B超引导下微创经皮肾镜取石术治疗儿童肾结石

Treatment of pediatric renal calculi with minimally invasive percutaneous nephrolithotomy under ultrasound guidance

目的：总结微创经皮肾镜取石术治疗儿童肾结石的技巧和经验,并评价其安全性和应用价值。方法：2007年8月至2013年5月,共有25例儿童肾结石患者在我科接受微创经皮肾镜取石术治疗,对其临床资料进行分析总结,男17例,女8例,年龄5～14岁,平均10.8岁。患儿经腹部B超、CT、KUB＋IVU检查诊断明确,患儿取俯卧位,B超引导下建立F16～20皮肾工作通道,用气压弹道或钬激光碎石。结果：25例均一期成功建立皮肾通道,均为单通道碎石。术后复查KUB片,一次性结石取尽22例,结石清除率约88.9%,2例术后单一盏残石,辅助体外冲击波碎石（ESWL）治疗成功,1例有结石碎片,予以肾石通丸（1.0BID）等药物辅助排石排尽。总结石清除率达到100%,手术时间50～100 min,平均70 min。所有患者未输血,且无严重并发症。结论：微创经皮肾镜取石术治疗儿童肾结石安全有效,术后结合ESWL治疗可以代替开放手术而成为儿童肾复杂结石、鹿角形结石的首选治疗方法。

Objective： To summarize the skills and experiences of minimally invasive percutaneous nephrolithotomy in treatment of pediatric renal calculi, and to evaluate its safety and application value.Methods： A total of 25 children patients with kidney stones in our department from August 2007 to May 2013 were treated with minimally invasive percutaneous nephrolithotomy. The clinical data were summarized and analyzed. The mean age of children（17 boys and 8 girls） was 10.8 years（5 to 14 years）. Percutaneous access was established under ultrasound guidance with the patients in the prone position. A pneumatic or holmium laser lithotripter was used for lithotripsy. Results： The percutaneous access was successfully established in all patients with only one trial. KUB was checked after the operation. The stone clearance rate for mini-PCNL was 88.9%（22cases）. 2 cases who had calyceal calculus accepted ESWL; 1 case with stone fragments was removed by taking medicine such as Shenshitong pills（1.0 bid）. The total stone clearance rate reached 100%. The median operative time was 70 minutes（from 50 to 100 minutes）. All patients did not receive blood transfusion, and there were no major complications. Conclusion： Mini-percutaneous nephrolithotomy is a safe and effective treatment for chil-dren with kidney stones. Combined with postoperative ESWL treatment, mini-percutaneous nephrolithotomy can replace open operation and become the first choice treatment of complex kidney stones and staghorn calculi in children.