微创经皮肾镜取石术治疗维吾尔族小儿上尿路结石的临床研究

Clinical study of mini-percutaneous nephrolithotomy for upper urinary stones in children of Uygur nationality

目的 探过微创经皮肾镜取石术（MPCNL）治疗维吾尔族小儿上尿路结石的安全性和有效性.方法 回顾性分析2016年3-12月新疆和田地区人民医院运用MPCNL治疗小儿上尿路结石158例,其中男性117例,女性41例;平均年龄2.59岁,年龄范围为5个月～14岁;5个月～3岁112例,4～7岁36例,8～14岁10例;左侧69例,右侧67例,双侧22例.结石大小平均2.3 cm×1.8 cm.根据结石大小,经皮肾通道选择在12～18 F之间,能量选择钬激光碎石,不使用灌注泵,静水压力控制在50～70 cm H2O（1 cmH2O=0.098 kPa）.术后139例患儿放置双J管和肾造瘘管,15例患儿术后未放置肾造瘘管,4例患儿彻底无管化.观察术前和术后发热患儿数量和比例,手术前后血常规指标的变化,以及手术时间、穿刺部位、通道大小和数目、住院时间、清石率、结石成分及各种其他术后并发症等.计数资料以率（％）表示,组间比较采用x2检验.结果 158例患儿共180侧肾脏MPCNL均成功.无ClavienⅡ级以上并发症发生.2例患儿术后输注1U红细胞治疗.单侧手术时间15 ～85 min,平均35 min.术后住院3～8d,平均6.2d.一期结石清除率为88.61％（140/158）,总的结石清除率为92.41％ （146/158）.结论 对于结石较大或合并积水的患儿运用MPCNL治疗小儿上尿路结石清石效率高,且具有安全、损伤小等优点.合适的患儿可以不留置肾造瘘管,或彻底无管化,有利于患儿康复.

Objective To explore the safety and effectiveness of Mini-percutaneous nephrolithotomy （MPCNL）in the treatment of upper urinary stones in uygur children.Methods Retrospectively analyzed the date 158 cases of upper urinary stones in children treated by MPCNL in xinjiang hotan people＇s hospital from March to December 2016,117 cases of males and 41 cases of females,aged from 5 months to 14 years （average：2.59 years）,including 112 cases of 5 months to 3 years old and 46 cases of 3 to 14 years old.There were 69 cases on the left,67 cases on the right and 22 cases on both sides.The average stone size was 2.3 cm × 1.8 cm.According to the size of the calculi,the percutaneous renal channel was selected between 12-18 F,the energy was selected for holmium laser lithotripsy,no perfusion pump was used and the hydrostatic pressure was controlled at 50 to 70 cm water column.Double J tube and renal fistula were placed postoperatively in 139 children;15 cases were not treated with renal fistula and 4 cases were completely free of tubulization.To observe the number and proportion of children with fever before and after operation.For multiple stones,use the accumulative maximum diameter calculation.To observe the changes of blood routine indexes before and after surgery,as well as operation time,puncture site,channel size and number,length of hospital stay,stone removal rate,stone composition and other postoperative complications.Counting data was expressed as a rate （%）,and comparison between groups was performed by chi-square test.Results A total of 180 cases were successfully operated on kidney MPCNL.No complications above ClavienⅡ occurred.Two cases were treated with 1 unit of postoperative erythrocyte transfusion.The time of unilateral operation was 15 to 85 minutes with an average of 35 minutes.The first-stage stone clearance rate was 88.6% （140/158） and the total stone clearance rate was 92.4% （146/158）.Postoperative hospitalization ranged from 3 to 8 days with an average of 6.2 days.Condusion MPCNL was used to treat upper urinary stones with high efficiency and safety and little damage for children with large stones or combined with water accumulation.Some appropriate children can be free of renal fistula or complete absence of tubulization to facilitate the recovery of children.