微通道经皮肾镜治疗新疆和田地区婴幼儿上尿路结石39例

Clinical analysis of mini - percutaneous nephrolithotomy in 39 infants with upper urolithiasis in Hotan region, Xinjiang Uyger Autonomous Region

目的总结微通道经皮肾镜碎石治疗婴幼儿上尿路结石的安全性和疗效。方法收集2015年3月至2016年1月和田地区人民医院收治婴幼儿上尿路结石患者39例。其中男21例，女18例；年龄6个月～3岁[（1.8±1.2）岁]；患儿术前均通过影像学检查除外泌尿系统先天性畸形。双侧上尿路结石者7例，共进行微通道经皮肾镜钬激光碎石术（mPCNL）治疗46侧肾。术后1周复查泌尿系平片或超声，记录手术时间、血红蛋白下降、电解质变化及结石清除率等指标。结果患儿均按计划完成mPCNL手术过程。46侧肾结石横径2.0～4.0 cm[（3.1±0.9） cm]；术前血红蛋白76～137 g/L[（114.0±22.1） g/L]，其中3例患儿血红蛋白〈80 g/L；血清蛋白〈25 g/L者3例，体质量低于标准体质量者14例。39侧肾常规选择肾中盏后组进行穿刺，6侧肾行肾上盏穿刺，1例因结石位于平行肾盏内而选择双通道mPCNL，手术时间37～65 min，平均52 min。术后1周结石清除率78.26%。术后Ⅰ级并发症3例（6.25%），Ⅱ级并发症5例（10.87%），其中3例（6.52%）出现感染性并发症，2例（4.35%）出现输血事件，无Ⅲ级以上并发症发生。结论单纯采用mPCNL可有效治疗婴幼儿上尿路结石。由于婴幼儿患者手术耐受力较差，完整而系统性对患儿进行术前评估，对mPCNL尤为重要。

Objective To evaluate the effectiveness and safety of mini-percutaneous nephrolithotomy in treating infant upper urolithiasis.Methods Retrospective analysis of 39 cases of infant upper urolithiasis treated with mini-percutaneous nephrolithotomy between March 2015 to January 2016 in Hotan Region People′s Hospital was performed, with the age of（1.8±1.2） years（6 months to 3 years old）, including 21 male and 18 female.Exclusion of inherent anatomical abnormalities of urinary tract was performed by pre-operation image screening.A total of 46 renal were treated with mini-percutaneous nephrolithotomy, including 7 cases of bilateral urolithiasis.Urinary tract radiograph or ultrasonagraphy, operation time, hemoglobin（Hb） decrease, electrolyte changes and stone clearance were recorded after operation.Results All scheduled mPCNLs were performed snccessfully.The stone burden was（3.1±0.9） cm（ranging from 2.0 to 4.0 cm） in 46 renal units with a the pre-operative Hb（114.0±22.1） g/L （76 -137 g/L）, including 3 cases Hb less than 80 g/L and 3 cases of serum albumin less than 25 g/L, and the weight of 14 patients was less than the standard weight.Access was gained from medium posterior calyx in 39 cases and upper calyx in 6 cases, and double access pathway was performed in 1 case who with parallel calyx urolithiasis.The operation time was 37-65 min, and the mean operation time was 52 min.Post-operative stone clearance was 78.26%.There were 3 cases（6.25%） grade Ⅰ and 5 cases（10.87%） grade Ⅱ complications including 3 cases（6.52%） with infectious complication and 2 cases（14.35%） with blood transfusion.No grade Ⅲ complications were observed.Conclusions Single mPCNL is recommended as a standard treatment for infant upper uroliathiasis with more carefully and systematic pre-operation evaluation due to their poor tolerance.