Fang Xiaoliang,Huang Yunteng,Xu Maosheng,et al.Efficacy of visualized ultra-mini percutaneous nephrolithotripsy in the treatment of pediatric nephrolithiasis without hydronephrosis[J].Journal of Clinical Pediatric Surgery,2020,19(08):688-693.[doi:10.3969/j.issn.1671-6353.2020.08.006]
可视化超微通道经皮肾镜碎石术治疗儿童无积水肾结石的疗效分析
- Title:
- Efficacy of visualized ultra-mini percutaneous nephrolithotripsy in the treatment of pediatric nephrolithiasis without hydronephrosis
- Keywords:
- Kidney Calculi/SU; Lithotripsy; Percutaneous Nephrostomy; Child
- 分类号:
- R692.4;R726.1;R726.1
- 摘要:
- 目的 探讨可视化超微通道经皮肾镜碎石术治疗儿童无积水肾结石的安全性及有效性。方法 回顾性分析上海交通大学医学院附属新华医院小儿泌尿外科2018年8月至2019年11月采用可视化超微通道经皮肾镜碎石术治疗的14例无积水肾结石患儿的临床资料。其中男童8例，女童6例；手术时中位年龄60.77个月，年龄范围7~190个月；左侧6例，右侧7例，双侧1例；单发肾结石3例，多发性肾结石11例，结石平均直径（14.47±6.52）mm，范围8~30 mm，术前结石的平均CT值为（1 031.80±341.35）HU，范围498~1951 HU。所有患儿膀胱截石位留置输尿管导管制造人工肾积水，俯卧位B超引导下应用可视化穿刺系统穿刺目标肾盏，根据结石大小和盏颈情况选择扩张至F12超微通道。结果 14例患儿共进行15侧次碎石手术，共建立15个工作通道，1侧次辅助F4.8极微通道辅助碎石，一次穿刺成功率100%，平均手术时间（107.00±18.25）min，范围80~145 min，术后血红蛋白下降（13.60±10.93）g/L，无输血及栓塞止血病例。术后发热2例，无集合系统穿孔、腹腔脏器损伤及胸膜损伤。其中2例鹿角形结石患儿因结石负荷大，需要分期手术，另有1例术后残留一个8 mm大小的结石，辅助体外冲击波碎石术（extracorporeal shock wave lithotripsy，ESWL）治疗，一期结石清除率80.0%（12/15），二期结石清除率93.3%（14/15）。术后平均随访时间（12.58±4.87）个月，范围6~22个月，仅有1例胱氨酸结石复发。结论 可视化穿刺系统可安全、快速地建立皮肾工作通道，配合超微通道经皮肾镜碎石术治疗儿童无积水肾结石具有较高的结石清除率和安全性。
- Abstract:
- Objective To evaluated the clinical safety and efficacy of visualized ultra-mini percutaneous nephrolithotripsy in the treatment of pediatric nephrolithiasis without hydronephrosis. Methods From August 2018 to November 2019, clinical data were analyzed retrospectively for 14 children with nephrolithiasis undergoing visualized ultra-mini percutaneous nephrolithotripsy. There were 8 boys and 6 girls with a median operative age of 60.77(70-190) months. The involved side was left (n=6), right (n=7) and bilateral (n=1). Nephrolithiasis was single (n=3) and multiple (n=11). The average diameter of nephrolithiasis was (14.47±6.52)(8-30) mm and the average CT value of nephrolithiasis (1031.80±341.35)(498-1951) HU. All children were placed in a lithotomy position with an indwelling ureteral stent for mimicking hydronephrosis. According to the size of stone and calf neck, selections were allowed for expanding to F12 ultra-micro channel. Percutaneous access (F12) was established under ultrasonic guidance and visualized ultra-mini percutaneous nephrolithotripsy performed with a F8 nephroscope and holmium laser lithotripsy. Results Percutaneous access was successfully established one-time in all 14 children. Visualized ultra-mini percutaneous nephrolithotripsy was performed with a single channel at 14 sides while F4.8 micro-percpercutaneous nephrolithotripsy assisted in only one case. The average operative duration was (80-145)(107.00±18.25) min and the average postoperative decline of hemoglobin (13.60±10.93) g/L. None of them required blood transfusion. The average stay of postoperative hospitalization was (6.87±2.97) days. There were postoperative fever (Clavien grade Ⅱ, n=2) and required staged operation due to staghorn nephrolithiasis (n=2). The stone-free rate was 80.0%(12/15) at the first stage and 93.3%(14/15) at the second stage. One case with clinical significant residual stone underwent extracorporeal shock wave lithotripsy (ESWL). No severe complications, such as septic shock, serious bleeding, perforation, thoracic or abdominal injury, etc. occurred. The average follow-up period was (6-22)(12.58±4.87) months. There was only one recurrent case of cysteine stone. Conclusion Visualized ultra-mini percutaneous nephrolithotripsy is both safe and effective for pediatric nephrolithiasis without hydronephrosis. With low complications and a satisfactory stone-free rate, it should be further popularized in clinical practice.
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备注/Memo
收稿日期:2020-06-12。
基金项目:国家自然基金面上项目（编号：81770702）
通讯作者:耿红全,Email:genghongquan@xinhuamed.com.cn