摘要
目的探讨微造瘘经皮肾镜碎石取石技术（miniPCNL）治疗3岁以下婴幼儿肾结石的手术技巧和临床应用价值。方法回顾性分析本中心2006至2012年收治的298例3岁以下婴幼儿319侧肾结石行miniPCNL术的临床资料，比较术前术后血红蛋白变化，手术时间，术后并发症如出血、尿外渗、发热等指标。患儿平均年龄21．7个月（7~36个月），平均结石直径1．8cm（1．0～4．5cm）。手术指征：结石直径≥1cm，合并肾积水，反复尿路感染。手术过程为在B型超声引导下穿刺目标肾盏，扩张至14～16F通道后，用小儿肾镜使用钬激光碎石取石。结果本组患儿均成功建立通道，～期清石299侧肾结石（93％），20侧肾脏残留结石，其中12侧肾脏残石1年内自行排出，8侧残石1年后增大再次手术取净。12例双侧肾结石一期行miniPCNL。35例手术后无管化。手术时间31～135min，平均（53±7．5）rain，血红蛋白平均下降（8±2．5）g／L，术后发热的有18．6%（57／307），肾周积液的有21．6％（69／319），腹腔积液的有2．3％（7／298），无输血患儿。住院4～10d，平均6．3d。197例随访6～24个月，未发现结石复发和手术相关长期并发症。结论miniPCNI。技术治疗3岁以下婴幼儿肾结石具有创伤小，恢复快和并发症少等优点，是一种安全、可行的治疗方法。
Objeetlve To evaluate the surgical techniques and clinical efficacies of mini-percuta- neous nephrolithotomy （mini-PCNL） for kidney stones in infants aged under 3 years. Methods A total of 3i9 children aged under 3 years （average： 7-36 months） with kidney stone （average： 1.0-4. 5 cm） underwent mini-PCNL from December 2006 to December 2012. Their pre-operative/post-operative he- moglobin levels, hospital stay, operative duration and complications were retrospectively reviewed. Surgical indications included stone diameter ≥ 1 cm, hydronephrosis and recurrent urinary tract infec- tions. The target calyx was punctured under the guidance of type B ultrasound and channel expanded to 14-16F. Then Holmium laser was used for shattering stones extracted under pediatric nephrolithot- omy. Results All channels were successfully established. Complete stone clearance was achieved in 299 kidney units （93~）. The procedures were simultaneous bilateral （n = 12） and tubeless （n = 35） mini-PCNL. Among 20 cases of residual stone, 12 were self-discharged within 1 year and 8 extracted because of expanding within I year. The mean operative duration was 53 ＋ 7. 5 （31-135） rain, mean hemoglobin decreased to 0. 8 ＋ 0. 52 （0. 2-1.46） g/dl, postoperative fever in 57/307（18. 6%）, perire- nal fluid in 69/319（21.6%）, ascites in 7/298（2. 30/oo） and no blood transfusion. The average hospital stay was 6. 3 （4-10） days. And 197 cases were followed up for 6-24 months and there was no stone re- currence or long-term complications associated with surgery. Conehisions Mini-PCNL has multiple advantages of less trauma, faster recovery and fewer complications, etc. Thus it is both safe and effec- tive for kidney stones in infants aged under 3 years.
出处
《中华小儿外科杂志》
CSCD
北大核心
2014年第5期374-377,共4页
Chinese Journal of Pediatric Surgery
关键词
经皮肾镜取石术
肾脏结石
婴儿
Percutaneous nephrolithotomy
Kidney stones
Infant
