Abstract：Objective: To evaluate the clinical safety and efficacy of super-micro percutaneous nephrolithotomy (SMP) in the treatment of paediatric renal pelvis calculi. Methods: The clinical data of 32 children with unilateral renal pelvis calculi treated by SMP in our institute from January 2013 to January 2016 were analyzed retrospectively. Thirty-two children, including 19 boys and 13 girls with the age ranging from 0.5 to 12 years (mean 7.3±3.2 years), were diagnosed as having unilateral renal pelvis calculi. The renal pelvis calculi were in the left side in 11 cases, and in the right side in 21 cases. The stone diameter ranged from 1.9 to 3.2 cm (mean 2.8±0.4 cm). Percutaneous access (F12) was established under ultrasound guidance, and SMP was performed using a F8/9.8 ureteroscope and holmium laser lithotripsy. The nephrostomy tube was removed at 3rd-5th day postoperation, and the double J sent was removed at 3rd-4th week postoperation. Results: The percutaneous access was successfully established in all children with only one trial, and SMP was performed under single channel. The operation time was (25.4±6.7) min, intraoperative bleeding volume was (83.5±14.6) mL, hospital stay was (3.1±1.3) days, and stone clearance rate was 96.9% (31/32). One case with clinically significant residual stones was treated by ESWL in the two-stage operation. No severe complications, such as septic shock, serious bleeding, perforation, thoracic or abdominal injury, etc. occurred. During a follow-up period of 6 to 9 months postoperation, no recurrent stones were observed and the stone-free rate was 100%. Conclusions: SMP is a safe and effective method for the treatment of paediatric renal pelvis calculi, and it is worthy of clinical application.
[1]Izol V, Aridogan IA, Karsli O, et al. The effect of prophylactic treatment with Shohl's solution in children with cystinuria. J Pediatr Urol, 2013,9(6):1218-1222. [2]Jurkiewicz B, Zbkowski T, Samotyjek J. Ureterolithotripsy in a paediatric population: a single institution's experience. Urolithiasis, 2014,42(2):171-176. [3]Horuz R, Sarica K. The management of staghorn calculi in children. Arab J Urol, 2012,10(3):330-335. [4]王志铁,阳海平,李秋,等.53例无症状小儿肾结石随访和预后分析.重庆医科大学学报,2013,38(11):1385-1388. [5]Gnessin E, Chertin L, Chertin B. Current management of paediatric urolithiasis. Pediatr Surg Int, 2012,28(7):659-665. [6]周淑新,梁剑虹.肾结石的治疗与预防.中国全科医学,2012,15(13):1431-1434. [7]González Herrero M, Morante Valverde R, Tordable Ojeda C, et al. Therapeutic approach in urinary tract stones in children. Cir Pediatr, 2014,27(3):135-139. [8]Altintas R, Oguz F, Tasdemir C, et al. The importance of instrument type in paediatric percutaneous nephrolithotomy. Urolithiasis, 2014,42(2):149-153. [9]Lu P, Wang Z, Song R, et al. The clinical efficacy of extracorporeal shock wave lithotripsy in pediatric urolithiasis: a systematic review and meta-analysis. Urolithiasis, 2015,43(3):199-206. [10]Aldaqadossi HA, Kotb Y, Mohi K. Efficacy and safety of percutaneous nephrolithotomy in children with previous renal stone operations. J Endourol, 2015,29(8):878-882. [11]Penbegul N, Tepeler A, Sancaktutar AA, et al. Safety and efficacy of ultrasound-guided percutaneous nephrolithotomy for treatment of urinary stone disease in children. Urology, 2012,79(5):1015-1019. [12]Brodie KE, Lane VA, Lee TW, et al. Outcomes following 'mini' percutaneous nephrolithotomy for renal calculi in children. A single-centre study. J Pediatr Urol, 2015,11(3):120.e1-120.e5. [13]吴文正,赵志健,钟文,等.PCNL治疗儿童与成人上尿路结石对比研究.微创泌尿外科杂志,2013,2(3):202-206. [14]王海东,李贵忠,王建伟,等.彩色多普勒超声引导下微通道经皮肾镜取石术治疗学龄前儿童肾结石.中华小儿外科杂志,2013,34(6):430-433. [15]Guo J, Yang WZ, Zhang Y, et al. Ultramini nephrostomy tract combined with flexible ureterorenoscopy for the treatment of multiple renal calculi in paediatric patients. Korean J Urol, 2015,56(7):519-524. [16]Desai J, Solanki R. Ultra-mini percutaneous nephrolithotomy (UMP): one more armamentarium. BJU Int, 2013,112(7):1046-1049. [17]孙红红,王小波,王亚申,等.超微经皮肾镜取石术治疗临床有意义残石的疗效观察.现代泌尿外科杂志,2016,21(4):295-297.
