微创PCNL治疗小儿输尿管中上段结石80例

Safety and efficacy of mini percutaneous nephrolithotomy for the management of upper and middle ureter- al calculi in pediatric patients： a consecutive review of 80 cases

目的对彩色多普勒超声引导的mPCNL术治疗小儿输尿管中上段结石效能及安全性进行评估。方法回顾性分析2006年1月至2011年10月间80例彩色多普勒超声引导的小儿mPCNL术，年龄7～60个月，平均32．76个月，左侧34例，右侧32例，双侧14例，共94侧。记录通道建立时间、手术时间、穿刺部位、净石率、术前术后血红蛋白变化及并发症情况。结果手术均获成功，结石大小为11～18mm，平均（11．9±3．2）mm。71侧肾均一期成功建立通道并处理结石，23侧。肾二期取石，平均手术时间（36．4±7．5）min。净石率为100％。术后72．34％（68／94）的患儿出现血红蛋白和红细胞压积下降，血红蛋白平均下降6．72g／L，红细胞压积平均下降2．13％。术后23例（28．75％）出现持续性或反复发热，无严重并发症发生。结论彩超引导的mPCNL治疗小儿输尿管上段结石具有手术时间短，净石率高，并发症少等优点，是治疗小儿输尿管中上段结石的最佳选择。

Objective To evaluated the safety and efficacy of mini percutaneous nephrolithotomy （mPCNL） under the guidance of ultrasonography for the management of upper and middle ureteral cal- culi in children below 5 years of age. Methods From January 2006 to October 2011, 80 children un- derwent mPCNL under the guidance of ultrasonography to remove the upper and middle ureteral calcu- li. The mean age of the patients was 32. 76 months old （range, 7-60 months）. The clinical data inclu- ding time to establish renal access, operative time, puncture sites, stone-free rate and postoperative hemoglobin drop were retrospectively analyzed. Stone clearance Was confirmed on X-radiography, ul- trasonography or CT. Results The mean stone burden, defined as the largest diameter of the calculi, was 11.9 ＋ 3.2 mm （range, 11 - 18 mm）. mPCNL was successfully preformed on all patients. Of the 94 kidneys, 71 were performed mPCNL in one stage. The other 23 kidneys underwent percutaneous nephrotomy due to severe urinary infection, and were performed secondary mPCNL to remove calculi. The mean time to establish renal access was 9. 7 ＋ 4. 3 min. The mean operative time was 36. 4 ＋ 7. 5 min. Superior and middle caliceal puncture was employed to establish access to 65 and 29 kidneys retrospectively. No lower caliceal puncture was Used. All patients were stone free after mPNCL. He- moglobin and hematocrit drop was noted in 72. 34 ~ （68/94）cases. The mean drop of Hemoglobin was 6. 72 g/L, and mean hematocrit drop was 2.13 %. Twenty three（28. 75 ~//00）children were administered intravenous antibiotics for post-operative fever（〉38.5℃）. No transfusion, kidney loss, collateral in- jury, sepsis shock and death were noted in this study. Conclusions Ultrasonography guided PCNL is safe and effective in the management of upper and middle ureteral stones in children.