超微经皮肾镜取石术治疗儿童上尿路结石的疗效评估
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摘要
目的:探讨超微经皮肾镜取石术(SMP)治疗小儿上尿路结石的有效性及安全性。方法:SMP是利用外径为7F、工作通道为3.3F的超细肾镜,10～14F带吸引功能鞘的取石系统。回顾性分析我国4家医院2013年8月～2017年12月因上尿路结石而行SMP患儿(<14岁)的临床资料。结果:共136例患儿入组,年龄0.5～14岁,平均(3.98±3.13)岁。多数患儿(63.2%)术前以腰痛和血尿症状为主。结石最大径为0.8～4.8cm,平均(1.58±0.78)cm;平均手术时间(37.86±25.64)min;术后住院天数1～8d,平均(2.7±1.7)d。114(83.82%)例患儿为完全无管化(术后未留置肾造瘘管和双J管)。术后第1天结石清除率为84.56%,术后3个月结石清除率为90.44%。术后有11例患儿出现发热。1例患儿因术后出现肾绞痛而行双J管置入术。6例患儿出现轻度肾盂撕裂或尿外渗。结石成分分析以感染性结石及草酸钙结石为主。结论:SMP应用于小儿上尿路结石具有结石清除率高、并发症低、无管化率高的优点,具有较高的推广价值。
Objective:To evaluate the safety and efficacy of super-mini percutaneous nephrolithotomy(SMP)in the management of pediatric upper urinary tract calculi.Method:We retrospectively reviewed pediatric patients who underwent SMP in four centers between August 2013 and December 2017.The SMP system consists a 7 Fnephroscope and a modified 10-14 Faccess sheath with a irrigation-suction function.Result:In all,136 pediatric patients with the mean age of 3.98 years old underwent SMP.Flank pain or hematuria was noted in 63.2% of the patients.The mean stone size was 1.58±0.78(range,0.8-4.8)cm.The average operation time was 37.86±25.64 minutes.Postoperative hospital stay was 2.7±1.7(range,1-8)days.One hundred and fourteen(83.82%)SMPs were totally tubeless.Patients undergoing SMP had a 90.44%stone-free rate.Only 11 patients had postoperative fever(>38.5).One patient required indwelling ureteral stent because of renal colic.None of the cases required transfusion.Struvite and calcium oxalate were the most prevalent stone compositions.Conclusion:SMP is a safe and effective treatment for the upper urinary tract stones in pediatric patients.It provided excellent stone-free rate,high tubeless rate and low complication rate.
Objective:To evaluate the safety and efficacy of super-mini percutaneous nephrolithotomy(SMP)in the management of pediatric upper urinary tract calculi.Method:We retrospectively reviewed pediatric patients who underwent SMP in four centers between August 2013 and December 2017.The SMP system consists a 7 Fnephroscope and a modified 10-14 Faccess sheath with a irrigation-suction function.Result:In all,136 pediatric patients with the mean age of 3.98 years old underwent SMP.Flank pain or hematuria was noted in 63.2% of the patients.The mean stone size was 1.58±0.78(range,0.8-4.8)cm.The average operation time was 37.86±25.64 minutes.Postoperative hospital stay was 2.7±1.7(range,1-8)days.One hundred and fourteen(83.82%)SMPs were totally tubeless.Patients undergoing SMP had a 90.44%stone-free rate.Only 11 patients had postoperative fever(>38.5).One patient required indwelling ureteral stent because of renal colic.None of the cases required transfusion.Struvite and calcium oxalate were the most prevalent stone compositions.Conclusion:SMP is a safe and effective treatment for the upper urinary tract stones in pediatric patients.It provided excellent stone-free rate,high tubeless rate and low complication rate.
引文
1 Dwyer M E,Krambeck A E,Bergstralh E J,et al.Temporal trends inincidence of kidney stones among children:a 25years population based study[J].J Urol,2012,188(1):247-252.
2徐科,石博文,黄云腾,等.小儿泌尿系结石治疗中的并发症分析与处理[J].临床泌尿外科杂志,2017,32(6):433-436.
3曾国华,万肖蓬,陈文忠,等.超微经皮肾镜取石术治疗31例肾结石的初步体会[J].中华泌尿外科杂志,2014,35(1):6-9.
4 Zeng G,Wan S,Zhao Z,et al.Super-mini percutaneous nephrolithotomy(SMP):a new concept in technique and instrumentation[J].BJU Int,2016,117(4):655-661.
5阿不力孜·司马义,艾尼瓦尔·玉苏甫,王晨宇,等.B超引导下超微通道经皮肾镜取石术治疗小儿上尿路结石的效果分析[J].中华泌尿外科杂志,2016,37(4):262-264.
6曾国华,朱玮.代谢评估在泌尿系结石诊治中的应用[J].临床泌尿外科杂志,2017,32(6):409-412.
7 Akin Y,Yucel S.Long-term effects of pediatric extracorporeal shockwave lithotripsy on renal function[J].Res Rep Urol,2014,6:21-25.
8 Vlajkovic'M,Slavkovic'A,Radovanovic'M,et al.Longterm functional outcome of kidneys in children with urolithiasis after ESWL treatment[J].Eur J Pediatr Surg,2002,12(2):118-123.
9 El-AssmyA,El-Nahas A R,Abou-El-Ghar M E,et al.Kidney stone size and hounsfield units predict successful shockwave lithotripsy in children[J].Urology,2013,81(4):880-884.
10 Badawy A A,Saleem M D,Abolyosr A,et al.Extracorporeal shock wave lithotripsy as first line treatment for urinary tract stones in children:outcome of 500cases[J].Int Urol Nephrol,2012,44(3):661-666.
11 De S,Autorino R,Kim F J,et al.Percutaneous nephrolithotomy versus retrograde intrarenal surgery:a systematic review and meta-analysis[J].Eur Urol,2015,67(1):125-137.
12阿布都卡哈尔·巴吐尔,艾尔肯·吐尔逊,曾国华,等.输尿管软镜碎石术治疗小儿尿路结石的疗效观察[J].临床泌尿外科杂志,2016,31(7):597-600.
13 Corcoran A T,Smaldone M C,Mally D,et al.When is prior ureteral stent placement necessary to access the upper urinary tract in prepubertal children?[J].JUrol,2008,180(4Suppl):1861-1863;discussion 1863-1864.
14梁东彦,李巧星,邵军,等.影响微创经皮肾取石术清石效果的相关因素分析[J].临床泌尿外科杂志,2016,31(7):610-612.
2徐科,石博文,黄云腾,等.小儿泌尿系结石治疗中的并发症分析与处理[J].临床泌尿外科杂志,2017,32(6):433-436.
3曾国华,万肖蓬,陈文忠,等.超微经皮肾镜取石术治疗31例肾结石的初步体会[J].中华泌尿外科杂志,2014,35(1):6-9.
4 Zeng G,Wan S,Zhao Z,et al.Super-mini percutaneous nephrolithotomy(SMP):a new concept in technique and instrumentation[J].BJU Int,2016,117(4):655-661.
5阿不力孜·司马义,艾尼瓦尔·玉苏甫,王晨宇,等.B超引导下超微通道经皮肾镜取石术治疗小儿上尿路结石的效果分析[J].中华泌尿外科杂志,2016,37(4):262-264.
6曾国华,朱玮.代谢评估在泌尿系结石诊治中的应用[J].临床泌尿外科杂志,2017,32(6):409-412.
7 Akin Y,Yucel S.Long-term effects of pediatric extracorporeal shockwave lithotripsy on renal function[J].Res Rep Urol,2014,6:21-25.
8 Vlajkovic'M,Slavkovic'A,Radovanovic'M,et al.Longterm functional outcome of kidneys in children with urolithiasis after ESWL treatment[J].Eur J Pediatr Surg,2002,12(2):118-123.
9 El-AssmyA,El-Nahas A R,Abou-El-Ghar M E,et al.Kidney stone size and hounsfield units predict successful shockwave lithotripsy in children[J].Urology,2013,81(4):880-884.
10 Badawy A A,Saleem M D,Abolyosr A,et al.Extracorporeal shock wave lithotripsy as first line treatment for urinary tract stones in children:outcome of 500cases[J].Int Urol Nephrol,2012,44(3):661-666.
11 De S,Autorino R,Kim F J,et al.Percutaneous nephrolithotomy versus retrograde intrarenal surgery:a systematic review and meta-analysis[J].Eur Urol,2015,67(1):125-137.
12阿布都卡哈尔·巴吐尔,艾尔肯·吐尔逊,曾国华,等.输尿管软镜碎石术治疗小儿尿路结石的疗效观察[J].临床泌尿外科杂志,2016,31(7):597-600.
13 Corcoran A T,Smaldone M C,Mally D,et al.When is prior ureteral stent placement necessary to access the upper urinary tract in prepubertal children?[J].JUrol,2008,180(4Suppl):1861-1863;discussion 1863-1864.
14梁东彦,李巧星,邵军,等.影响微创经皮肾取石术清石效果的相关因素分析[J].临床泌尿外科杂志,2016,31(7):610-612.