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目的探讨微创经皮肾镜术(MPCNL)治疗婴幼儿肾结石的安全性和有效性。方法回顾性分析2008年1月至2012年12月新疆医科大学第一附属医院共234例婴幼儿肾结石病例,均行MPCNL。其中女性72例,男性162例。最小5个月,最大3岁,年龄中位数14个月;1岁以内125例,1~2岁67例,2~3岁42例。结石分别位于左肾(n=116)右肾(n=105)和双肾(n=13);手术指针为结石大于1 cm2、肾脏结石并积水、反复的泌尿系感染。在超声引导下穿刺肾盏,用小儿肾镜经14 F通道钬激光碎石取石。结果所有患者均单一通道取石,共建立247个取石通道。其中包括14 F通道245个,16 F通道和12 F通道各1个。穿刺位点第12肋下228例,第11~12肋间有19例。目标穿刺肾盏:上盏39例、中盏148例、下盏60例,结石残留分别为:2例,3例,2例。平均手术时间为(33±10)min,总清石率97.2%。未见明显出血及感染性休克发生,3例出现大量冲洗液外渗致腹腔。结论对于婴幼儿肾结石,14 F及以下单通道取石是安全有效的。
Objective To investigate the safety and efficacy of minimally invasive percutaneous nephrolithotomy (MPCNL) in the treatment of infant kidney stones. Methods Retrospective analysis of January 2008 to December 2012, the First Affiliated Hospital of Xinjiang Medical University, a total of 234 cases of infants and young children with kidney stones, all underwent MPCNL. 72 were female and 162 were male. A minimum of 5 months, a maximum of 3 years old, the median age 14 months; 125 cases within 1 year of age, 67 cases of 1 to 2 years old, 42 cases of 2 to 3 years old. The stones were located in the right kidney (n = 105) and the kidneys (n = 13) in the left kidney (n = 116). The operative indicators were urinary tract infections with stones larger than 1 cm2 and stones and water in the kidney. Under the guidance of ultrasound puncture calyceal, renal pediatric renal F 14 holmium laser lithotripsy stone. Results All patients were single access stone, a total of 247 stone access. Including the 14 F channel 245, 16 F channel and 12 F channel 1 each. There were 228 cases under the 12th rib site and 19 cases between the 11th and 12th ribs. Target puncture of the calyce: 39 cases of upper lamp, middle lamp in 148 cases, lower lamp in 60 cases, residual stones were: 2 cases, 3 cases, 2 cases. The average operation time was (33 ± 10) min, the total clear stone rate was 97.2%. No significant hemorrhage and septic shock occurred, and 3 cases showed a large amount of extravasation fluid resulting in abdominal cavity. Conclusions Single kidney stones below 14 F are safe and effective for infant kidney stones.