论文部分内容阅读
目的:评价微创经皮肾镜取石术(MPCNL)治疗小儿上尿路结石的临床价值。方法:收治上尿路结石患儿149例,男85例,女64例,年龄1~16岁,平均8.7岁。左侧80例,右侧58例,双侧11例。结石大小平均1.3cm×0.9cm。均行MPCNL治疗;合并输尿管下段结石及膀胱结石者,术中均先予输尿管镜取石术及经皮膀胱穿刺取石术处理。术中结石寻找困难者联合软性输尿管镜治疗。结果:149例160侧手术均成功。无Ⅲb级以上并发症发生。单侧手术时间20~65min,平均50min。一期结石清除率为87.9%(131/149),二期结石清除率为93.9%(140/149),总清除率为95.3%(142/149)。本组11例行双侧同期MPCNL;13例行“无管化”MPCNL,其中1例行“完全无管化”MPCNL。术后住院3~15d,平均7.2d。结论:运用MPCNL治疗小儿上尿路结石安全、可行,具有高效、损伤小、痛苦少、恢复快等优点。符合条件者可不留置肾造瘘管,恢复更快。配合软性输尿管镜技术可提高结石清除率。
Objective: To evaluate the clinical value of minimally invasive percutaneous nephrolithotomy (MPCNL) in the treatment of children with upper urinary tract calculi. Methods: 149 cases of children with upper urinary tract stones, 85 males and 64 females, aged from 1 to 16 years, with an average of 8.7 years. Left 80 cases, right 58 cases, bilateral 11 cases. The average size of stones 1.3cm × 0.9cm. MPCNL treatment; lower ureteral calculi and bladder stones were intraoperative ureterolithotomy and percutaneous bladder puncture and lithotomy. Finding intraoperative calculi in patients with soft ureteroscopy. Results: All 149 cases of 160 sides were successful. No Ⅲ b above the complications occurred. Unilateral surgery time 20 ~ 65min, an average of 50min. The first stage stone clearance rate was 87.9% (131/149), the second stage stone clearance rate was 93.9% (140/149), the total clearance rate was 95.3% (142/149). The group of 11 patients underwent simultaneous bilateral MPCNL; 13 patients underwent “unmanaged” MPCNL, 1 of which underwent “complete unmanaged” MPCNL. After hospitalization 3 ~ 15d, an average of 7.2d. Conclusion: MPCNL treatment of children with upper urinary tract stones safe and feasible, with high efficiency, less damage, less pain, fast recovery and so on. Meet the conditions may not indwelling renal fistula, faster recovery. With soft ureteroscopy can improve stone clearance.