摘要
目的 探讨微创经皮肾镜术（MPCNL）治疗婴幼儿肾结石的安全性和有效性.方法 回顾性分析2008年1月至2012年12月新疆医科大学第一附属医院共234例婴幼儿肾结石病例,均行MPCNL.其中女性72例,男性162例.最小5个月,最大3岁,年龄中位数14个月;1岁以内125例,1～2岁67例,2～3岁42例.结石分别位于左肾（n=116）右肾（n=105）和双肾（n=13）;手术指针为结石大于1 cm2、肾脏结石并积水、反复的泌尿系感染.在超声引导下穿刺肾盏,用小儿肾镜经14F通道钬激光碎石取石.结果 所有患者均单一通道取石,共建立247个取石通道.其中包括14F通道245个,16 F通道和12 F通道各1个.穿刺位点第12肋下228例,第11～12肋间有19例.目标穿刺肾盏：上盏39例、中盏148例、下盏60例,结石残留分别为：2例,3例,2例.平均手术时间为（33±l0）min,总清石率97.2％.未见明显出血及感染性休克发生,3例出现大量冲洗液外渗致腹腔.结论 对于婴幼儿肾结石,14 F及以下单通道取石是安全有效的.
Objective To evaluate the safety and efficiency of minimally invasive percutaneous nephrolithotomy （MPCNL） for the treatment of children with renal stones.Methods From January 2008 to December 2012,234 children treated with MPCNL for renal stones were analyzed retrospectively,including 72 girls and 162 boys,range 5-36 months.Of the patients,125 cases were younger than 12 months,67 cases were between 12-24 months and 42 cases between 24-36 months.The stones located in the left kidney （n=116）,fight kidney（n=105） and both kidneys （n=13）,respectively.The indications for MPCNL were：（i） stone over 1 cm2,（ii） hydronephrosis,（iii） recurrent urinary tract infection.Initial percutaneous access to the targeted renal calyx was obtained through an ultrasound-guided peripheral calyceal puncture.Stones were fragmented by holmium laser with pediatric nephroscope via 14 F tract.Results All the procedures were performed by single tract and totally 247 tracts were established,which including 245 F14,1 F16 and 1 F12 tracts,respectively.Regarding the puncture point,228 cases were in the 12th subcostal space,19 cases in the 1 lth intercostal space.The distribution of target puncture calyx and the subsequent residual calculi were as follows：39 cases in upper calyx with 2 case stone residual,148 in middle calyx with 3 residual,and 60 in lower calyx with 2 stone residual,respectively.As a result,complete stone free was achieved in 240 kidney units （97.2%）.The mean operating time was （33±10） minutes.None of the patients required blood transfusion and no septic shock occurred after operation.A large quantity of washing fluid infiltrated into the abdominal cavity in three cases.Conclusion Using single tract ofF14 （or below F14）,MPCNL is a safe and effective procedure in management of renal stone in infant less than 3-years old.
出处
《中华腔镜泌尿外科杂志（电子版）》
2014年第6期32-36,共5页
Chinese Journal of Endourology(Electronic Edition)
基金
国家自然科学基金(81460513)
关键词
婴幼儿
肾结石
经皮肾镜碎石术
Infant
Urolithiasis
PercutaneousNephrolithotomy
