Zhong Liang,Zou Xiangyu,Hou Yanping,et al.Comparative study of flexible ureteroscopy and mini-percutaneous nephrolithotomy for treating 1-2 cm pediatric renal stones[J].Journal of Clinical Pediatric Surgery,2025,(01):13-17.[doi:10.3760/cma.j.cn101785-202410032-003]
输尿管软镜与小通道经皮肾镜治疗儿童1~2厘米肾结石的对比研究
- Title:
- Comparative study of flexible ureteroscopy and mini-percutaneous nephrolithotomy for treating 1-2 cm pediatric renal stones
- Keywords:
- Urinary Calculi; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨输尿管软镜(flexible ureteroscopy,fURS)与小通道经皮肾镜(mini-percutaneous nephrolithotomy,mini-PCNL)治疗儿童1~2 cm肾结石的安全性及有效性。方法 本研究为回顾性研究,收集2019年10月至2024年10月于上海儿童医学中心接受输尿管软镜、小通道经皮肾镜(F4.8、F11)治疗的儿童肾结石患者资料,按照手术方式分为输尿管软镜组(n=26)与小通道经皮肾镜组(n=18),对两组患儿年龄、性别、结石大小、位置、下盏结石占比、累计手术时间、累计住院天数、累计住院费用、3 mm以上结石残留等数据进行对比分析。结果 输尿管软镜组与小通道经皮肾镜组患儿年龄、结石最大长径、结石密度、下盏结石占比(2/26比4/18)比较,差异无统计学意义(P＞0.05);两组累计住院天数、累计手术时间比较,差异有统计学意义(P<0.05);两组累计住院费用、术后2个月结石清除率(21/26比16/18)比较,差异无统计学意义(P>0.05)。结论 F4.8、F11小通道经皮肾镜手术治疗儿童1~2 cm肾结石安全有效,较输尿管软镜手术具有手术时间短、住院时间短等优点,尤其对于下盏结石更具有优势。
- Abstract:
- Objective To evaluate the safety and efficacy of flexible ureteroscopy (fURS) and mini-percutaneous nephrolithotomy (mini-PCNL) in the treatment of 1-2 cm renal stones in pediatric patients. Methods This retrospective study analyzed the clinical data of pediatric patients treated for renal stones with fURS or mini-PCNL (F4.8 and F11) at Shanghai Children’s Medical Center between October 2019 and October 2024.Patients were divided into the fURS group (n=26) and the mini-PCNL group (n=18) based on the surgical approach.Data on age,gender,stone size,location,proportion of lower calyx stones,cumulative operation time,hospital stay,hospital costs,and residual stones larger than 3 mm were compared between the groups. Results There were no significant differences between the fURS and mini-PCNL groups in terms of age,maximum stone diameter, stone density or proportion of lower calyx stones (2/26 vs.4/18).However,the mini-PCNL group had significantly shorter cumulative hospital stay and cumulative operation times (P<0.05) There were no significant differences between the two groups in cumulative hospital costs or stone-free rates at two months post-surgery (21/26 vs.16/18) (P>0.05). Conclusions Mini-PCNL (F4.8,F11) is a safe and effective surgical option for treating 1-2 cm pediatric renal stones.Compared with fURS,it offers advantages such as shorter operative and hospital stays,particularly for lower calyx stones.
参考文献/References:
[1] Tasian GE, Ross ME, Song LH, et al.Annual incidence of nephrolithiasis among children and adults in South Carolina from 1997 to 2012[J]. Clin J Am Soc Nephrol, 2016, 11(3):488-496.DOI:10.2215/CJN.07610715.
[2] Akin Y, Yucel S.Long-term effects of pediatric extracorporeal shockwave lithotripsy on renal function[J]. Res Rep Urol, 2014, 6:21-25.DOI:10.2147/RRU.S40965.
[3] Aksoy Y, ?zbey I·, Atmaca AF, et al.Extracorporeal shock wave lithotripsy in children:experience using a mpl-9000 lithotriptor[J]. World J Urol, 2004, 22(2):115-119.DOI:10.1007/s00345-003-0385-5.
[4] 刘李, 李创业, 赵夭望, 等.逆行输尿管软镜碎石术治疗儿童肾及输尿管上段结石的疗效与安全性探讨[J]. 临床小儿外科杂志, 2022, 21(9):866-870.DOI:10.3760/cma.j.cn101785-202205066-013. Liu L, Li CY, Zhao YW, et al.Flexible ureteroscopic lithotripsy for upper urinary tract calculi in children[J]. DOI:10.3760/cma.j.cn101785-202205066-013.
[5] 卡哈尔曼·斯拉木, 赵方舟, 迪力夏提·吾麦尔, 等.两种经皮肾镜碎石术式治疗新疆维吾尔族儿童多发性肾结石疗效的回顾性分析[J]. 临床小儿外科杂志, 2020, 19(11):1026-1031.DOI:10.3969/j.issn.1671-6353.2020.11.013. Islam Kahriman, Zhao FZ, Omar Dilxat, et al.Retrospective comparison of two different PCNL procedures for pediatric sporadic nephrolithiasis in Xinjiang[J]. J Clin Ped Sur, 2020, 19(11):1026-1031.DOI:10.3969/j.issn.1671-6353.2020.11.013.
[6] 中华医学会小儿外科学分会泌尿外科学组.儿童肾结石诊疗的临床专家共识[J]. 临床小儿外科杂志, 2021, 20(2):107-113.DOI:10.12260/lcxewkzz.2021.02.002. Group of Urology, Branch of Pediatric Surgery, Chinese Medical Association.Clinical expert consensus on managing kidney stones in children[J]. J Clin Ped Sur, 2021, 20(2):107-113.DOI:10.12260/lcxewkzz.2021.02.002.
[7] He Q, Xiao KW, Chen YT, et al.Which is the best treatment of pediatric upper urinary tract stones among extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy and retrograde intrarenal surgery:a systematic review[J]. BMC Urol, 2019, 19(1):98.DOI:10.1186/s12894-019-0520-2.
[8] Ergin G, Kirac M, Kopru B, et al.Shock wave lithotripsy or retrograde intrarenal surgery:which one is more effective for 10-20-mm renal stones in children[J]. Ir J Med Sci, 2018, 187(4):1121-1126.DOI:10.1007/s11845-018-1776-3.
[9] Dogan HS, Asci A, Kahraman O, et al.Comparison of efficiency and safety of retrograde intrarenal surgery and micropercutaneous nephrolithotomy in pediatric kidney stones smaller than 2 cm:a prospective cohort study[J]. J Endourol, 2021, 35(8):1124-1129.DOI:10.1089/end.2020.0624.
[10] 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.e1-517.e6.DOI:10.1016/j.jpurol.2019.06.010.
[11] Desai MR, Sharma R, Mishra S, et al.Single-step percutaneous nephrolithotomy (microperc):the initial clinical report[J]. J Urol, 2011, 186(1):140-145.DOI:10.1016/j.juro.2011.03.029.
[12] Liu Y, AlSmadi J, Zhu W, et al.Comparison of super-mini PCNL (SMP) versus Miniperc for stones larger than 2 cm:a propensity score-matching study[J]. World J Urol, 2018, 36(6):955-961.DOI:10.1007/s00345-018-2197-7.
[13] Dede O, Sancaktutar AA, Dagˇguli M, et al.Ultra-mini-percutaneous nephrolithotomy in pediatric nephrolithiasis:both low pressure and high efficiency[J]. J Pediatr Urol, 2015, 11(5):253.e1-253.e6.DOI:10.1016/j.jpurol.2015.03.012.
[14] ElSheemy MS, Daw K, Habib E, et al.Lower calyceal and renal pelvic stones in preschool children:a comparative study of mini-percutaneous nephrolithotomy versus extracorporeal shockwave lithotripsy[J]. Int J Urol, 2016, 23(7):564-570.DOI:10.1111/iju.13093.
相似文献/References:
[1]杜朝峻,丁力,胡英超,等.手术治疗婴幼儿法洛四联症83例[J].临床小儿外科杂志,2010,9(06):413.
DU Chao jun,DING Li,HU Ying chao,et al.Surgical treatment of Tetralogy of Fallot in infancy: Experiences of 83 cases.[J].Journal of Clinical Pediatric Surgery,2010,9(01):413.
[2]李勇,尹强,周小渔,等.术中胆道造影在先天性胆总管囊肿手术中的应用[J].临床小儿外科杂志,2010,9(06):430.
LI Yong,YIN Qiang,ZHOU Xiao yu,et al.The clinic application experience on intraoperative cholangiography in pediatric surgery.[J].Journal of Clinical Pediatric Surgery,2010,9(01):430.
[3]许芝林,王强,李琰,等.乙状结肠冗长症的术式选择探讨[J].临床小儿外科杂志,2010,9(06):432.
XU Zhi lin,WANG Qiang,LI Yan,et al.Initiatory exploration of the standard of surgical treatment methods for Dolichosigmoid.[J].Journal of Clinical Pediatric Surgery,2010,9(01):432.
[4]常绘文,沈振亚.右腋下小切口在儿童心内手术中的应用[J].临床小儿外科杂志,2010,9(06):439.
[5]胡明,施诚仁,严志龙.脐环小切口治疗婴幼儿腹盆腔疾病的探讨[J].临床小儿外科杂志,2010,9(06):471.
[6]丁勇,魏华,孔燕,等.横裁包皮岛状皮瓣法在尿道下裂治疗中的应用[J].临床小儿外科杂志,2010,9(06):474.
[7]江峰赵阳孙莲萍金惠明马杰.婴幼儿阻塞性脑积水两种手术方式的疗效比较[J].临床小儿外科杂志,2011,10(01):0.
JIANG Feng,ZHAO Yang,SUN Liang ping,et al.Endoscopic third ventricul ostomy versus ventricul operitoneal shunt:clinical study of obstructive hydro cephalus in infants.[J].Journal of Clinical Pediatric Surgery,2011,10(01):0.
[8]王伟程少文彭磊林忠勤张伟陈庆玉寇冬权.弹性髓内钉在儿童肱骨骨折中的应用[J].临床小儿外科杂志,2011,10(01):0.
WANG Wei,CHENG Shaowen,PENG Lei,et al.Application of elastic intramedullary nailing in pediatric humeral fractures.[J].Journal of Clinical Pediatric Surgery,2011,10(01):0.
[9]景登攀张根领孙蔓丽.改良Snodgrass术治疗尿道下裂疗效观察[J].临床小儿外科杂志,2011,10(01):0.
[10]刘国庆 王剑锋 朵永福 李杰荣 陈一平 黄振强 叶章群. 妊娠期尿结石对胎儿早产流产的影响[J].临床小儿外科杂志,2011,10(02):115.
Urolithiasis influence to develop of fetus in gestation period[J].Journal of Clinical Pediatric Surgery,2011,10(01):115.
备注/Memo
收稿日期:2024-10-14。
基金项目:三亚市科技创新专项项目(2022KJCX40)
通讯作者:孙杰,Email:sunjie@scmc.com