微创经皮肾镜取石术治疗4岁以下小儿上尿路结石的疗效和安全性评价

Evaluation on the efficacy and safety of minimally invasive percutaneous nephrolithotomy for upper urinary tract calculus in children under 4 years old

目的 探讨微创经皮肾镜取石术（MPCNL）治疗4岁以下小儿上尿路结石的疗效和安全性.方法 回顾性分析2010年1 1月至2012年10月103例MPCNL术治疗的4岁以下上尿路结石患儿的临床资料.男87例,女16例.年龄5～48个月,平均26个月.患儿皆为维吾尔族.右肾结石41例、左肾结石32例、双肾结石8例,其中多发性结石23例、鹿角形结石7例;右侧输尿管上段结石10例、左侧输尿管上段结石6例;同时伴有肾、输尿管结石6例.结石长径0.7～ 2.4 cm,平均1.5 cm.合并无尿6例,脓肾3例.复查CT或B超,结石残留小于4 mm 为结石取净.结果 103例MPCNL均获成功.手术时间30～ 65 min,平均47 min.其中一期取石90例,二期取石13例,一期清石率为87.4％.术后发热1 8例,经加强抗炎、对症处理后恢复正常.延迟出血1例,经平卧休息后白愈.未出现周围脏器损伤、肠道损伤、感染性休克和肾切除等严重并发症.67例术后随访18～36个月,平均26个月.结石复发8例（11.9％）.B超随访未见肾萎缩和肾结构破坏,12例患儿伴有轻度肾积水和输尿管扩张.结论 MPCNL治疗4岁以下小儿上尿路结石具有创伤小、安全、有效的特点,值得在有相关设备和技术条件的单位推广.

Objective To evaluate the efficacy and safety of minimally invasive percutaneous nephrolithotomy （MPCNL） for upper urinary tract calculus in children under 4 years old.Methods The clinical data of 103 Uighur children under 4 years old （87 males and 16 females） with upper urinary tract calculus treated with MPCNL in our hospital from November 2011 to October 2012were analyzed retrospectively （range from 5 to 48 months,average in 26 months）.There were 41 cases in the right,32 cases in the left and 8 cases bilateral,among which 23 cases were multiple renal calculus and 7 cases were staghorn calculus.There were 10 cases in the right uteter and 6 cases in the left ureter,and 6 cases were with renal and urethral calculi.The diameter of calculi ranged from 0.7 to 2.4 cm with an average of 1.5 cm.There were 6 cases with anuria and 3 cases with pyonephrosis.Results All 103 MPCNL surgical procedures were successful,with the duration ranged from 30 to 65 min with an average of 47 min.Ninety patients received onestage MPCNL with a stone clear rate of 87.4％,while the rest 13 cases received two-stage MPCNL.Eighteen patients had postoperative fever and recovered after anti-inflammatory and symptomatic treatments.Postponed hemorrhage occurred in one case,and cured spontaneously after bed rest.No severe complications happened.The 67 patients were followed up from 18 to 36 nonths with an average of 26 months,and the stone recurrence was 11.9％ （8/67）.No renal atrophy or renal destruction were observed by B ultrasound,while 12 patients had mild hydronephrosis and ureterectasis.Conclusion MPCNL for upper urinary tract calculus in children under 4 years old is a minimal invasive,safe and effective technique,worthy of promotion.