Fang Xiaoliang,Huang Yunteng,Xu Maosheng,et al.Efficacy of visualized ultra-mini percutaneous nephrolithotripsy in the treatment of pediatric nephrolithiasis without hydronephrosis[J].Journal of Clinical Pediatric Surgery,,19():688-693.[doi:10.3969/j.issn.1671-6353.2020.08.006]
Efficacy of visualized ultra-mini percutaneous nephrolithotripsy in the treatment of pediatric nephrolithiasis without hydronephrosis
- Keywords:
- Kidney Calculi/SU; Lithotripsy; Percutaneous Nephrostomy; Child
- CLC:
- R692.4;R726.1;R726.1
- Abstract:
- Objective To evaluated the clinical safety and efficacy of visualized ultra-mini percutaneous nephrolithotripsy in the treatment of pediatric nephrolithiasis without hydronephrosis. Methods From August 2018 to November 2019, clinical data were analyzed retrospectively for 14 children with nephrolithiasis undergoing visualized ultra-mini percutaneous nephrolithotripsy. There were 8 boys and 6 girls with a median operative age of 60.77(70-190) months. The involved side was left (n=6), right (n=7) and bilateral (n=1). Nephrolithiasis was single (n=3) and multiple (n=11). The average diameter of nephrolithiasis was (14.47±6.52)(8-30) mm and the average CT value of nephrolithiasis (1031.80±341.35)(498-1951) HU. All children were placed in a lithotomy position with an indwelling ureteral stent for mimicking hydronephrosis. According to the size of stone and calf neck, selections were allowed for expanding to F12 ultra-micro channel. Percutaneous access (F12) was established under ultrasonic guidance and visualized ultra-mini percutaneous nephrolithotripsy performed with a F8 nephroscope and holmium laser lithotripsy. Results Percutaneous access was successfully established one-time in all 14 children. Visualized ultra-mini percutaneous nephrolithotripsy was performed with a single channel at 14 sides while F4.8 micro-percpercutaneous nephrolithotripsy assisted in only one case. The average operative duration was (80-145)(107.00±18.25) min and the average postoperative decline of hemoglobin (13.60±10.93) g/L. None of them required blood transfusion. The average stay of postoperative hospitalization was (6.87±2.97) days. There were postoperative fever (Clavien grade Ⅱ, n=2) and required staged operation due to staghorn nephrolithiasis (n=2). The stone-free rate was 80.0%(12/15) at the first stage and 93.3%(14/15) at the second stage. One case with clinical significant residual stone underwent extracorporeal shock wave lithotripsy (ESWL). No severe complications, such as septic shock, serious bleeding, perforation, thoracic or abdominal injury, etc. occurred. The average follow-up period was (6-22)(12.58±4.87) months. There was only one recurrent case of cysteine stone. Conclusion Visualized ultra-mini percutaneous nephrolithotripsy is both safe and effective for pediatric nephrolithiasis without hydronephrosis. With low complications and a satisfactory stone-free rate, it should be further popularized in clinical practice.
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Memo
收稿日期:2020-06-12。
基金项目:国家自然基金面上项目（编号：81770702）
通讯作者:耿红全,Email:genghongquan@xinhuamed.com.cn