05）。随访无血尿、尿路感染、输尿管狭窄等并发症发生。结论对已取得一定微创技术经验的医生,小儿多发上尿路结石微创手术可行、安全、有效。

Objective To report endoscopic management of multiple upper urinary tract calculi in children.Methods We reviewed retrospectively case notes and recorded videos from May 1993 to December 2009.A total of 12 children with a median age of 3.5 years（6 months to 15 years old）underwent 5 PCNL,4 ureteroscopy with laser lithotripsy,and 3 laparoscopy ureterolithotomy with ureteroscopy for multiple calculus of upper urinary tract.Stone size was 6~40 mm（mean,15 mm）.Results Overall stone-free rate after initial operation was 75%.There were no significant changes between the mean preoperative and postoperative hemoglobin and serum creatinine values respectively（P0.05）.Three patients with kidney and proximal ureteral stones required a secondary procedure to become stone-free.After a mean 2.5 years of followup,there were no significant bleeding,infection and all children were symp-tom-free.Conclusions Minimally invasive methods like ureteroscopy,laparoscopy and PCNL are effective and safe methods for treating upper urinary tract stones in children.