输尿管软镜碎石术治疗小儿尿路结石的疗效观察

Flexible ureteroscopic lithotripsy for treatment of urinary tract stones in children

目的：探讨输尿管软镜碎石术（flexible ureteroscopic lithotripsy,FURL）治疗小儿上尿路结石的疗效和安全性。方法：回顾性分析2014年1月~2015年10月应用FURL术治疗的66例上尿路结石患儿的临床资料：年龄5个月~14岁,平均（4.22±3.84）岁。其中多发性结石52例,单发结石14例;结石位于肾上盏6例,中盏7例,下盏8例,肾盂33例,输尿管上段12例;结石最大径平均（13.6±7.3）（6~25）mm。17例因输尿管中下段结石先采用辅助硬镜碎石,随后使用FURL处理。结果：66例FURL均获得成功,手术时间（35.05±23.25）（6~90）min。术后1个月结石清除率（stone free rate,SFR）为78.78%（53/66）,术后3个月SFR为86.36%（57/66）;5例需要二期处理（1例SMP,4例输尿管镜下碎石）,最终SFR为93.93%（62/66）。术后发热38.5℃以上者9例,经常规处理后恢复正常,无其他严重并发症发生。结论：FURL治疗小儿上尿路结石具有创伤小、安全、有效、恢复快、住院时间短等特点,甚至适用于肾下盏结石,值得在临床上进一步应用和推广。

Objective：To evaluate the efficacy and safety of flexible ureteroscopic lithotripsy（FURL）for treatment of upper urinary tract stones in children.Method：We retrospectively analyzed the clinical data of 66 children with upper urinary tract stones who were treated by FURL from January 2014 to October 2015.Multiple stones were found in 52 cases,and single stone was found in 14 cases.Stones in the upper renal calyx were found in six cases,stones of seven cases were found in middle calyx,stones of eight cases were found in lower calyx,stones of33 cases were found in renal pelvis,and stones of 12 cases were found in upper ureter.Average stone size was 13.6±7.3（range,6-25）mm.Seventeen children with ureteral stones in the middle and lower ureter received rigid ureteroscopic lithotripsy followed by FURL.Result：All procedures were successful.The mean operation time was35.05±23.25（range,6-90）min.Stone free rate（SFR）was 78.78%（53/66）one month postoperatively,86.36%（57/66）three months postoperatively.Five cases needed secondary treatment（one SMP,four ureteroscopic lithotripsies）.The final SFR was 93.93%（62/66）.No serious complication occurred except that nine cases had fever higher than 38.5 ℃,and they returned to normal by regular treatment.Conclusion：FURL in the treatment of upper urinary tract calculi in children is minimally invasive,safe and effective.Also,it has the advantages of rapid recovery and shorter hospital stay,even it＇s applicable for the stones in lower calyx.So it＇s worthy of further application and promotion.