摘要
目的探讨经皮肾穿刺微造瘘取石术（mini—PCNL）治疗儿童肾结石的手术技巧及临床应用价值。方法回顾性分析总结35例儿童肾结石患儿采用mini—PCNL术治疗的临床资料。结果22例I期取净结石，12例经二次取石，9例取净，另有1例经三次取石仍未取净。4例有残石者术后配合ESWL治疗，2例排净。随访2～32个月，患儿肾积水明显好转，结石无复发，7例肾盏颈部扩张者狭窄消失。1例有少许残石患儿结石体积有增大。结论mini—PCNL治疗儿童肾结石创伤小，安全、有效。结合术后ESWL治疗可以代替开放手术而成为儿童肾复杂结石、鹿角形结石以及合并肾内狭窄的首选治疗方法。
Objective To evaluate the surgical techniques and clinical effects of mini-percutaneous nephrolithotomy （mini-PCNL）in pediatric renal calculi. Methods The clinical data of 35 cases （21 males and 14 females,age ranged from 2 to 14 years with the mean of 7 years） treated by this method were retrospectively analyzed. Twenty-four cases were visited for hematuria and/or lumbago and 9 cases for urinary frequency while 2 were discovered by routine examination. Thirty-five cases were obtained final diagnosis by B-us,KUB ＋ IUV and CT. Twenty-eight cases had hydronephrosis. Nineteen cases were in the left side and 16 in the right. Seven cases were complicated by the renal calices cervical stenosis. Thirty-one cases had multiple calculi （13 cases were staghorn calculi 1） while 4 cases had single pelvis calculus. The calculi size ranged from 0. 8 cm 1. 4 cm to 2. 6 cm 3.8 cm. Ureteral catheter was antidrom-intubated from ureterostoma to renal pelvis or abutting stone under anesthesia. 18G renal transfixion pin was punctured to select renal calices by monitoring with B-us. Extender expanded renal punctuation tunnel to 16F size. 16F plastic cannula was pushed in to establish passageway. Calculi were searched for by ureteroscope and shredded by lithotripsy of air-pressure lithotripter. Caller shred was dislodged. Seven cases with cervical stenosis were treated by distension. F5D-J catheter and renal drainage tube were inserted. Results The tunnel was successfully established in all patients by one time punctuation. The operative time ranged from 45 to 200 min （mean 110 min）. Bleeding amount ranged from 10 to 40 ml （mean 20 ml） and no case needed for blood transfusion. Calculi were completely removed in 22 cases. One case appeared secondary bleeding 4 d later （amount 200 ml） and was recovered with anti-infection and absolute bed rest. Nine were completely removed in 12 cases with the second mini-PCNL by quondam sinus tract （8 cases） or by the second punctuation （4 cases）. One case could not be completely removed even by three times of mini-PCNL. Leftover calculi in 4 cases were treated by ESWL and 2 cases were removed completely. All cases were followed up for 2 to 32 months. Hydronephrosis was obviously extenuated. Calculus had no recurrence. Renal cervical stenosis was disappeared in 7 cases. The size of the leftover calculus in 1 case was increasing. Conclusions Mini-PCNL is a safe,effective and less trauma treatment for pediatric renal calculi. Combination of mini-PCNL and ESWL can displace opening operation.
出处
《中华小儿外科杂志》
CSCD
北大核心
2006年第7期364-367,共4页
Chinese Journal of Pediatric Surgery
关键词
肾结石
泌尿外科手术方法
Renal calculi
Urologic surgical procedures
