超微经皮肾镜取石术治疗儿童上尿路结石的疗效评估

Safety and efficacy of super-mini percutaneous nephrolithotomy for upper urinary tract calculi in pediatric patients

目的:探讨超微经皮肾镜取石术(SMP)治疗小儿上尿路结石的有效性及安全性。方法:SMP是利用外径为7F、工作通道为3.3F的超细肾镜,10～14F带吸引功能鞘的取石系统。回顾性分析我国4家医院2013年8月～2017年12月因上尿路结石而行SMP患儿(<14岁)的临床资料。结果:共136例患儿入组,年龄0.5～14岁,平均(3.98±3.13)岁。多数患儿(63.2%)术前以腰痛和血尿症状为主。结石最大径为0.8～4.8cm,平均(1.58±0.78)cm;平均手术时间(37.86±25.64)min;术后住院天数1～8d,平均(2.7±1.7)d。114(83.82%)例患儿为完全无管化(术后未留置肾造瘘管和双J管)。术后第1天结石清除率为84.56%,术后3个月结石清除率为90.44%。术后有11例患儿出现发热。1例患儿因术后出现肾绞痛而行双J管置入术。6例患儿出现轻度肾盂撕裂或尿外渗。结石成分分析以感染性结石及草酸钙结石为主。结论:SMP应用于小儿上尿路结石具有结石清除率高、并发症低、无管化率高的优点,具有较高的推广价值。

Objective:To evaluate the safety and efficacy of super-mini percutaneous nephrolithotomy(SMP)in the management of pediatric upper urinary tract calculi.Method:We retrospectively reviewed pediatric patients who underwent SMP in four centers between August 2013 and December 2017.The SMP system consists a 7 Fnephroscope and a modified 10-14 Faccess sheath with a irrigation-suction function.Result:In all,136 pediatric patients with the mean age of 3.98 years old underwent SMP.Flank pain or hematuria was noted in 63.2% of the patients.The mean stone size was 1.58±0.78(range,0.8-4.8)cm.The average operation time was 37.86±25.64 minutes.Postoperative hospital stay was 2.7±1.7(range,1-8)days.One hundred and fourteen(83.82%)SMPs were totally tubeless.Patients undergoing SMP had a 90.44%stone-free rate.Only 11 patients had postoperative fever(>38.5).One patient required indwelling ureteral stent because of renal colic.None of the cases required transfusion.Struvite and calcium oxalate were the most prevalent stone compositions.Conclusion:SMP is a safe and effective treatment for the upper urinary tract stones in pediatric patients.It provided excellent stone-free rate,high tubeless rate and low complication rate.