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目的:探讨微造瘘经皮肾镜气压弹道联合超声碎石取石术治疗小儿上尿路结石的安全性及有效性。方法:回顾性分析自2008年2月～2011年5月12例应用微造瘘经皮肾镜气压弹道联合超声碎石取石术治疗小儿上尿路结石的临床资料。12例患儿均在输尿管镜下逆行向患侧输尿管放置F3～F5号输尿管导管,B超引导下穿刺并扩张建立F16皮肾通道,在F8.0/9.8输尿管镜下采用瑞士EMS第四代超声气压弹道碎石机,争取一期粉碎结石并主动吸出体外。结果:12例患儿均I期建立F16皮肾通道,I期手术净石率10例(83.3%),2例结石残留,经ESWL及口服排石溶石药物治疗后排出。手术时间30～116min,平均53min,无输血病例,无出现气胸、腹腔脏器损伤等严重并发症。术后随访3个月～2年,患肾功能较术前改善,肾积水减轻或缓解,无结石复发,无输尿管狭窄、肾积水加重、肾功能不全等并发症。结论:微造瘘经皮肾镜碎石取石术治疗小儿上尿路结石具有创伤小、恢复快、取石效率高等优点,是治疗小儿肾结石、输尿管上段结石一种安全有效手术方法。
Objective: To investigate the safety and efficacy of percutaneous nephrolithotomy combined with ultrasonic lithotripsy in the treatment of pediatric upper urinary tract stones. Methods: From February 2008 to May 2011, 12 cases of pediatric upper urinary tract stones treated with micro-fistula percutaneous nephrosgraphy and pneumatic lithotripsy combined with ultrasonic lithotripsy were retrospectively analyzed. All 12 patients underwent retrograde ureteroscopic placement of F3 to F5 ureteral catheters on the ipsilateral ureter, punctured and expanded under B ultrasound to establish F16 renal access, and F8.0 / 9.8 ureteroscopy using Swiss EMS fourth generation Ultrasonic pneumatic lithotripsy, for a crushed stones and take the initiative out of the body. Results: All the 12 children underwent stage I F-1 renal bypass. The rate of net I-phase neoplasm in stage I was 10 (83.3%). The remaining 2 stones were discharged after treatment with ESWL and oral tourmaline. Surgery time 30 ~ 116min, an average of 53min, no blood transfusion cases, no pneumothorax, abdominal organ injury and other serious complications. Postoperative follow-up of 3 months to 2 years, compared with preoperative improvement of renal function, hydronephrosis to reduce or alleviate, no recurrence of stones, no ureteral stricture, hydronephrosis, renal insufficiency and other complications. Conclusion: Percutaneous nephrolithotomy lithotripsy is a safe and effective surgical treatment of pediatric upper calculus and upper ureteral calculi. It has the advantages of less trauma, faster recovery and higher stone retrieval efficiency.