两种经皮肾镜碎石术式治疗新疆维吾尔族儿童多发性肾结石疗效的回顾性分析

Retrospective comparison of two different PCNL procedures for pediatric sporadic nephrolithiasis in Xinjiang

目的比较微通道经皮肾镜碎石术(mini-percutaneous nephrolithotomy,Mini-PCNL)与可视经皮肾镜碎石术(Microperc)治疗维吾尔族儿童多发性肾结石的有效性与安全性。方法收集2015—2020年新疆喀什第一人民医院泌尿外科收治的68例维吾尔族多发性肾结石患儿临床资料,其中男40例,女28例,年龄8个月至12岁;29例患儿接受33侧Mini-PCNL手术治疗(为Mini-PCNL组),39例患儿接受46侧Microperc手术治疗(为Microperc组)。比较两组患儿的年龄、性别、体重指数、患肾侧别、术前尿培养结果、术前肾积水情况、结石直径总和、CT值、结石数目、累计肾盏数目。统计两组手术相关参数、术后1天及术后1个月随访结石清除率(stone free rate,SFR)和并发症发生率。结果68例中位年龄为4.0(3.0,5.0)岁,体质指数(body mass index,BMI)为16.4(15.1,17.7)kg/m 2,术前尿培养结果呈阳性者共35例(51.2%),术前尿路感染共45例(66.2%);两组中位结石直径总和分别为2.4(2.0,3.0)cm、1.2(1.0,1.7)cm(P<0.001);平均CT值分别为(720.3±277.2)Hu、(666.9±295.4)Hu(P=0.49);结石数量为2.4(2.0,3.0)个(P=0.577);累计肾盏数目分别为2(1,2)个、1(1,1.75)个(P=0.002);两组SFR分别为93.9%和91.3%(P=0.996)。两组中位手术时间分别为30(25,52.5)min、40(20,60)min(P=0.929);术中灌注量分别为600(300,800)mL、220(150,300)mL(P=0.006);中位住院天数为5.0(4.0,6.0)d(P=0.735);手术前后血红蛋白变化值分别为7.0(2.0,10.0)g/L、3.0(2.0,6.75)g/L(P=0.284)。两组并发症发生率分别为21.2%和17.4%(P=0.721)。结论Mini-PCNL和Microperc在平均发病年龄低、术前感染率高的新疆维吾尔族儿童多发性肾结石中的应用均表现出较好的有效性与安全性。在术式的选择上,Mini-PCNL能够更有效地处理负荷较大(结石最大直径总和>2 cm、多肾盏分布)的维吾尔族儿童肾结石。

Objective To compare the effectiveness and safety of mini-percutaneous nephrolithotomy(Mini-PCNL)versus Microperc for Uygur pediatric multiple nephrolithiasis.Methods Clinical data were reviewed for 68 Uygur multiple nephrolithiasis children during 2015-2020.There were 40 boys and 28 girls aged from 8 months to 12 years.The baseline data of two groups was compared,including age,gender,body mass index(BMI),laterity,positive urine culture,hydronephrosis,sum of stone diameter,computed tomography(CT)value,number of stones and involved calyces for determining the comparability of two groups.Surgical parameters,stone free rate and complications at Day 1 and Month 1 post-operation were calculated.Results Their median age was 4.0(3.0,5.0)years,BMI 16.4(15.1,17.7)kg/m 2,positive urine culture preoperatively 35 cases(51.2%),urinary infection 45(66.2%),median sum of stone diameters 2.4(2.0,3.0)cm、1.2(1.0,1.7)cm(P<0.001);CT values(720.3±277.2)Hu、(666.9±295.4)Hu(P=0.49);stone numbers were both(2.0,3.0)(P=0.577);involved calyces(1,2)、1(1,1.75)(P=0.002);SFR 93.9%and 91.3%(P=0.996);median surgical duration 30(25,52.5)min、40(20,60)min(P=0.929);intraoperative irrigation volume 600(300,800)ml、220(50,300)ml(P=0.006);median hospitalization both 5.0(4.0,6.0)d(P=0.735);perioperative drop of hemoglobin 7.0(2.0,10.0)g/L、3.0(2.0,6.75)g/L(P=0.284);complication rate 21.2%and 17.4%(P=0.721)respectively.Conclusion Mini-PCNL and Microperc offer comparable levels of effectiveness and safety for Uygur children of multiple nephrolithiasis with a lower mean age of onset,higher preoperative rate of urinary infection is higher and worse surgical tolerance.Also Mini-PCNL resolves heavier stone burden more effectively(sum of max stone diameters>2 cm&multiple calyceal distribution).