经皮肾穿刺微造瘘碎石取石术治疗小儿上尿路结石

Minimally invasive percutaneous nephrolithotomy for treatment of upper urinary calculi in children

目的:探讨微造瘘经皮肾镜气压弹道联合超声碎石取石术治疗小儿上尿路结石的安全性及有效性。方法:回顾性分析自2008年2月～2011年5月12例应用微造瘘经皮肾镜气压弹道联合超声碎石取石术治疗小儿上尿路结石的临床资料。12例患儿均在输尿管镜下逆行向患侧输尿管放置F3～F5号输尿管导管,B超引导下穿刺并扩张建立F16皮肾通道,在F8.0/9.8输尿管镜下采用瑞士EMS第四代超声气压弹道碎石机,争取一期粉碎结石并主动吸出体外。结果:12例患儿均I期建立F16皮肾通道,I期手术净石率10例(83.3%),2例结石残留,经ESWL及口服排石溶石药物治疗后排出。手术时间30～116min,平均53min,无输血病例,无出现气胸、腹腔脏器损伤等严重并发症。术后随访3个月～2年,患肾功能较术前改善,肾积水减轻或缓解,无结石复发,无输尿管狭窄、肾积水加重、肾功能不全等并发症。结论:微造瘘经皮肾镜碎石取石术治疗小儿上尿路结石具有创伤小、恢复快、取石效率高等优点,是治疗小儿肾结石、输尿管上段结石一种安全有效手术方法。

Objective：To evaluate the clinical effect and safety of minimally invasive percutaneous nephrolithot omy（mPCNL） for the treatment of upper urinary calculi in children. Method：We retrospectively reviewed the clini cal records of 12 cases of children who underwent percutaneous nephrolithotomy procedures from February 2008 to May 2011. All patients received retrogradeplacement of F3-F5 ureteral catheter under the ureteroscope, with the help of B type uhrasonography,a F16 percutaneous working channel for ureteroscope was established. Renal stones were tried to fragment and extract one stage under a F8.0/9.8 ureteroscope by using the fourth generation Swiss Litho Clast Master. Result： A F16 percutaneous renal access was successfully established in all patients. The stones were cleared out completely in 10 out of 12 cases, a 83.3 % stone-free rate was achieved using percutaneous neph- rolithotomy monotherapy. Other 2 cases had a residual stones, they underwent extracorporeal shock-wave lithotripsy（ESWL） and lithagogue medicine. The operation duration was 30-116 minutes, averaged 53 minutes. No complica tions such as blood transfusion, pneumothorax or injury of intra-abdominal organs were recorded. All patients Were followed up for at least 3-24 months. Renal function test got a better result. Uronephrosis relieved. No complica- tions such as palindromia of lithiasis, ureterostenosis, hydronephrosis or renal inadequacy were recorded. Conclu- sion：Treatment of children＇s upper urinary tract stone by mPCNL has the advantages of high efficiency, reliability, safety,mini- invasion,less haemorrhage and rapid recovery. It should be the first choice for children＇s upper urina- ry tract stone at present.