小儿无管化经皮肾镜取石术的安全性和效果分析

Safety and efficacy of tubeless percutaneous nephrolithotomy in children

目的探讨小儿无管化经皮肾镜取石术（tubelessPCNL）的安全性和有效性。方法回顾性分析6例应用留置输尿管外支架的tubelessPCNL治疗肾或输尿管上段结石的患儿资料。男4例，女2例。年龄2～12岁，平均6．5岁。其中肾盂结石3例，输尿管上段结石2例，肾多发性结石1例。结石平均大小为（2．5±2．1）cm2。合并患肾中度积液4例，轻度积液2例。6例在经皮肾镜取石术结束时，通过B超和C臂X线证实结石已经完全清除，然后把逆行插入的输尿管导管的头端调整至肾盂的中央，让扩张鞘退至肾造瘘通道以外，证实瘘道无活动性出血，最后拔除扩张鞘，并用丝线缝合皮肤伤口。结果6例患儿通过单一通道完全清除结石，其中4例经肾上盏入路，2例经肾中盏入路。手术时间30~75min，平均35min。手术引起血红蛋白下降3～10g／L，平均6．5g／L。术后住院2d。无出现严重出血、尿外渗、发热和邻近器官损伤等并发症。结论在严格掌握手术适应证的前提下，在小儿施行留置输尿管外支架的tubelessPCNL是安全和有效的。

Objective To evaluate the safety and efficacy of tubeless percutaneous nephrolithot- omy （tubeless PCNL） in children. Methods From May 2010 to December 2011,6 patients including 4 males and 2 females, with a mean age of 6. 5 years old, were performed tubeless PCNL to remove re- nal or proximal ureteral calculi. Among the patients, 3 were diagnosed with renal pelvic calculi, 2 with upper ureteral calculi, and 1 with multiple renal calculi. Four patients had moderate hydronephrosis, and the other 2 had mild hydronephrosis. During PCNL, the calculi was cleared under the monitoring of C-arm fluoroscopy and B-ultrasound. Then the head end of the urethral catheter was adjusted to the center of renal pelvis. The peel-away sheath was removed when hemostat was confirmed. Results The calculi were cleared through a single tract in all cases. Of the 6 cases, upper pole access was applied on 4, and middle pole access on the other 2. The average operation time was 35 rain （range, 30 - 75 min）. The mean hemoglobin reduction after surgery was 6. 5 g/L （range, 3-10 g/L）. The postopera- tive hospital stay was 2 days. Significant complications including bleeding, collecting system perforation, and collateral injury to neighboring organ did not occur. Conclusions Tubeless percutaneous nephrolithotomy is safe and effective for the treatment of nephrolith in children.