Li Chuangye,Zhao Yaowang,Liu Li,et al.Efficacy and prevention of complications in percutaneous nephrolithotomy for pediatric complex renal stones[J].Journal of Clinical Pediatric Surgery,,():25-29.[doi:10.3760/cma.j.cn101785-202411030-005]
Efficacy and prevention of complications in percutaneous nephrolithotomy for pediatric complex renal stones
- Abstract:
- Objective To summarize the efficacy of percutaneous nephrolithotomy (PCNL) in the treatment of pediatric complex renal stones and share expriences in managing complications. Methods A retrospective analysis was conducted on clinical data from 144 children with complex renal stones treated with PCNL at the Department of Urology,Hunan Children’s Hospital (Center of Prevention and Treatment of Pediatric Urolithiasis,International Alliance of Urolithiasis) between June 2017 and December 2021.The cohort included 100 boys and 44 girls with a mean age of 7.3±4.2 years (range:0.4-18.0 years).Single stones were observed in 38 cases,while 106 cases had multiple stones.The mean stone diameter was 2.3±0.5 cm (range:1.5-3.8 cm),and all single stones exceeded 2 cm in diameter.Preoperative evaluations included urinary system ultrasound,kideny ureter bladder (KUB) X-rays,or CT scans to assess stone and anatomical conditions.Follow-ups ranged from 1 to 7 years,during which surgical time,outcomes,intraoperative and postoperative complications,and their management were recorded. Results The mean surgical time was 62.7±11.3 minutes (range:41-94).At 1-month postoperative review,128 cases achieved complete stone clearance (clearance rate:88.9%).At three month,131 cases achieved complete clearance (clearance rate:90.1%).Postoperative complications occurred in 16 cases (11.1%),classified according to the Clavien-Dindo system:Grade Ⅰ in 1 case,Grade Ⅱ in 13 cases,and Grade Ⅲ in 2 cases.No Grade Ⅳ or higher complications were reported. Conclusions PCNL is highly effective in treating pediatric complex renal stones,offering high stone clearance rates.It is currently the preferred treatment method,with manageable complications.Proper and timely interventions for complications can prevent major risks.
References:
[1] Sharma AP, Filler G.Epidemiology of pediatric urolithiasis[J]. Indian J Urol, 2010, 26(4):516-522.DOI:10.4103/0970-1591.74450.
[2] Kusumi K, Becknell B, Schwaderer A.Trends in pediatric urolithiasis:patient characteristics, associated diagnoses, and financial burden[J]. Pediatr Nephrol, 2015, 30(5):805-810.DOI:10.1007/s00467-014-3012-3.
[3] Liu YH, Yen CH, Tai YS, et al.Contemporary management of large and complex renal calculi:Have we found the perfect solution yet?[J]. Urol Sci, 2023, 34(4):164-169.DOI:10.4103/UROS.UROS_108_22.
[4] Yuan Y, Liang YN, Li KF, et al.A meta-analysis:retrograde intrarenal surgery vs.percutaneous nephrolithotomy in children[J]. Front Pediatr, 2023, 11:1086345.DOI:10.3389/fped.2023.1086345.
[5] Bujons A, Millán F, Centeno C, et al.Mini-percutaneous nephrolithotomy with high-power holmium YAG laser in pediatric patients with staghorn and complex calculi[J]. J Pediatr Urol, 2016, 12(4):253.e1-253.e5.DOI:10.1016/j.jpurol.2016.04.027.
[6] 厉晓伟, 袁杰, 沈大渝, 等.输尿管软镜联合负压吸引鞘治疗复杂肾结石的疗效和安全性[J]. 江苏大学学报(医学版), 2024, 34(4):317-320.DOI:10.13312/j.issn.1671-7783.y240021. Li XW, Yuan J, Shen DY, et al.The efficacy and safety of ureteroscopy combined with negative pressure suction sheath in the treatment of complex kidney stones[J]. J Jiangsu Univ (Med Ed), 2024, 34(4):317-320.DOI:10.13312/j.issn.1671-7783.y240021.
[7] 谢华伟, 周辉霞, 马立飞, 等. 两种经脐腹腔镜肾盂成形术治疗儿童肾积水的疗效比较[J]. 中华小儿外科杂志, 2015, 36(10):732-735.DOI:10.3760/cma.j.issn.0253-3006.2015.10.004. Xie HW, Zhou HX, Ma LF, et al.Comparison of two transumbilical laparoscopic pyeloplasties for treating ureteropelvic junction obstruction in children[J]. Chin J Pediatr Surg, 2015, 36(10):732-735.DOI:10.3760/cma.j.issn.0253-3006.2015.10.004.
[8] Xu ZH, Du GY, Zhao YJ, et al.Endoscopic combined intrarenal surgery composed of micro-perc and retrograde intrarenal surgery in the treatment of complex kidney stones in children[J]. World J Urol, 2024, 42(1):21.DOI:10.1007/s00345-023-04695-3.
[9] Qin DR, Tang YM, Wang XJ, et al.Combined laparoscope and flexible ureteroscope pyelolithotomy dealing with Large-Burden complex renal calculi in children less than 1 year old[J]. J Laparoendosc Adv Surg Tech A, 2019, 29(11):1492-1496.DOI:10.1089/lap.2019.0159.
[10] Radmayr C, Bogaert G, Bujons A, et al.EAU guidelines on paediatric urology[M]. Arnhem:EAU Guidelines Office, 2024.
[11] Jones P, Hawary A, Beck R, et al.Role of mini-percutaneous nephrolithotomy in the management of pediatric stone disease:a systematic review of literature[J]. J Endourol, 2021, 35(5):728-735.DOI:10.1089/end.2020.0743.
[12] 雍江, 覃锋, 赵夭望, 等.小儿泌尿系结石术后尿脓毒血症风险因素的分析[J]. 中华小儿外科杂志, 2024, 45(9):827-832.DOI:10.3760/cma.j.cn421158-20231227-00596. Yong J, Qin F, Zhao YW, et al.Risk factors of urinary sepsis after operation for urolithiasis in children[J]. Chin J Pediatr Surg, 2024, 45(9):827-832.DOI:10.3760/cma.j.cn421158-20231227-00596.
[13] Liu JC, Zhou CK, Gao WJ, et al.Does preoperative urine culture still play a role in predicting post-PCNL SIRS? A retrospective cohort study[J]. Urolithiasis, 2020, 48(3):251-256.DOI:10.1007/s00240-019-01148-8.
[14] Poudyal S.Current insights on haemorrhagic complications in percutaneous nephrolithotomy[J]. Asian J Urol, 2022, 9(1):81-93.DOI:10.1016/j.ajur.2021.05.007.
[15] Senocak C, Ozbek R, Bozkurt OF, et al.Predictive factors of bleeding among pediatric patients undergoing percutaneous nephrolithotomy[J]. Urolithiasis, 2018, 46(4):383-389.DOI:10.1007/s00240-017-1001-2.
[16] Razvi S, Zaidi Z.Percutaneous nephrolithotomy (PCNL) in horse shoe kidneys[J]. J Pak Med Assoc, 2007, 57(5):222-225.
[17] El Ghoneimy MN, Kodera AS, Emran AM, et al.Percutaneous nephrolithotomy in horseshoe kidneys:is rigid nephroscopy sufficient tool for complete clearance? A case series study[J]. BMC Urol, 2009, 9:17.DOI:10.1186/1471-2490-9-17.
[18] El-Nahas AR, Shokeir AA, El-Assmy AM, et al.Post-percutaneous nephrolithotomy extensive hemorrhage:a study of risk factors[J]. J Urol, 2007, 177(2):576-579.DOI:10.1016/j.juro.2006.09.048.
[19] Matlaga BR, Shah OD, Assimos DG.Complications of percutaneous approaches, including incisions[M] //Nakada SY, Pearle MS.Advanced Endourology.Totowa, NJ:Humana Press, 2006:283-297.DOI:10.1007/978-1-59259-954-7_17.
[20] Gnessin E, Yossepowitch O, Holland R, et al.Holmium laser endoureterotomy for benign ureteral stricture:a single center experience[J]. J Urol, 2009, 182(6):2775-2779.DOI:10.1016/j.juro.2009.08.051.
[21] Nerli RB, Kadeli V, Deole S, et al.Postpercutaneous nephrolithotomy ureteropelvic junction obstruction[J]. J Endourol Case Rep, 2020, 6(1):13-15.DOI:10.1089/cren.2019.0084.
Memo
收稿日期:2024-11-13。
基金项目:湖南省儿童泌尿生殖疾病临床医学研究中心(2021SK4017);湖南省重点领域研发计划项目(2020SK211)
通讯作者:赵夭望,Email:yw508@sina.com