超微经皮肾镜取石术治疗儿童肾结石

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摘要目的:评估超微经皮肾镜取石术(SMP)治疗儿童肾结石的安全性和有效性。方法:回顾性分析2014年9月~2015年9月在新疆喀什地区第一人民医院运用SMP治疗51例儿童肾结石的患者资料。男32例,女19例,年龄5个月~12岁,平均(2.9±2.4)岁。结石大小为0.8~4.8 cm,平均(1.9±0.7)cm。结果:本组51例,除了2例患者合并脓肾须行二期SMP,其余49例一次完成SMP手术。手术时间(49.8±15.5) min。术后血红蛋白下降(10.4±4.7)g/L,均无需输血。其中44例(86.3%)没有放置肾造瘘管与输尿管支架管,2例(3.9%)只放置输尿管外支架,2例(3.9%)放置肾造瘘管和输尿管外支架管、3例(5.9%)同时放置肾造瘘管和双J管。术后第1天和术后3个月的完全结石清除率分别86.3%和 90.2%。8例(15.7%)出现并发症,均属轻度(Clavien 分级Ⅰ/Ⅱ),包括3例术后发热、1例术后血尿、2例轻微肾盂穿孔和2例尿外渗。术后住院时间为(2.7±1.0) d。结论:对于≤2.5 cm的儿童肾结石,SMP是一种有效且安全的治疗方法。SMP可作为冲击波碎石术(SWL) 或输尿管软镜碎石术(RIRS)治疗无效的儿童肾结石的理想选择。

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	刘永达艾尔肯·吐尔逊蔡超刘旸阿布都卡哈尔·巴吐尔周奕洲罗嘉伟吴文起陈文忠钟文曾国华

关键词 ：超微经皮肾镜取石术, 儿童肾结石, 治疗

Abstract：Objective: To evaluate the efficacy and safety of Super-mini percutaneous nephrolithotomy (SMP) in the treatment of pediatric renal stones. Methods: Data of 51 pediatric patients with renal stones who were managed by SMP in the First People's Hospital of Kashi from September 2014 to September 2015 were retrospectively reviewed, including 32 boys and 19 girls. The mean age of patients was (2.9±2.4) years (range: 5 months to 12 years). The mean stone burden was (1.9±0.7) cm (range: 0.8 to 4.8 cm). Results: Of 51 cases, 49 cases were managed by SMP successfully in one session, however, 2 cases were given two-stage SMP due to pyonephrosis. The mean operative time was (49.8±15.5) min. The mean hemoglobin drop was found to be (10.4±4.7) g/L and no transfusion was needed. There were 44 cases (86.3%) without nephrostomy tube or ureteric stent (totally tubeless), 2 cases (3.9%) only with ureteric catheter, 2 cases (3.9%) with nephrostomy tube and ureteric catheter, and 3 cases (5.9%) with nephrostomy tube and double J stent. The stone-free rate (SFR) at 24 h and 3 months was 86.3% and 90.2%, respectively. Clavien Ⅰ/Ⅱ complication rate was 15.7% (8/51),
基金项目:广东省科技计划项目(2016A020212023);广州市科技计划项目(201507020026)
including 3 cases of postoperative fever, 1 case of hematuria, 2 cases of minimal pelvis perforation and 2 cases of urinary extravasation. The postoperative hospital stay was (2.7±1.0) days. Conclusions: SMP is safe and effective for the management of <2.5 cm renal stones in children. SMP could be an ideal alternative modality for pediatric renal stones that not amenable to extracorporeal shock wave lithotripsy or flexible ureteroscopic lithotripsy.

Key words： super-mini percutaneous nephrolithotomy pediatric renal stones treatment

收稿日期: 2016-06-12

ZTFLH:

R692

基金资助:广东省科技计划项目(2016A020212023);广州市科技计划项目(201507020026)

通讯作者: 曾国华,gzgyzgh@vip.sina.com

引用本文:

刘永达艾尔肯·吐尔逊蔡超刘旸阿布都卡哈尔·巴吐尔周奕洲罗嘉伟吴文起陈文忠钟文曾国华. 超微经皮肾镜取石术治疗儿童肾结石[J]. 微创泌尿外科杂志, 2016, 5(5): 295-299.
Liu Yongda Aierken Tuerxun Cai Chao Liu Yang
Abudukahaer Batuer Zhou Yizhou Luo Jiawei Wu Wenqi
Chen Wenzhong Zhong Wen Zeng Guohua. Initial report of SMP in the treatment of pediatric nephrolithiasis. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2016, 5(5): 295-299.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1214.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2016/V5/I5/295