一期输尿管双J管置入联合体外冲击波碎石治疗婴儿上尿路多发结石

Combined Surgery of Primary Ureteral Catheter Insertion and Extracorporeal Shock Wave Lithotripsy for the Treatment of Upper Urinary Multiple Stones in Infants

目的探讨一期输尿管双J管置入联合体外冲击波碎石(extracorporeal shock wave lithotripsy,ESWL)治疗婴儿上尿路多发结石的安全性及有效性。方法 2013年1月~2015年6月我科对22例婴儿上尿路多发结石行一期输尿管双J管置入联合ESWL,全麻下经F6或F8膀胱镜置入输尿管双J管(F3或F4.6)后转运至碎石室,麻醉状态下行ESWL(电压7.5~10 k V,冲击波频率70次/min)。结果 22例手术均一期顺利完成,术中无输尿管穿孔、输尿管黏膜撕脱发生,术后未发生泌尿系感染、尿源性脓毒血症、肾被膜下血肿、输尿管狭窄等严重并发症。术后2~4周结石均完全排出(平均排石时间3.5周),排石率100%。术后随访观察12个月,1例患儿术后1年复查发现肾结石复发,行ESWL清除结石,其余无结石复发,泌尿系超声或CT未见肾脏及输尿管形态改变,肾功能无异常。结论一期留置输尿管双J管联合ESWL治疗婴儿上尿路多发结石,可有效减少手术次数,减少腔内侵入性有创操作,安全有效,值得临床推广。

bObjective To investigate the safety and efficacy of combined surgery of primary ureteral catheter insertion and extracorporeal shock wave lithotripsy（ ESWL） for the treatment of upper urinary multiple stones in infants. Methods We performed combined surgery of primary ureteral catheter insertion and ESWL treatment in 22 infants from January 2013 to June 2015. Under the general anesthesia,a double-J ureteral catheter（ F_3 or F_（4. 6）） was inserted through F_6 or F_8cystoscope to remove the stones into the ESWL room. Then the ESWL was conducted under 7. 5-10 k V at 70 times/min. Results The operations were performed at one stage successfully in all the 22 cases without ureteral perforation or ureter mucosa avulsion. No postoperative urinary infection,urinary sepsis,hematoma under renal capsule,or ureteral stenosis occurred. All the stone were removed in 2-4 weeks（ mean,3. 5 weeks）,the lithagogue rate being 100%. After postoperative follow-ups for 12 months,only 1 patient suffered from the recurrence of kidney stones and was given ESWL for stone removal. The urinary ultrasonography or CT scanning found no renal and ureteral morphological changes or renal dysfunctions. Conclusion Combined surgery of primary ureteral catheter insertion and ESWL for the treatment of upper urinary multiple stones in infants can effectively reduce the number of operations and the trauma to urinary system,being worthy of clinical promotion.