B超引导下超微通道经皮肾镜取石术治疗小儿上尿路结石的效果分析

Super mini-percutaneous nephrolithotomy （SMP） by ultrasound-guided for pediatric kidney stones

目的 探讨B超引导下超微通道经皮肾镜取石术（super mini-PCNL,SMP）治疗小儿上尿路结石的安全性和临床疗效.方法 回顾性分析2015年5-8月采用B超引导下SMP治疗20例上尿路结石患儿的临床资料.男6例,女14例;年龄11～144个月,中位年龄31.5个月.结石最大径0.8 ～2.5cm,平均（1.48±0.59） cm.单发肾盂结石8例,肾盂合并下盏结石10例,输尿管上段结石2例.所有患儿既往均无手术史.全麻俯卧位,输尿管镜下患侧输尿管逆行留置F4～5输尿管导管,B超引导下穿刺目标肾盏,F12 ～14带有吸引排空装置的Peel-away鞘作为手术通道,应用WOLF输尿管镜,气压弹道碎石,采用特殊设计的吸引排空系统吸出结石.对手术时间、术后血红蛋白（Hb）、红细胞压积（HCT）变化以及术后并发症、结石清除率等临床资料进行分析.结果 所有患儿均一期单通道取净结石,14例穿刺中盏,4例穿刺中上盏,2例穿刺中下盏.2例扩张至F14通道,18例用F12通道.术后第1天净石率100％,手术时间6～40 min,平均（17.6±11.6） min,术后Hb下降2 ～ 16 g/L,平均（7.6±4.1）g/L,术后HCT下降0.02 ～0.059,平均（0.027 ±0.015）.所有小儿均未予留置肾造瘘管和D-J管.14例患儿术后保留输尿管导管,术后第1天拔除输尿管导管及尿管,6例患儿完全无管化.术后住院时间1 ～4d,平均（2.4±0.8）d.所有患儿无输血,无术后疼痛、发热等并发症发生.结论 SMP并发症少、恢复更快、疗效确切,可作为＜2.0 cm小儿上尿路结石的首选治疗方法之一.

Objective To evaluate the safety and efficacy of super mini-percutaneous nephrolithotomy （SMP） by ultrasound-guided renal access in pediatric with renal calculus.Methods From May to August 2015, 20 pediatric patients with upper tract stones underwent the SMP by ultrasound guidance.The patients aged 11-144 months , median age 31.5 months, The stone size ranged 0.8-2.5 cm, mean（1.48 ±0.59） cm.Among the 20 children, single pelvis stones were in 8, multiple stones in 10 and upper ureter stones in 2.All patients had no previous surgery treatment.The SMP system consists of a F6.0 -7.5 nephroscope and a modified F12-14 access sheath with suction-evacuation function.Nephrostomy tract dilation was performed up to F12-14 and lithotripsy procedure was performed by using pneumatic lithotripter.Nephrostomy tube or double J stent was placed only if clinically indicated.Results The stone size was 0.8-2.5 cm ,mean （1.48 ± 0.59）cm.Among the 20 children, there were 8 patients with single pelvis stone, 10 with multiple stones and 2 with upper ureter stones.All the patients were completed successfully without surgery conversion.Mean operative time ranged 6-40 minutes ,mean（17.6 ± 11.6） minutes.The stone free rate was 100% after the evaluation in the postoperative day.The hemoglobin drop was 2-16 g/L,mean （7.6-± 4.1） g/L.No major complications occurred, neither patient required transfusion.The tubeless PCNL without double J stents and nephrostomy tubes placed were achieved in all patients.Only 14 patients had a ureter catheter placement for one day.The average hospital stay ranged 1-4 days, mean （2.4 ± 0.8） days.Conclusions SMP could be a safe and effective treatment for kidney stone up to 2.0 cm in pediatric cases with advantages of short recovery time, high stone free rate and no catheter placement.SMP could be the ideal procedure for children with upper urinary tract calculus.