Kahriman·Islam,Zhao Fangzhou,Dilxat·Omar,et al.Retrospective comparison of two different PCNL procedures for pediatric sporadic nephrolithiasis in Xinjiang[J].Journal of Clinical Pediatric Surgery,2020,19(11):1026-1031.[doi:10.3969/j.issn.1671-6353.2020.11.013]
两种经皮肾镜碎石术式治疗新疆维吾尔族儿童多发性肾结石疗效的回顾性分析
- Title:
- Retrospective comparison of two different PCNL procedures for pediatric sporadic nephrolithiasis in Xinjiang
- 关键词:
- 微通道经皮肾镜碎石术; 可视穿刺经皮肾镜碎石术; 肾结石; 维吾尔族
- Keywords:
- Mini-PCNL; Microperc; Nephtolithiasis; Uygur
- 分类号:
- R726.9;R692.4
- 摘要:
- 目的 比较微通道经皮肾镜碎石术（mini-percutaneous nephrolithotomy，Mini-PCNL）与可视经皮肾镜碎石术（Microperc）治疗维吾尔族儿童多发性肾结石的有效性与安全性。方法 收集2015—2020年新疆喀什第一人民医院泌尿外科收治的68例维吾尔族多发性肾结石患儿临床资料，其中男40例，女28例，年龄8个月至12岁；29例患儿接受33侧Mini-PCNL手术治疗（为Mini-PCNL组），39例患儿接受46侧Microperc手术治疗（为Microperc组）。比较两组患儿的年龄、性别、体重指数、患肾侧别、术前尿培养结果、术前肾积水情况、结石直径总和、CT值、结石数目、累计肾盏数目。统计两组手术相关参数、术后1天及术后1个月随访结石清除率（stone free rate，SFR）和并发症发生率。结果 68例中位年龄为4.0（3.0，5.0）岁，体质指数（body mass index，BMI）为16.4（15.1，17.7）kg/m2，术前尿培养结果呈阳性者共35例（51.2%），术前尿路感染共45例（66.2%）；两组中位结石直径总和分别为2.4（2.0，3.0）cm、1.2（1.0，1.7）cm（P<0.001）；平均CT值分别为（720.3±277.2）Hu、（666.9±295.4）Hu（P=0.49）；结石数量为2.4（2.0，3.0）个（P=0.577）；累计肾盏数目分别为2（1，2）个、1（1，1.75）个（P=0.002）；两组SFR分别为93.9%和91.3%（P=0.996）。两组中位手术时间分别为30（25，52.5）min、40（20，60）min（P=0.929）；术中灌注量分别为600（300，800）mL、220（150，300）mL（P=0.006）；中位住院天数为5.0（4.0，6.0）d（P=0.735）；手术前后血红蛋白变化值分别为7.0（2.0，10.0）g/L、3.0（2.0，6.75）g/L（P=0.284）。两组并发症发生率分别为21.2%和17.4%（P=0.721）。结论 Mini-PCNL和Microperc在平均发病年龄低、术前感染率高的新疆维吾尔族儿童多发性肾结石中的应用均表现出较好的有效性与安全性。在术式的选择上，Mini-PCNL能够更有效地处理负荷较大（结石最大直径总和>2 cm、多肾盏分布）的维吾尔族儿童肾结石。
- Abstract:
- Objective To compare the effectiveness and safety of mini-percutaneous nephrolithotomy (Mini-PCNL) versus Microperc for Uygur pediatric multiple nephrolithiasis.Methods Clinical data were reviewed for 68 Uygur multiple nephrolithiasis children during 2015-2020.There were 40 boys and 28 girls aged from 8 months to 12 years.The baseline data of two groups was compared,including age,gender,body mass index (BMI),laterity,positive urine culture,hydronephrosis,sum of stone diameter,computed tomography (CT) value,number of stones and involved calyces for determining the comparability of two groups.Surgical parameters,stone free rate and complications at Day 1 and Month 1 post-operation were calculated.Results Their median age was 4.0(3.0,5.0) years,BMI 16.4(15.1,17.7) kg/m2,positive urine culture preoperatively 35 cases (51.2%),urinary infection 45 (66.2%),median sum of stone diameters 2.4 (2.0,3.0) cm、1.2 (1.0,1.7) cm (P<0.001); CT values (720.3±277.2) Hu、(666.9±295.4) Hu (P=0.49); stone numbers were both (2.0,3.0)(P=0.577); involved calyces (1,2)、1 (1,1.75) (P=0.002); SFR 93.9% and 91.3% (P=0.996); median surgical duration 30 (25,52.5) min、40 (20,60) min (P=0.929); intraoperative irrigation volume 600 (300,800) ml、220 (50,300) ml (P=0.006); median hospitalization both 5.0 (4.0,6.0)d (P=0.735); perioperative drop of hemoglobin 7.0 (2.0,10.0) g/L、3.0 (2.0,6.75)g/L (P=0.284); complication rate 21.2% and 17.4% (P=0.721) respectively.Conclusion Mini-PCNL and Microperc offer comparable levels of effectiveness and safety for Uygur children of multiple nephrolithiasis with a lower mean age of onset,higher preoperative rate of urinary infection is higher and worse surgical tolerance.Also Mini-PCNL resolves heavier stone burden more effectively (sum of max stone diameters >2 cm & multiple calyceal distribution).
参考文献/References:
1 Marra G,Taroni F,Berrettini A,et al.Pediatric nephrolithiasis:a systematic approach from diagnosis to treatment[J].J Nephrol,2019,32(2):199-210.DOI:10.1007/s40620-018-0487-1.
2 Miah T,Kamat D.Pediatric nephrolithiasis:a review[J].Pediatr Ann,2017,46(6):e242-e244.DOI:10.3928/19382359-20170517-02.
3 Mai Z,Liu Y,Wu W,et al.Prevalence of urolithiasis among the Uyghur children of China:a population-based cross-sectional study[J].BJU Int,2019,124(3):395-400.DOI:10.1111/bju.14776.
4 Huang J,Tusong H,Batuer A,et al.High prevalence of pediatric urinary tract stones in Xinjiang Uyghur[J].Urolithiasis,2019,47(3):265-272.DOI:10.1007/s00240-018-1074-6.
5 Huang J,Tuerxun A,Tusong H,et al.Composition of urinary tract stones formed by children in two populations in the Uyghur region of China[J].J Chin Med Assoc,2018,81(11):949-954.DOI:10.1016/j.jcma.2018.04.007.
6 Braun DA,Lawson JA,Gee HY,et al.Prevalence of monogenic causes in pediatric patients with nephrolithiasis or nephrocalcinosis[J].Clin J Am Soc Nephrol,2016,11(4):664-672.DOI:10.2215/cjn.07540715.
7 Daga A,Majmundar AJ,Braun DA,et al.Whole exome sequencing frequently detects a monogenic cause in early onset nephrolithiasis and nephrocalcinosis[J].Kidney Int,2018,93(1):204-213.DOI:10.1016/j.kint.2017.06.025.
8 Halbritter J,Baum M,Hynes AM,et al.Fourteen monogenic genes account for 15% of nephrolithiasis/nephrocalcinosis[J].J Am Soc Nephrol,2015,26(3):543-551.DOI:10.1681/asn.2014040388.
9 Aldaqadossi HA,Khairy Salem H,Kotb Y,et al.Prediction of pediatric percutaneous nephrolithotomy outcomes using contemporary scoring systems[J].J Urol,2017,198(5):1146-1152.DOI:10.1016/j.juro.2017.04.084.
10 Caione P,De Dominicis M,Collura G,et al.Microperc for pediatric nephrolithiasis:technique in valdivia-modified position[J].Eur J Pediatr Surg,2015,25(1):94-99.DOI:10.1055/s-0034-1387939.
11 Farouk A,Tawfick A,Shoeb M,et al.Is mini-percutaneous nephrolithotomy a safe alternative to extracorporeal shockwave lithotripsy in pediatric age group in borderline stones? a randomized prospective study[J].World J Urol,2018,36(7):1139-1147.DOI:10.1007/s00345-018-2231-9.
12 Kumar A,Kumar N,Vasudeva P,et al.A single center experience comparing miniperc and shockwave lithotripsy for treatment of radiopaque 1-2 cm lower caliceal renal calculi in children:a prospective randomized study[J].J Endourol,2015,29(7):805-809.DOI:10.1089/end.2015.0020.
13 Karatag T,Tepeler A,Silay M,et al.A comparison of 2 percutaneous nephrolithotomy techniques for the treatment of pediatric kidney stones of sizes 10-20 mm:Microperc vs Miniperc[J].Urology,2015,85(5):1015-1018.DOI:10.1016/j.urology.2015.02.010.
14 Wang W,Ge Y,Wang Z,et al.Comparing micropercutaneous nephrolithotomy and retrograde intrarenal surgery in treating 1-2 cm solitary renal stones in pediatric patients younger than 3 years[J].J Pediatr Urol,2019,15(5):e511-e517.DOI:10.1016/j.jpurol.2019.06.010.
15 Rashid AO,Amin SH,Al Kadum MA,et al.Mini-percutaneous nephrolithotomy for complex staghorn stones in children[J].Urol Int,2019,102(3):356-359.DOI:10.1159/000499491.
16 Sen H,Seckiner I,Bayrak O,et al.A comparison of micro-PERC and retrograde intrarenal surgery results in pediatric patients with renal stones[J].J Pediatr Urol,2017,13(6):e611-e619.DOI:10.1016/j.jpurol.2017.04.022.
17 Ba? O,Dede O,Aydogmus Y,et al.Comparison of retrograde intrarenal surgery and micro-percutaneous nephrolithotomy in moderately sized pediatric kidney stones[J].J Endourol,2016,30(7):765-770.DOI:10.1089/end.2016.0043.
18 Sabnis RB,Ganesamoni R,Doshi A,et al.Micropercutaneous nephrolithotomy (microperc) vs retrograde intrarenal surgery for the management of small renal calculi:a randomized controlled trial[J].BJU Int,2013,112(3):355-361.DOI:10.1111/bju.12164.
19 Silay M,Tepeler A,Atis G,et al.Initial report of microperc in the treatment of pediatric nephrolithiasis[J].J Pediatr Surg,2013,48(7):1578-1583.DOI:10.1016/j.jpedsurg.2013.06.015.
20 Li J,Wang W,Du Y,et al.Combined use of flexible ureteroscopic lithotripsy with micro-percutaneous nephrolithotomy in pediatric multiple kidney stones[J].J Pediatr Urol,2018,14(3):281·e1-281·e6.DOI:10.1016/j.jpurol.2018.03.005.
21 石博文,徐科,黄云腾.经皮肾镜取石术在儿童肾结石中的应用及进展[J].临床小儿外科杂志,2017,16(6):617-621.DOI:10.3969/j.issn.1671-6353.2017.06.021. Shi BW,Xu K,Huang YT.Applications and advances in percutaneous nephrolithotomy for pediatric kidney stones[J].J Clin Ped Sur,2017,16(6):617-621.DOI:10.3969/j.issn.1671-6353.2017.06.021.
22 Tepeler A,Akman T,Silay M,et al.Comparison of intrarenal pelvic pressure during micro-percutaneous nephrolithotomy and conventional percutaneous nephrolithotomy[J].Urolithiasis,2014,42(3):275-279.DOI:10.1007/s00240-014-0646-3.
23 梁宗,李晓刚,曹国灿.小儿与成人经皮肾镜取石术中穿刺的比较[J].临床小儿外科杂志,2015,14(2):130-132.DOI:10.3969/j.issn.1671-6353.2015.02.014. Liang Z,Li XG,Cao GC.Differences in time and space between children and adults via percutaneous renal access during micro-percutaneous nephrolithotomy[J].J Clin Ped Sur,2015,14(2):130-132.DOI:10.3969/j.issn.1671-6353.2015.02.014.
备注/Memo
收稿日期:2020-03-24。
通讯作者:李钧,Email:zfzlijun@126.com