摘要
目的:探讨微创经皮肾镜取石术(MPCNL)治疗小儿肾结石的疗效及并发症的处理.方法:回顾性分析2006年3月～2012年7月95例接受MPCNL的肾结石患儿临床资料.年龄10个月～15岁,其中11例为鹿角形肾结石,多发肾结石19例.MPCNL结合气压弹道/超声/钬激光/U100激光碎石机等进行治疗.结果:95例共103侧肾接受MPCNL治疗.手术时间平均65 min.术中出血平均(20±5)ml.发生手术并发症7例(7.3％),包括2例肾穿刺失败；1例术中出血,1例马蹄肾患儿降结肠损伤,保守治疗2周后痊愈.2例患儿术后出现患侧肾盂输尿管连接部梗阻,行肾盂输尿管离断再吻合术.1例患儿术后出现患侧输尿管中下段“石街”,行输尿管镜钬激光碎石.所有患儿随访3～72个月,超声检查示86例(90.5％)结石消失,9例(9.5％)肾结石残留.结论:MPCNL治疗小儿肾结石,结石清除率高、手术有效、创伤小.规范操作MPCNL,术中、术后密切观察并及时处理,MPCNL是安全可行的.
Objective:To evaluate the clinical efficacy of minimally invasive percutaneous nephrolithotomy for the treatments of kidney calculi in children and to prevent complications.Methods:We retrospectively reviewed the clinical data of 95 cases with kidney calculi between March 2006 and July 2012.These children's age ranged from 10 months to 15 years old.11 cases were staghorn stone and multiple renal calculi in 19 cases.MPCNL combined with pneumatic ballistic/ultrasonic/holmium laser/U100 laser lithotripsy for treatment.Results:Ninety-five cases(103 kidney)underwent MPCNL.Among the 10 cases of bilateral kidney stone only unilateral MPCNL,another 6 cases completed in two phases of MPCNL.Mean operative time was 65 minutes.Average amount of bleeding were(20± 5)ml in the operation.There were seven cases with complications:the puncture failures were in 2 cases;the bleeding was in another case,transfused red cells suspension 200ml after operation;the colon injury was in 1 case with horseshoe kidney,recovery after 2 weeks of conservative treatment;the Ureteropelvic junction obstructions were found in 2 cases after operation,accepted ureter and renal pelvis disarticulation reanastomosis;1 case of postoperative patient with ureteral steinstrasse,accepted ureteroscopic holmium laser lithotripsy.After follow-up 3 to 72 months,ultrasound showed stones disappear in 86 cases(90.5%),the kidney calculi in nine cases were remained.There were no operative death and renal loss.Conclusions:MPCNL for the treatment of kidney calculi was safe and effective in children.A well-standardised technique and postoperative follow-up are mandatory for early detection of complications.
出处
《微创泌尿外科杂志》
2013年第1期58-60,共3页
Journal of Minimally Invasive Urology
关键词
小儿
肾结石
经皮肾镜取石术
并发症
children
kidney calculi
percutaneous nephrolithotomy
complication
