输尿管镜气压弹道碎石术治疗小儿下尿路结石疗效观察

Efficacies of ureteroscopic pneumatic lithotripsy for lower urinary calculi in children

目的探讨经输尿管镜气压弹道碎石术在治疗小儿下尿路结石中的应用效果。方法收集我科2012年1月至2015年1月33例小儿下尿路结石患儿，其中男32例，女1例，年龄6个月至12岁，平均年龄29个月，年龄小于3岁的患儿有27例。膀胱结石17例，尿道结石16例，其中前尿道结石6例，后尿道结石10例，结石大小8mm-25mm，平均13mm。所有患儿经B型超声、泌尿系CT等检查，均无尿道狭窄、神经源性膀胱、先天性畸形。全身麻醉、电视监视系统下应用Wolf输尿管镜（Wolf6～7．5F，工作通道F4．0）气压弹道碎石术（碎石杆直径1．0mm）治疗，观察碎石成功率、术后有无尿道损伤、膀胱穿孔、有无发热等并发症发生情况及结石复发情况。结果33例患儿均1次碎石成功，碎石时间15～60min，平均（26±9）min，术后2d～7d内结石清除率100％，4例患儿术后第一天体温超过38．0℃、无“石街”、无尿道狭窄、无尿道损伤、无膀胱穿孔和排尿异常等并发症发生，术后住院时间2～3d，平均2．4d。随访2～24个月，无结石复发。结论经输尿管镜气压弹道碎石术治疗小儿尿路结石安全简便、效果确切、结石清除率高，且损伤小，术后恢复快，可作为小儿下尿路结石治疗的首选方法之一。

Objective To evaluate the efficacies of transurethral ureteroscopic pneumatic lithotripsy （TUPL） for lower urinary calculi in children. Methods From January 2012 to January 2015, 33 children with lower urinary calculi were recruited. There were 32 males and 1 female with an average age of 29 （6-144） months. And 27 cases were aged under 3 years. There were bladder stones （n= 17） and urethral calculi （n = 16）. And urethral calculi were anterior （n = 6） and posterior （n = 10）. The average stone size was 13 （8-25） mm. Urological ultrasound and computed tomography revealed no stenosis, congenital malformation or neurogenic bladder. TUPL was applied with a Wolf 6-7. 5F ureteroscope of a working channel 4. 0F. The postoperative complications and stone recurrence were observed. Results All cases were treated one-time successfully with a stone clearance rate of 100%. The average operative time was26 ±9 （15-60）min. There was no onset of urethral stricture, urinary abnormalities or stone recurrence during a follow-up period of 2-24 months. Only 4 cases developed fever over 38℃ at Day I post-operation. Conclusions As a first option for lower urinary calculi in children, TUPI. offers multiple advantages of greater safety, quicker recovery, mini-invasion and fewer complications.