输尿管软镜联合钬激光碎石治疗小儿上尿路结石112例

Flexible Ureteroscopy Combined With Holmium Laser Lithotripsy for Children With Upper Urinary Stones:Report of 112 Cases

目的探讨输尿管软镜联合钬激光治疗儿童上尿路结石的疗效和安全性。方法2017年2月~2020年2月收治上尿路结石患儿112例,年龄6个月~12岁,中位数28个月。肾盏结石59例(68侧),其中上盏31侧,中盏15侧,下盏22侧;肾盂结石53例,其中单侧肾盂结石49例(合并输尿管结石2例),双侧肾盂结石4例。结果112例中,95例一期碎石成功,一期结石清除率84.8%(95/112);3例进镜困难,留置双J管2~3周后输尿管软镜碎石成功;11例肾下盏结石因肾下盏角度大,碎石失败,中转行经皮肾镜碎石;2例术后残留结石合并肾盂输尿管连接部狭窄,二期行肾盂成形术同时去除结石;1例肾盂结石进输尿管软镜时输尿管壁撕裂,留置双J管1个月,行经皮肾镜碎石。手术时间16~72 min,平均48 min。3例术中出血>50 ml,3例术后高热。结论输尿管软镜联合钬激光治疗儿童上尿路结石疗效确切,值得推广应用。

Objective To evaluate the efficacy and safety of flexible ureteroscopy combined with holmium laser lithotripsy in the treatment of children with upper urinary stones.Methods From February 2017 to February 2020,112 children with upper urinary tract stones were treated.They were aged from 6 months to 12 years old,with a median of 28 months.There were 59 cases(68 sides)of renal calyceal stones,including 31 sides of upper calves,15 sides of middle calves,and 22 sides of lower calves.There were 53 cases of renal pelvic stones,including 49 cases of unilateral renal pelvic stones(2 cases with ureteral calculi)and 4 cases of bilateral renal pelvis stones.Results Among the 112 cases,95 cases had a successful first-stage lithotripsy,and the first-stage stone removal rate was 84.8%(95/112).Difficulty in entering the ureteroscope was encountered in 3 cases,and the ureteroscopy was successfully carried out after 2-3 weeks of indwelling of a double J tube.There were 11 patients with lower calyx calculi experienced a failure of lithotripsy due to large angle of the lower calyx,and then a conversion to percutaneous nephrolithotripsy was performed.Two children with renal calculi failed to completely remove the stones during the operation and developed ureteropelvic junction stenosis after operation,and stones were removed simultaneously by two-stage pyeloplasty.In 1 case of renal pelvis stones,the ureter wall was torn after insertion of the ureteroscope,and the double J tube was left for 1 month,and finally a percutaneous nephrolithotomy was performed.The operation time ranged from 16 to 72 minutes,with an average of 48 minutes.Three patients had more than 50 ml of intraoperative blood loss and three patients had postoperative fever.Conclusion Flexible ureteroscopy combined with holmium laser lithotripsy for children with upper urinary stones has definite curative effect and is worthy of popularization and application.