腔内微创技术在三聚氰胺所致婴幼儿尿路结石治疗中的应用

The endoscopic therapy for the infant urinary calculus induced by melamine

目的：探讨腔内微创技术在三聚氰胺所致婴幼儿尿路结石治疗中的临床价值。方法：对33例三聚氰胺所致婴幼儿尿路结石施行腔内微创治疗。肾结石5例,肾结石合并输尿管上段结石2例,双肾结石合并单侧输尿管上段结石1例,肾结石合并膀胱结石1例;单侧输尿管结石18例,双侧输尿管结石2例,输尿管结石合并尿道结石1例;膀胱结石1例,尿道结石2例。结果：14例尿道结石、膀胱结石和输尿管中下段结石行输尿管镜取石术（URL）硬镜下治疗,2例输尿管上段结石、1例肾结石行输尿管软镜URL,14例肾结石、输尿管上段结石行微创经皮肾镜取石术（MPCNL）,2例尿路多发性结石行URL＋MPCNL,手术均获成功,均无大于0.3 cm碎石残留。术中、术后无严重不良反应发生。随访10~25个月,2例复发,成功再次行URL。其余31例结石无复发。结论：对有手术指征的三聚氰胺所致婴幼儿尿路结石,综合运用腔内微创技术治疗可行,安全、高效、痛苦少、恢复快,无需后续处理,可作为一线选择。

Objective：To explore the efficacy and safety of endoscopic therapy for urolithiasis caused by melamine in infants.Methods：The clinical data of 33 infants with urinary calculus caused by melamine who had undergone endoscopic therapy were retrospectively analyzed.Among them,5 were renal calculus,2 were renal calculus associated proximal ureteral calculus,1 case showed bilateral renal calculi associated with unilateral proximal ureteral calculus,1 was renal calculus associated vesical calculus,18 were unilateral ureteral calculi,2 cases were bilateral ureteral calculi,1 was ureteral calculus associated distal urethral calculus,1 was vesical calculus and 2 were urethral calculus.Results：Ureterorenolithotripsy（rigid URL） was performed on 14 patients with distal urinary tract calculus or middle and distal ureteral calculus,flexible ureterorenolithotripsy was performed on 2 cases with proximal ureteral calculus and 1 case with renal calculus,14 cases with renal calculus or proximal ureteral calculus underwent mini-invasive percutaneous nephrolithotomy（MPCNL）,while 2 cases underwent URL and MPCNL in synchronization.The operations were performed successfully in all patients.No major complications like hemorrhea,perforation and organic injury were noted.There were no fragments of stone larger than 0.3 cm in diameter left after operation by B ultrasound or KUB.All cases were followed up from 10 to 25 months.Recurrence of calculus was found in 2 cases and URLs were performed again successfully.Conclusion：Endoscopic therapy is a minimally invasive and effective treatment for urolithiasis caused by melamine in infants.It appears to be a first line choice for the treatment of melamine-associated urolithiasis.