摘要
目的 探讨软性输尿管镜技术在小儿上尿路结石治疗中的临床价值. 方法 2007年6月至2013年6月应用软性输尿管镜技术治疗小儿上尿路结石21例.男12例,女9例.年龄2.3～16.0岁,平均7.2岁.输尿管上段结石12例（原位10例,2例系输尿管中下段结石行硬性输尿管镜碎石移位所致）、肾结石9例,均合并同侧轻、中度肾积水.其中三聚氰胺所致输尿管上段结石3例、肾结石1例.左侧11例,右侧7例,双侧3例（均为输尿管上段结石）.结石最大径0.6～1.5 cm,平均1.0 cm.分别施行经尿道（逆行）软性输尿管镜钬激光碎石术和经皮肾（顺行）软性输尿管镜碎石术治疗. 结果 经尿道软性输尿管镜碎石术18例,1例因软性输尿管镜进镜失败,改行微创经皮肾镜取石术；2例未能置入输尿管输送鞘直接进镜,分2次碎石；17例结石寻及率100％；15例一次碎石成功,单次碎石成功率88％.行经皮肾软性输尿管镜碎石术3例均为单一皮肾通道,均寻及结石并成功碎石.手术时间20～ 70 min,平均35 min.术中、术后无严重并发症发生.术后住院时间3～7d,平均4.5 d.术后2～4周复查均无＞2 mm结石残留,拔除双J管.随访3～72个月,均无结石复发、尿道狭窄、输尿管狭窄、尿失禁及膀胱输尿管反流. 结论 应用软性输尿管镜技术治疗小儿上尿路结石安全可行,创伤小,可作为小儿上尿路结石常用腔内技术治疗的有益补充,成为部分小儿上尿路结石微创治疗的新选择.
Objective To evaluate the efficacy of flexible ureteroseopyfor the treatment of the upper urinary tract calculi in children. Methods There were 21 children with 12 males and 9 females ineluded in this study. The mean age was 7.2 （range 2.3 to 16.0） years. Among them, 12 had upper ureteral ealeuli （10 with caleuli in situ, 2 with middle/distal ureteral calculi shifting to upper ureteral after rigid uretero- seopie ]ithqtripsy） and 9 had renal calculi. Ipsilateral mild to moderate hydronephrosis was found in all of the cases. Four children had melamine-induced stones （3 with upper ureteral caleuli and 1 with renal calculi）. The calculi were found on left side in 11 cases, on right side in 7, and on both sides in 3 （upper ureteral calculi）. The mean stone size was 1.0 （range 0.6 to 1.5） em. Retrograde flexible ureteroscopy and anterograde flexible ureteroscopy in mini-percutaneous nephrolithotomy was performed. Results Eighteen cases were performed retrograde flexible ureteroscopic procedure. One case was conversed to mini-pereutaneous nephrolithotomy because the flexible ureteroscope could not be inserted into the upper ureter. The flexible ureteral access sheath was failed to insert into the upper ureter in 2 cases, then the flexible ureteroseope was inserted into ureter directly. The stones were successfully fragmented after two stages in these two cases. The successful rate of stone search was 100% in 17 cases. Fifteen cases were successfully performed in one stage. The success rate of stone fragmentation was 88% with the holmium laser lithotripsy. Three anterograde flexi- ble ureteroscopy with mini-pereutaneous nephrolithotomy were successfully performed, and the stones were successfully found and fragmentated after a single holmium laser lithotripsy. The mean operative time was 35 （ range 20 to 70） min. There was no major perioperative complication. The patients were discharged from hospital after a mean of 4.5 days （range 3 to 7）. Double-J stent was removed after 2 to 4 weeks when no re- sidual stones more than 2.0 mm was found. No recurred stones, no urethra stricture, no ureter stricture, no urinary incontinence and no vesieoureteral reflux was found during the 3 to 72-months follow-up. Conclusions Flexible ureteroscopy could be a safe and feasible method for the treatment of the upper urina- ry tract calculi in children. It is suitable for the stones in the pelvis and ealyceal where the rigid ureteroscopy could not reach.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2013年第11期827-830,共4页
Chinese Journal of Urology
基金
江西省＂赣鄱英才555工程＂领军人才培养计划项目
江西省科技厅科技支撑计划项目（20132BBG70089）
关键词
软性输尿管镜
儿童
上尿路结石
钬
碎石术
激光
Flexible ureteroseopy
Child
Upper urinary tract calculi
Holmium
Lithotrip- sy, laser
作者简介
通信作者：邹晓峰，Email：gyfyurology@126．com
