经皮肾穿刺碎石取石术治疗婴幼儿肾结石

Mini-percutaneous nephrolithotomy for Kidney stones in early children

目的探讨微创经皮肾穿刺碎石取石术（MPCNL）治疗婴幼儿肾结石的疗效与安全性。方法回顾性分析湖南省儿童医院2008年10月至2011年2月，应用经皮肾穿刺术钬激光治疗婴幼儿肾结石47例的临床资料。结果47例患儿50个肾脏行50次mini—PCNL治疗，其中一期碎石取石成功46个肾脏，二期碎石取石成功3个。肾脏，结石残留1例。单通道取石49个肾脏，双通道取石1个。肾脏。3例肾盂输尿管交界处狭窄（UPJO）患儿经钬激光内切开，8例息肉切除。术中通道迷失1例，经再穿刺成功。术后血红蛋白浓度平均下降2．5g／dL。2例肾功能异常者术后1—3d恢复正常。术后拔出DJ管后4周复查B超或X线平片，结石排尽率94％（47／50），术后3个月复查，除1例结石残余外，其余均排尽。手术肾脏未见缩小，IVU检查提示8例双肾显影正常。38例肾积水患儿中，30例肾积水消失，8例由中重度肾积水转为轻度肾积水。47例术后随访2个月至1年6个月，无其他并发症。结论在明确掌握适应证和操作熟练的情况下，经皮肾穿刺碎石取石术治疗婴幼儿肾结石安全、有效，是一种较为理想的方法。

Objective To study the effect and safety of mini-percutaneous nephrolithotomy（MPCNL） in early children. Methods We retrospectively analyzed the clinical data of 47 cases of infant kidney stones in our hospital underwent minimally invasive percutaneous nephrolithotomy holmium laser surgery from October 2008 to 2011 February. Results 47 cases （50 kidney-stones） underwent mini-PCNL surgery,including 46 cases of lithotripsy successful in one-stage operation,3 cases in secondary operation and 1 case had residual stones . Single-channel was used for49 stone kidney,and bi-channels in lease. 3 cases of pelviureteric junction obstruction （UPJO）were underwent internal urethrotomy by holmium laser,8 cases did polypeetomy. Among the operation, 1 ease was failed to erect oeeup aisle, and then punctured successfully, hemoglobin concentration average dropped 2.5 g/dl after operation. 2 cases of renal dysfunction were revert to normal afre operation 1 - 3 days. Postoperative reexamine of B-ultrasonic or radiographs after pull out the DJ tube 4 weeks after mPCNL, The stone-free rate of lithotripsy was 94% （47/50）. All stones were totally removed after operation 3 months. , except 1 ease has residual stones. Renal volume was not shrank after surgery. IVU examination of 8 cases showed renal function were noma1,30 cases of hydronephrosis were disappeared and for 8 eases the severe hydronephrosis were converted to mild hydronephrosis. 47 cases were followed-up for 2 months to 1 yeay and 6 months, there were not other complications. Conclusions The minimally invasive percutaneous lithotripsy treatment of infant kidney stones is safe and effective with the indications and operation in the case of skilled. MPCNL is an ideal way for infant kidney stones.