体外冲击波碎石术治疗小儿鹿角状结石

Treatment for staghorn calculi by extracorporeal shock wave lithotripsy in children

目的 评价体外冲击波碎石术治疗小儿鹿角状结石的安全性和疗效。方法 从 1997年 3月至 2 0 0 2年 3月 ,共收治 8例小儿鹿角状结石患儿 ,年龄 1.5～ 14岁 ,平均 7.8岁 ,结石直径均大于 2 0mm ,完全鹿角状结石 3例 ,部分鹿角状结石 5例 ,DonierCompactS碎石机治疗。 3例低龄患儿行氯胺酮麻醉 ,全部患儿碎石 1～ 5次 ,无需置D J管 ,随访 6个月以上。结果 6例无结石残留(75 .0 % ) ,2例残留结石 ,需经皮肾取石术治疗。 2例形成输尿管石街 ,轰击石街 1～ 2次后结石排出。随访 6个月以上 ,肾功能恢复正常 ,无高血压发生。结论 体外冲击波碎石是小儿鹿角状结石的首选治疗方法 ,安全性好 ,疗效高。应重视代谢障碍、解剖异常问题及并发症的防治。

Objective To evaluate the safety and efficacy of extracorporeal shock wave lithotripsy (ESWL) for staghorn calculi in children. Methods From March 1997 to March 2002, 8 children with a mean age of 7.8 years (18 months～14 years) were treated for complete (3) and partial (5) staghorn calculi using Donier Compact S Lithotriptor. Three of them were injected with intramuscular ketamine anesthesia. Ureteral catheterization was not required during the progress.The size of calculus was more than 20mm in diameter .All cases were received 1～5 ESWL course.Results Six patients were no residual stone (75%), and 2 had asymptomatic residual fragments and required percutaneous nephrolithothomy (PCNL). Two patients had ureteral obstruction with fragments (lithic street) and were treated successfully after another 1 ESWL. No major complication was detected. A follow up more than 6 months showed all patients had normal blood pressure without renal function damage.Conclusions ESWL is a safe, effective and first choice for the treatment of staghorn calculi in children. The comprehensive care of children with staghorn calculi should include metabolic and anatomical anomalies evaluation.