Che Yu,Abudusaimi Abudureyimu,Li Kai,et al.Efficacy analysis of visual needle nephroscopy combined with holmium laser lithotripsy for upper urinary tract stones in infants and young children[J].Journal of Clinical Pediatric Surgery,2025,(09):864-867.[doi:10.3760/cma.j.cn101785-202410063-011]
可视针状肾镜联合钬激光治疗婴幼儿上尿路结石的疗效分析
- Title:
- Efficacy analysis of visual needle nephroscopy combined with holmium laser lithotripsy for upper urinary tract stones in infants and young children
- Keywords:
- Urinary Calculi; Lasers; Solid-State; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨可视针状肾镜联合钬激光治疗婴幼儿上尿路结石的可行性、有效性。方法 本研究为回顾性研究，收集2021年5月至2024年3月于新疆维吾尔自治区儿童医院泌尿外科行可视针状肾镜治疗的35例(38侧)上尿路结石患儿临床资料。其中男22例、女13例，均为维吾尔族，年龄6~34个月。35例均经泌尿系CT检查确诊；单侧上尿路结石32例(左侧肾盂结石6例，右侧肾盂结石5例，左侧肾下盏结石12例，右侧肾下盏结石9例)，双侧上尿路结石3例；伴肾积水11例，上尿路感染5例，血尿8例，结石最长径12~25 mm，结石CT值960~1 530 Hu。主要观察指标包括：手术时间、术后住院时间、术后尿管留置时间、术中出血量，通过术后泌尿系平片(plain film of kidney-ureter-bladder，KUB)或泌尿系超声评估结石清除率。结果 本组35例中，27例单用F4.2可视针状肾镜穿刺目标肾盏，自针芯置入200 μm钬激光光纤粉末化碎石；8例经可视针状肾镜穿刺成功后，用筋膜扩张器扩张至F12，留置Peer-away鞘，用输尿管硬镜联合550 μm钬激光碎石。35例均穿刺成功并碎石，其中3例双肾多发性结石行双侧Ⅰ期碎石，平均手术时间40 min(35~55 min)。术后所有患儿留置F5输尿管导管和尿管1~2 d，尿液转清后去除，术后住院3~5 d。术后4周复查泌尿系B超，36侧结石排尽，结石清除率94.7%(36/38)。结论 超声引导下可视针状肾镜辅助经皮肾镜碎石治疗婴幼儿上尿路结石安全、有效，可有效避免通道扩张所致的肾脏出血，降低穿刺副损伤风险，缩短手术时间，提高手术安全性，亦可达到一期清石效果，适合婴幼儿上尿路的个体化治疗。
- Abstract:
- Objective To evaluate the feasibility and efficacy of visual needle nephroscopy combined with holmium laser lithotripsy for upper urinary tract stones in infants and young children. Methods This retrospective study included 35 pediatric patients who underwent visual needle nephroscopy for upper urinary tract stones at the Department of Urology, Children’s Hospital of Xinjiang Uygur Autonomous Region, from May 2021 to March 2024.The cohort consisted of 22 males and 13 females, all of Uyghur ethnicity, aged 6 to 34 months.All cases were confirmed by urinary system CT.There were 32 cases of unilateral upper urinary tract stones (left renal pelvis stones in 6 cases, right renal pelvis stones in 5 cases, left lower calyx stones in 12 cases, and right lower calyx stones in 9 cases) and 3 cases of bilateral upper urinary tract stones.Additionally, 11 cases had hydronephrosis, 5 had upper urinary tract infections, and 8 had hematuria.The maximum stone diameter ranged from 12 to 25 mm, with CT values between 960 and 1530 Hu.The primary outcome measures included operation time, postoperative hospital stay, postoperative urinary catheterization duration, and intraoperative blood loss.Stone clearance rate was assessed using postoperative kidney-ureter-bladder (KUB) X-ray or urinary ultrasound. Results Among the 35 cases, 27 underwent F4.2 visual needle nephroscopy for targeted renal calyx puncture, with 200 μm holmium laser fiber used for stone fragmentation via dusting technique.In the remaining 8 cases, after successful puncture with visual needle nephroscopy, fascial dilators were used to expand the tract to F12, followed by the placement of a Peer-away sheath and lithotripsy using a ureteroscope combined with a 550 μm holmium laser.All 35 cases achieved successful puncture and stone fragmentation, with 3 cases undergoing bilateral staged lithotripsy for multiple kidney stones.The average operative time was 40 minutes (range: 35-55 minutes).Postoperatively, all patients had an F5 ureteral catheter and a urinary catheter placed for 1-2 days, which were removed once urine became clear.The postoperative hospital stay ranged from 3 to 5 days.Follow-up ultrasound at 4 weeks post-surgery showed complete stone clearance in 36 renal units, yielding a stone-free rate of 94.7% (36/38). Conclusions Ultrasound-guided visual needle nephroscopy-assisted percutaneous nephrolithotomy is a safe and effective treatment for upper urinary tract stones in infants and young children.This approach minimizes renal bleeding caused by tract dilation, reduces the risk of puncture-related complications, shortens operative time, enhances surgical safety, and enables single-stage stone clearance.It provides an individualized treatment option for pediatric upper urinary tract stones.
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备注/Memo
收稿日期:2024-10-28。
基金项目:新疆维吾尔自治区重点研发计划资助项目(2023B03018-2)
通讯作者:刘东，Email：ld0275@163.com