免人工肾积水针状肾镜系统治疗儿童肾结石的疗效分析

Efficacy analysis of the Needle-perc system in pediatric renal stone treatment without artificial hydronephrosis

目的探讨免人工肾积水针状肾镜系统(Needle-perc)辅助经皮肾镜碎石(percutaneous nephrolithotripsy,PCNL)治疗儿童肾结石的安全性和有效性。方法收集2021年8月—2022年10月期间山南市人民医院收治的11儿童肾结石资料,其中男7例,女4例,年龄5~16岁,其中右侧4例,左侧7例,单发肾盂结石5例,多发结石6例,结石最大直径为(18.46±6.52)mm,结石的CT值为(835.04±135.74)HU。均在全麻下行免人工肾积水可视化针状肾镜系统穿刺辅助经皮肾镜钬激光碎石术,术中在超声引导下使用4.5Fr可视化穿刺针在直视下行目标肾盏穿刺,随后建立F16经皮肾通道,配合使用550μm钬激光完成碎石,术后留置F12造瘘管,其中完全可视化肾镜碎石则无管化处理。评估手术时间、手术并发症、术后住院时间及术后结石清除率情况。结果所有患儿均成功完成手术,其中行完全可视化肾镜下钬激光碎石3例,8例行可视化穿刺系统辅助下经皮肾镜激光碎石术,手术时间(79.55±10.76)min,术后血红蛋白下降(10.09±5.25)g/L,术后住院时间(5.54±1.07)d,术后4周复查结石清除率为100%。术中术后未出现通道丢失、感染发热、严重出血、肾脏及邻近器官损伤等严重并发症。结论免人工肾积水针状肾镜辅助经皮肾镜碎石治疗儿童肾结石安全、有效,且手术并发症发生率低,可以达到满意的结石清除率,适合儿童肾结石的个体化治疗,在高原儿童肾结石好发地区具有一定的临床推广应用价值。

Objective This study aims to evaluate the efficacy and safety of percutaneous nephrolithotripsy assisted by the needle-perc system without artificial hydronephrosis in the treatment of pediatric renal stones.Methods A total of 11 pediatric patients with renal stones treated underwent percutaneous nephrolithotripsy using the visualized needle-perc system were enrolled in Shannan People's Hospital during August 2021 to October 2022.The cohort included 7 males and 4 females aged 5-16 years,with 4 patients on the right side and 7 patients on the left side.Among them,5 patients had single renal pelvis stone and 6 patients had multiple calculi.The maximum mean diameter of calculi was(18.46±6.52)mm,with a mean CT value of(835.04±135.74)HU.All of them underwent percutaneous holmium laser lithotripsy under general anesthesia using a visualized needle-perc system,with the target calyx punctured by a 4.5Fr visualized puncture needle under ultrasound guidance.Subsequently,F16 percutaneous renal access was established,and lithotripsy was completed using a 550μm holmium laser.After the operation,an F12 fistula was maintained in place,following a needle-perc nephrolithotripsy procedure without the need for an indwelling nephrostomy tube.The operation duration,complications,hospital stay,and stone clearance post-surgery were evaluated.Results All children were successfully operated,with 3 cases undergoing complete needle-perc nephrolithotripsy and 8 cases using a visualized needle-perc system.The average operation duration was(79.55±10.76)min,postoperative hemoglobin decreased by(10.09±5.25)g/L,and the average postoperative hospitalization period was(5.54±1.07)days.The stone clearance rate was 100%at the 4-week postoperative follow-up.No serious complications such as access loss,postoperative infection,severe bleeding,or injury to the kidney or adjacent organs during and after the surgery.Conclusion Needle-perc system assisted percutaneous nephrolithotomy without artificial hydronephrosis is safe and effective in the treatment of pediatric renal stones.It demonstrates a low incidence of surgical complications and can achieve a satisfactory stone removal rate,making it suitable for individualized pediatric renal stone treatment.Furthermore,this technique holds clinical significance in regions with a high incidence of kidney stones among children living on plateau.