Ainiwaer Aierken,Xu Hai,Kahaerman Silamu,et al.Curative comparison of three mini-invasive surgical treatments for 10-20 mm kidney calculi in children[J].Journal of Clinical Pediatric Surgery,2025,(09):853-857.[doi:10.3760/cma.j.cn101785-202412055-009]
三种微创手术治疗10~20 mm儿童肾结石的疗效对比
- Title:
- Curative comparison of three mini-invasive surgical treatments for 10-20 mm kidney calculi in children
- Keywords:
- Kidney Calculi; Surgical Procedures; Operative; Child
- 摘要:
- 目的 比较超微通道经皮肾镜取石术(super mini-percutaneous nephrolithotomy, SMP)、微通道经皮肾镜取石术(mini-percutaneous nephrolithotomy, mPCNL)与输尿管软镜碎石术(retrograde intrarenal surgery, RIRS)对10~20 mm儿童肾结石的疗效。方法 回顾性分析2015年1月至2019年12月喀什地区第一人民医院128例结石直径为10~20 mm的儿童(< 14岁)肾结石患者临床资料。其中SMP组43例，采用SMP进行碎石取石(F12 — 14)；mPCNL组45例，采用mPCNL进行碎石取石(F14 — 16)；RIRS组40例，采用输尿管软镜进行碎石取石。比较3组手术时间、住院时间，术后即刻血红蛋白下降度、结石清除率，术后无管化率及并发症发生率。结果 SMP组住院时间(6.9±1.1)d，明显短于mPCNL组[(7.9±0.9)d]和RIRS组[(7.5±1.3)d]，差异有统计学意义(P < 0.05)；SMP组完全无管化率(72.1%，31/43)明显高于mPCNL组(48.9%，22/45)和RIRS组(0%，0/40)，差异有统计学意义(P < 0.001)；RIRS组手术时间[(31.6±10.9)min]明显短于mPCNL组[(44.1±17.8)min]，差异有统计学意义(P=0.001)，但与SMP组[(40.5±19.1)min]差异没有统计学意义(P>0.05)；RIRS组留置输尿管支架率(100%，40/40)明显高于SMP组(23%，10/43)和mPCNL组(26.7%，12/45)，差异有统计学意义(P < 0.001)；mPCNL组留置肾造瘘管率(24%，11/45)高于SMP组(4.6%，2/43)和RIRS组(0%，0/40)，差异有统计学意义(P < 0.001)；3组术后1个月结石清除率、术后即刻血红蛋白下降率差异均没有统计学意义(P>0.05)。结论 SMP、mPCNL和RIRS均为治疗直径10~20 mm儿童肾结石的安全、有效方法，其中SMP具有住院时间短、无管化率高的优点，RIRS具有手术时间短的优点。
- Abstract:
- Objective To compare the efficacies of super mini-percutaneous nephrolithotomy (SMP), mini-percutaneous nephrolithotomy (mPCNL) and retrograde intrarenal surgery (RIRS) for 10-20 mm kidney calculi in children. Methods From January 2015 to December 2019, the relevant clinical data were retrospectively reviewed for 128 children aged < 14 year with 10-20 mm kidney calculi.SMP group underwent lithotripsy (F12-14)(n=43) while mPCNL group lithotriptic extraction (F14-16)(n=45) and RIRS group ureteral soft scope lithotripsy (n=40).Operative duration, hospitalization stay, immediate postoperative hemoglobin decline, calculi clearance rate, postoperative catheterization rate and complication rate were compared among three groups. Results Length of hospitalization stay in SMP group was (6.9±1.1) day.It was significantly shorter than that in mPCNL group (7.9±0.9) day and RIRS group (7.5±1.3) day.The difference was statistically significant (P < 0.05).The rate of complete distubation in SMP group (72.1%, 31/43) was significantly higher than that in mPCNL group (48.9%, 22/45) and RIRS group (0%, 0/40).And the difference was statistically significant (P < 0.001).Operative duration of RIRS group was (31.6±10.9)min and it was significantly shorter than that of mPCNL group (44.1±17.8) min.And the difference was statistically significant (P=0.001).However, no statistically significant difference existed between RIRS and SMP groups (40.5±19.1) min (P>0.05).Rate of ureteral stenting in RIRS group (100%, 40/40) was significantly higher than that in SMP group (23%, 10/43) and mPCNL group (26.7%, 12/45).And the difference was statistically significant (P < 0.001).Rate of indentable nephrostomy tube in mPCNL group (24%, 11/45) was higher than that in SMP group (4.7%, 2/43) and RIRS group (0%, 0/40).And the difference was statistically significant (P < 0.001).No significant difference existed in calculi clearance rate or immediate hemoglobin decline rate at Month 3 post-operation among 3 groups (P>0.05). Conclusions SMP, mPCNL and RIRS are all safe and efficacious for 10-20 mm kidney calculi in children.However, SMP offers the advantages of shorter hospitalization stay and a higher tube-free rate.RIRS group has short operative duration.
参考文献/References:
[1] 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. 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.
[2] Huang YL, Li KW, Yang WZ, et al. A scoring system for optimal selection of endoscopic treatment for 1-2 cm lower pole renal calculi[J]. Urol J, 2022, 19(5): 356-362. DOI:10.22037/uj.v19i.7195.
[3] Julieb?-Jones P, Gauhar V, Lim EJ, et al. Outcomes and considerations for retrograde intrarenal surgery (RIRS) in the setting of multiple and large renal stones (>15 mm) in children: findings from multicentre and real-world setting[J]. BJUI Compass, 2024, 5(6): 558-563. DOI:10.1002/bco2.357.
[4] Zeng GH, Zhang T, Agrawal M, et al. Super-mini percutaneous nephrolithotomy(SMP)vs retrograde intrarenal surgery for the treatment of 1-2 cm lower-pole renal calculi: an international multicentre randomised controlled trial[J]. BJU Int, 2018, 122(6): 1034-1040. DOI:10.1111/bju.14427.
[5] Fahmy A, Dawoud W, Badawy H, et al. Optimum duration of ureteral prestenting dwelling time in children undergoing retrograde intrarenal surgery[J]. J Pediatr Urol, 2021, 17(6): 845. e1-845. e6. DOI:10.1016/j.jpurol.2021.08.005.
[6] Simayi A, Lei P, Tayier T, et al. Comparison of super-mini versus mini percutaneous nephrolithotomy for the treatment of upper urinary tract stones in children: a single centre experience[J]. Pediatr Surg Int, 2021, 37(8): 1141-1146. DOI:10.1007/s00383-021-04925-y.
[7] Zhong W, Wen JJ, Peng LJ, et al. Enhanced super-mini-PCNL (eSMP): low renal pelvic pressure and high stone removal efficiency in a prospective randomized controlled trial[J]. World J Urol, 2021, 39(3): 929-934. DOI:10.1007/s00345-020-03263-3.
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备注/Memo
收稿日期:2024-12-20。
基金项目:“天山英才”医药卫生高层次人才培养计划项目(TSYC202301B078);新疆人工智能影像辅助诊断重点实验室开放课题项目(XJRGZN2024011)
通讯作者:加素尔·巴吐尔，Email: Jasurbatur@foxmail.com