B型超声引导下无管化经皮肾镜取石术在儿童上尿路结石的疗效评价

Efficacy of ultrasound-guided mini-percutaneous nephrolithotomy for upper urinary tract calculi in children

目的评价完全B型超声引导下无管化(无肾造瘘管)经皮肾镜取石术治疗儿童上尿路结石的安全性和有效性。方法收集新疆维吾尔自治区人民医院泌尿中心2015年5月至2020年12月行B型超声引导下无管化经皮肾镜取石术的111例患儿资料,其中男67例,女44例,患儿年龄为(5.3±5.2)岁,体重为(17.9±9.1)kg,身高为(102.5±23.4)cm,结石最长径为(1.9±0.8)cm,所有患儿术前经B型超声检查、泌尿系CT检查确诊。记录所有患儿一般情况、结石大小、手术时间和术后并发症等。结果所有患儿均在完全B型超声引导下穿刺成功,97例(87.4%,97/111)患儿为完全无管化(即手术后无肾造瘘管、也无双"J"管)。手术建立通道时间为(4.8±3.0)min,碎石时间为(26.1±13.7)min,术后血色素下降(7.7±8.7)g/l,术后24 h净石率为97.3%(108/111),术后1个月净石率为98.2%(109/111),术后发生并发症8例,其中ClavienⅠ级5例,ClavienⅡ级3例,无ClavienⅢ级和Ⅳ级并发症,术后住院天数为(2.1±0.9)d。结论无管化经皮肾镜取石术治疗儿童上尿路结石是安全、有效的。具有术后恢复快、术后住院时间短等特点,减少了二次住院及麻醉次数。

Objective To evaluate the safety and efficacy of tubeless percutaneous nephrolithotomy(PCNL)under the guidance of B-ultrasound for children with upper urinary tract calculi.Methods From May 2015 to December 2020,111 children underwent PCNL without nephrostomy tube under the guidance of B-ultrasound were retrospectively analyzed.There were 67 boys and 44 girls with an average age of(5.3±5.2)years,an average weight of(17.9±9.1)kg and an average height of(102.5±23.4)cm.The average maximal diameter of calculi was(1.9±0.8)cm.General profiles,stone size,operative duration and postoperative complications were recorded.Results Among them,97 cases(87.4%)were completely tubeless(no nephrostomy/double"J"tube).The average accessing time was(4.8±3.0)min and operative duration(26.1±13.7)min.The average postoperative hemoglobin declined by(7.7±8.7)g/L.The stone-free rate was 97.3%(108/111)at 48h and 98.2%(109/111)at 1 month postoperatively.There were 8 postoperative complications,including Clavien grade I(n=5),grade II(n=3)and grade III/IV(n=0).The average postoperative hospital stay was(2.1±0.9)days.Conclusions Tubeless percutaneous nephrolithotomy is both safe and effective for upper urinary tract calculi in children.With the characteristics of quick postoperative recovery and fewer complications,it lowers the frequency of secondary hospitalization and anesthesia.