Zhong Liang,Zou Xiangyu,Sun Jie.Feasibility analysis of combined endoscopes for complicated upper urinary calculi in children[J].Journal of Clinical Pediatric Surgery,2020,19(08):677-682.[doi:10.3969/j.issn.1671-6353.2020.08.004]
双镜联合治疗儿童复杂上尿路结石的可行性分析
- Title:
- Feasibility analysis of combined endoscopes for complicated upper urinary calculi in children
- Keywords:
- Urinary Calculi/SU; Laparoscopes; Ureteroscopes; Percutaneous Nephrostomy; Child
- 分类号:
- R691.4;R726.9;R726.1
- 摘要:
- 目的 探讨双镜联合治疗儿童复杂性上尿路结石的可行性和安全性。方法 回顾性收集2017年1月至2020年1月于上海交通大学医学院附属上海儿童医学中心接受治疗的9例复杂性上尿路结石患儿作为研究对象，其中5例为输尿管末端狭窄合并肾结石，1例为右肾重复畸形下半肾积水合并结石，1例为双侧输尿管结石伴右肾重度积水，1例为肾盂输尿管连接部狭窄合并下盏结石，1例为鹿角状结石。手术方式包括腹腔镜联合输尿管软镜或经皮肾镜、经皮肾镜联合输尿管软镜2种。结果 9例患儿中男童7例，女童2例，平均年龄（45±47）个月，中位年龄27个月。所有患儿均成功完成手术，平均手术时间（138±37）min，中位手术时间134 min，无明显手术并发症。5例输尿管末端狭窄合并肾结石患儿结石成分均为草酸钙，术后随访期间未见结石复发。1例重复肾下半肾积水患儿结石成分为草酸钙，术后随访期间未见结石复发。1例双侧输尿管结石伴右肾重度积水患儿结石成分为尿酸，目前该患儿尚未拔除DJ管。1例肾盂输尿管连接部狭窄合并肾下盏结石的患儿结石成分为碳酸磷灰石和一水草酸钙，随访至今未见复发。1例鹿角状结石成分为草酸钙，术后随访1年结石复发。结论 双镜联合治疗方法可安全有效地处理儿童复杂性上尿路结石。
- Abstract:
- Objective To explore the feasibility and safety of combined endoscopic treatment for complicated upper urinary calculi in children. Methods Retrospective reviews were conducted for 9 children undergoing two concomitant endoscopes from January 2017 to January 2020. The clinical data of gender, age and operative duration were collected and treatment flows and outcomes summarized. There were ureteral terminal stricture with renal calculi (n=5), hydronephrosis in duplex kidney plus calculi (n=1), bilateral ureteral calculi with severe hydronephrosis in right kidney (n=1), ureteropelelic junction obstruction with lower calyceal calculi (n=1) and staghorn calculi (n=1). Concomitant endoscopes included laparoscope plus flexible ureteroscope or percutaneous nephroscope and percutaneous nephroscope plus flexible ureteroscope. Results There were 7 boys and 2 girls with a median age of 27(45±47) months. All operations were completed successfully without obvious complications. The mean operative duration was 134(138±37) min. Ureteral terminal stricture (n=5) and hydronephrosis in duplex kidney (n=1) were all composed of calcium oxalate and there was no recurrence of calculi during postoperative follow-ups. The composition of bilateral ureteral calculi with severe hydronephrosis in right kidney was uric acid and DJ tube remained in place. Then the composition of ureteropelelic junction obstruction with lower calyceal calculi was carbonate apatite and calcium oxalate and there was no recurrence of calculi. Staghorn calculi was composed of calcium oxalate and recurrence occurred during a 1-year follow-up period. Conclusion Concomitant endoscopes may safely and effectively treat complicated upper urinary calculi in children.
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备注/Memo
收稿日期:2020-06-07。
基金项目:国家自然科学基金青年基金（编号：81601267）；国家自然科学基金面上项目（编号：81871149）；上海交通大学医工交叉基金（编号：ZH2018ZDB07）
通讯作者:孙杰,Email:sunjie@scmc.com.cn