Zhao Fangzhou,Li Jun,Jiao Jianwei.Comparison of effectiveness and safety for pediatric 1-2 cm lower calyceal stones between micro-percutaneous nephrolithotomy and retrograde intrarenal stone surgery[J].Journal of Clinical Pediatric Surgery,,19():672-676,682.[doi:10.3969/j.issn.1671-6353.2020.08.003]
Comparison of effectiveness and safety for pediatric 1-2 cm lower calyceal stones between micro-percutaneous nephrolithotomy and retrograde intrarenal stone surgery
- Keywords:
- Kidney Calculi/SU; Lithotripsy; Percutaneous Nephrostomy; Ureteroscopes; Child
- CLC:
- R692.4;R616.5;R726.1
- Abstract:
- Objective To compare the therapeutic effectiveness and safety for pediatric 1-2cm moderately-sized lower calyceal stones between micro-percutaneous nephrolithotomy (Microperc) and retrograde intrarenal stone surgery (RIRS). Methods Between 2014 and 2020, clinical data were collected for 61 children with 1-2 cm lower calyceal stones. There were 46 boys and 15 girls with an age range of 6 to 144 months. They were divided into two groups of Microperc (n=27) and RIRS (n=34). Baseline data of age, gender, body mass index, kidney laterality, fever, preoperative positive urine culture, hydronephrosis and stone diameters were compared to determine the comparability of two groups. Surgical parameters, stone free rate (SFR) and complication rates at Day 1 and Month 1 were recorded. Results For Microperc and RIRS groups, SFR was 92.6% (25/27) vs. 82.4% (28/34) without significant difference (χ2=0.632, P=0.427), auxiliary therapeutic rate 0% vs. 11.8% without significant difference (P=0.122), surgical duration (41.2±20.0 vs. 36.5±11.1) min with statistical significance (t=2.109, P=0.039), fluid irrigation (192.6±101.5) vs. (392.1±171.8) ml with statistical significance (t=-4.357, P=0.005), hospitalization stay (5.9±2.7 vs. 5.4±1.6 days) without significant difference (t=0.812, P=0.420) and complication rate 22.2% vs. 14.7% without statistical significance (χ2=0.575, P=0.448). Conclusion Microperc and RIRS have similar therapeutic effectiveness and safety for pediatric 1-2 cm moderately-sized lower calyceal stones.
References:
1 Miah T,Kamat D.Pediatric nephrolithiasis:a review[J].Pediatr Ann,2017,46(6):e242-e244.DOI:10.3928/19382359-20170517-02.
2 Desai M,Mishra S.‘Microperc’ micro percutaneous nephrolithotomy:evidence to practice[J].Curr Opin Urol,2012,22(2):134-138.DOI:10.1097/MOU.0b013e32834fc3bb.
3 Sen H,Seckiner I,Bayrak O,et al.A comparison of micro-PERC and retrograde intrarenal surgery results in pediatric patients with renal stones[J].J Pediatr Urol,2017,13(6):619.e611-619.e615.DOI:10.1016/j.jpurol.2017.04.022.
4 Wang W,Ge Y,Wang Z,et al.Comparing micropercutaneous nephrolithotomy and retrograde intrarenal surgery in treating 1-2 cm solitary renal stones in pediatric patients younger than 3 years[J].J Pediatr Urol,2019,15(5):517.e511-517.e516.DOI:10.1016/j.jpurol.2019.06.010.
5 施卫国, 周华设, 沈亮. 输尿管镜碎石与后腹腔镜取石术后血尿的对照研究[J].中外医学研究,2018,16(36):15-17.DOI:10.14033/j.cnki.cfmr.2018.36.006. Shi WG,Zhou HS,Shen L.The Study of Post-operation Hematuria between Ureteroscopic Lithotripsy and Retroperitoneal Laparoscopic Ureterolithotomy[J].Chinese and Foreign Medical Research,2018,16(36):15-17.DOI:10.14033/j.cnki.cfmr.2018.36.006.
6 Inoue T,Murota T,Okada S,et al.Influence of pelvicaliceal anatomy on stone clearance after flexible ureteroscopy and holmium laser lithotripsy for large renal stones[J].J Endourol,2015,29(9):998-1005.DOI:10.1089/end.2015.0071.
7 Karim S,Hanna L,Geraghty R,et al.Role of pelvicalyceal anatomy in the outcomes of retrograde intrarenal surgery (RIRS) for lower pole stones:outcomes with a systematic review of literature[J].Urolithiasis,2020,48(3):263-270.DOI:10.1007/s00240-019-01150-0.
8 Karatag T,Tepeler A,Silay M,et al.A Comparison of 2 percutaneous nephrolithotomy techniques for the treatment of pediatric kidney stones of sizes 10-20 mm:Microperc vs Miniperc[J].Urology,2015,85(5):1015-1018.DOI:10.1016/j.urology.2015.02.010.
9 Farouk A,Tawfick A,Shoeb M,et al.Is mini-percutaneous nephrolithotomy a safe alternative to extracorporeal shockwave lithotripsy in pediatric age group in borderline stones? a randomized prospective study[J].World J Urol,2018,36(7):1139-1147.DOI:10.1007/s00345-018-2231-9.
10 Caione P,De Dominicis M,Collura G,et al.Microperc for pediatric nephrolithiasis:technique in valdivia-modified position[J].Eur J Pediatr Surg,2015,25(1):94-99.DOI:10.1055/s-0034-1387939.
11 Ba? O,Dede O,Aydogmus Y,et al.Comparison of retrograde intrarenal surgery and micro-percutaneous nephrolithotomy in moderately sized pediatric kidney stones[J].J Endourol,2016,30(7):765-770.DOI:10.1089/end.2016.0043.
12 石博文,徐科,黄云腾.经皮肾镜取石术在儿童肾结石中的应用及进展[J].临床小儿外科杂志,2017,16(6):617-621.DOI:10.3969/j.issn.1671-6353.2017.06.021.Shi BW,Xu K,Huang YT.Applications and advances of percutaneous nephrolithotomy for pediatric nephrolithiasis[J].J Chin Ped Sur,2017,16(6):617-621.DOI:10.3969/j.issn.1671-6353.2017.06.021.
13 Baum M.Editorial:Pediatric nephrolithiasis[J].Curr Opin Pediatr,2020,32(2):261-264.DOI:10.1097/mop.0000000000000874.
14 Karim SS,Hanna L,Geraghty R,et al.Role of pelvicalyceal anatomy in the outcomes of retrograde intrarenal surgery (RIRS) for lower pole stones:outcomes with a systematic review of literature[J].Urolithiasis,2020,48(3):263-270.DOI:10.1007/s00240-019-01150-0.
15 Li J,Wang WY,Du Y,et al.Combined use of flexible ureteroscopic lithotripsy with micro-percutaneous nephrolithotomy in pediatric multiple kidney stones[J].J Pediatr Urol,2018,14(3):281.e281-281.e286.DOI:10.1016/j.jpurol.2018.03.005.
16 Da?gülli M,Utan?a? M,Dede O,et al.Micro-percutaneous nephrolithotomy in the treatment of pediatric nephrolithiasis:A single-center experience[J].J Pediatr Surg,2016,51(4):626-629.DOI:10.1016/j.jpedsurg.2015.09.012.
17 Silay M,Tepeler A,Atis G,et al.Initial report of microperc in the treatment of pediatric nephrolithiasis[J].J Pediatr Surg,2013,48(7):1578-1583.DOI:10.1016/j.jpedsurg.2013.06.015.
18 Tepeler A,Akman T,Silay M,et al.Comparison of intrarenal pelvic pressure during micro-percutaneous nephrolithotomy and conventional percutaneous nephrolithotomy[J].Urolithiasis,2014,42(3):275-279.DOI:10.1007/s00240-014-0646-3.
Memo
收稿日期:2020-06-18。
基金项目:北京市医院管理局临床技术创新项目（编号：XMLX201826）
通讯作者:李钧,Email:zfzlijun@126.com