输尿管软镜在小儿上尿路结石治疗中的应用及并发症分析

Application of flexible ureteroscopy for treatment of upper urinary tract calculi in children and its complications analysis

目的探讨输尿管软镜技术在小儿上尿路结石治疗中的效果和并发症分析。方法分析2014年1月至2015年5月郑州大学第一附属医院收治的应用输尿管软镜技术治疗的小儿上尿路结石20例患儿的临床资料。男16例，女4例；年龄2.7～15.0岁，平均6.4岁。肾结石14例，输尿管上段结石6例，均为单侧；左侧12例，右侧8例；均伴有患侧肾脏轻、中度积水。结石直径0.5～1.8 cm，平均1.2 cm。经积极保守治疗无效后均采用经尿道输尿管软镜技术联合钬激光碎石治疗。术前1周，常规患侧留置输尿管双J管被动扩张输尿管内径。术后常规留置双J管1个月。结果20例患儿中，2例由于输尿管狭窄未能顺利置入软镜鞘，导丝引导下直接置入输尿管软镜碎石，其余患儿均顺利置入软镜鞘，通过软镜鞘置入输尿管软镜。手术时间20～60 min，平均38 min。术后住院时间3～7 d，平均4.5 d。18例患儿一期均探及结石，一期清石率〉90%。2例患儿肾下盏残留碎石屑。术中灌注量200～1 000 mL，平均500 mL。一过性肉眼血尿和发热为术后常见并发症，术中、术后无严重并发症发生。术后1个月复查彩超及泌尿系平片显示无结石残留，拔出双J管。结论输尿管软镜技术治疗小儿上尿路结石具有较高的清石率和临床安全性，但其并发症仍不可忽视，需充分的术前准备和细致的围手术期安全控制。

Objective To evaluate the efficacy and complications of flexible ureteroscopy for the treatment of upper urinary tract calculi in children. Methods The clinical data of upper urinary tract calculi in 20 children including 16 male and 4 female, treated by using flexible ureteroscopy, were collected from January 2014 to May 2015 in the First Affiliated Hospital of Zhengzhou University. The mean age was 6.4 years （ranging from 2.7 - 15.0 years old）. Among them,6 cases had upper ureteral calculi and 14 cases had renal calculi. All the calculi was found unilaterally with on the left side in 12 eases and on the right side in 8 cases. Ipsilateral mild to moderate hydronephrosis were found in all of the cases. The mean stone size was 1.2 cm（ ranging from 0.5 - 1.8 cm）. All the cases were treated through retrograde flexible ureteroscopy holmium laser lithotripsy after the invalid conservative through conservative treatment. Double J tube was left routinely in the sick side 1 week before operation to expand the internal diameter of the ureter. A double J stent was left in place for 1 month after operation as a routine. Results The flexible ureteral access sheath failed to insert into the upper ureter in 2 cases because of the narrow ureter, then the flexible ureteroseopy was inserted into ureter through wire directly. The flexible ureteral access sheath was successfully inserted into the ureter for the others and flexible ureteroscopy were inserted through flexible sheath. The mean operative time was 38 min （ranging from 20 - 60 min）. The patients were discharged from hospital after a mean of 4.5 days（ ranging from 3 - 7 days）. The rate of stone - free in one - stage was more than 90%. There were residual small stones in the lower ealices of kidney in 2 cases. The perfusion liquid volume during the operation was 500 mL（ranging from 200 - 1 000 mL）. There was no major perioperative complication, while transient macroscopic hematuria and fever were common complications after operation. The stone search was performed successfully in the whole 14 cases. NO residual stone could be fotmd through ultrasound and kidney ureter bladder plain and Double - J stent was removed 1 month after operation. Conclusions Flexible ureteroscopy produces high stone - free rate and clinical safety for upper urinary calculi in children. However, the complications of flexible ureteroscopy lithotripsy cannot be ignored and sufficient preoperative preparation and careful perioperative safety control should be required.