Li Chuangye,Zhao Yaowang,Liu Li,et al.Efficacy and prevention of complications in percutaneous nephrolithotomy for pediatric complex renal stones[J].Journal of Clinical Pediatric Surgery,2025,(01):25-29.[doi:10.3760/cma.j.cn101785-202411030-005]
经皮肾镜治疗儿童复杂性肾结石的疗效及并发症防治
- Title:
- Efficacy and prevention of complications in percutaneous nephrolithotomy for pediatric complex renal stones
- 摘要:
- 目的 总结经皮肾镜碎石术治疗儿童复杂性肾结石的疗效及并发症防治经验。方法 回顾性分析湖南省儿童医院泌尿外科(国际尿石症联盟儿童尿石病防治中心)2017年6月至2021年12月期间144例行经皮肾镜手术的复杂性肾结石患儿临床资料。男100例,女44例;年龄(7.3±4.2)岁(0.4~18.0岁);单发结石38例,多发结石106例;结石直径(2.3±0.5)cm(1.5~3.8 cm),单发结石直径均>2 cm。术前均进行泌尿系B超、腹部平片(kidney ureter bladder,KUB)或泌尿系CT检查评估结石及局部解剖情况。随访1~7年,记录手术时间,手术效果,术中、 术后各种并发症及其处理措施。结果 144例患儿手术时间(62.7±11.3)min(41~94 min);术后1个月复查,128例获得完全清石(结石清除率88.9%);术后3个月复查,131例获得完全清石(结石清除率90.1%)。术后出现并发症16例(11.1%),按照Clavien-Dindo手术并发症分级:ClavienⅠ级1例,ClavienⅡ级13例,Clavien Ⅲ级2例,无一例Clavien Ⅳ级及以上并发症。结论 经皮肾镜碎石术治疗儿童复杂性肾结石疗效确切,清石率高,且并发症可控,是目前的首选措施;及时正确处理并发症可以避免重大风险的发生。
- Abstract:
- Objective To summarize the efficacy of percutaneous nephrolithotomy (PCNL) in the treatment of pediatric complex renal stones and share expriences in managing complications. Methods A retrospective analysis was conducted on clinical data from 144 children with complex renal stones treated with PCNL at the Department of Urology,Hunan Children’s Hospital (Center of Prevention and Treatment of Pediatric Urolithiasis,International Alliance of Urolithiasis) between June 2017 and December 2021.The cohort included 100 boys and 44 girls with a mean age of 7.3±4.2 years (range:0.4-18.0 years).Single stones were observed in 38 cases,while 106 cases had multiple stones.The mean stone diameter was 2.3±0.5 cm (range:1.5-3.8 cm),and all single stones exceeded 2 cm in diameter.Preoperative evaluations included urinary system ultrasound,kideny ureter bladder (KUB) X-rays,or CT scans to assess stone and anatomical conditions.Follow-ups ranged from 1 to 7 years,during which surgical time,outcomes,intraoperative and postoperative complications,and their management were recorded. Results The mean surgical time was 62.7±11.3 minutes (range:41-94).At 1-month postoperative review,128 cases achieved complete stone clearance (clearance rate:88.9%).At three month,131 cases achieved complete clearance (clearance rate:90.1%).Postoperative complications occurred in 16 cases (11.1%),classified according to the Clavien-Dindo system:Grade Ⅰ in 1 case,Grade Ⅱ in 13 cases,and Grade Ⅲ in 2 cases.No Grade Ⅳ or higher complications were reported. Conclusions PCNL is highly effective in treating pediatric complex renal stones,offering high stone clearance rates.It is currently the preferred treatment method,with manageable complications.Proper and timely interventions for complications can prevent major risks.
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备注/Memo
收稿日期:2024-11-13。
基金项目:湖南省儿童泌尿生殖疾病临床医学研究中心(2021SK4017);湖南省重点领域研发计划项目(2020SK211)
通讯作者:赵夭望,Email:yw508@sina.com