摘要
目的:评价超声引导下经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)在14岁以下小儿上尿路结石应用中的安全性和有效性。方法:回顾性分析2006年3月~2016年4月在我院行PCNL治疗14岁以下上尿路结石134例(151侧)患儿的临床资料。其中男91例,女43例;年龄0.5~14岁,平均(4.6±3.7)岁;结石负荷10~68mm,平均(19.6±10.6)mm;单发结石49侧,多发结石75侧,鹿角形结石16侧,输尿管上段结石11侧。尿路解剖异常20例,泌尿系感染20例,有体外冲击波碎石(ESWL)史6例。结果:144侧肾脏一期完成碎石,7侧肾脏二期完成碎石。145侧肾脏使用单通道,6侧肾脏使用多通道。平均手术时间为(70.2±30.7)min,术后平均血红蛋白发生下降(11.0±7.4)g/L,平均肾造瘘管移除时间为(3.9±2.0)d,术后平均住院时间(6.5±3.5)d。出院时清石率为92.7%。22例(16.4%)术后发生ClavienⅠ、Ⅱ分级并发症,其中20例(14.9%)出现发热,2例(1.5%)进行了输血。无脓毒症、气胸、腹腔脏器损伤等术后Clavien高分级并发症。结论:PCNL治疗上尿路结石清石率高,Clavien高级别并发症发生率低。
Objective：To evaluate the efficiency and safety of percutaneous nephrolithotomy（PCNL）in the treatment of pediatric patients under 14 years old.Method：From March 2006 to April 2016,the clinical data of134 pediatric patients with 151 affected kidney units who underwent PCNL at Peking University People＇s Hospital were retrospectively reviewed.The group of patients included 91 males and 43 females with mean age of（4.6±3.7）years old（range,0.5-14）.The mean stone diameter was（19.6±10.6）mm（range,10-68）.The type of stone included single stone in 49 kidney units,multiple stones in 75,staghorn stone in 16 and upper ureter stone in 11.Besides,there were 20 patients with anatomic abnormality of urinary tract and 20 patients with urinary infection.The history of extracorporeal ultrasonic lithotripsy occurred in 6 patients.Result：The stone of 144 kidney units were removed with one session while 7 kidney units were removed with two sessions.And single tract was established in 145 kidney units and multiple tracts were established in 6 kidney units.The mean operative time was（70.2±30.7）min and mean hemoglobin drop was（11.0±7.4）g/L.The time of nephrostomy removal was（3.9±2.0）d and the mean postoperative hospital stay was（6.5±3.5）d.The stone free rate of hospital discharge was92.7 %.Clavien gradeⅠ and Ⅱ complications occurred in 22（16.4%）patients including fever in 20（14.9%）patients and blood transfusion in 2（1.5%）patients.Conclusion：PCNL shows a high stone free rate and low incidence of Clavien high grade complications in the treatment of upper urinary calculi.
作者
洪扬
许清泉
黄晓波
朱振杰
叶海云
杨庆亚
安立哲
张丰识
徐涛
HONG Yang;XU Qingquan;HUANG Xiaobo;ZHU Zhenjie;YE Haiyun;YANG Qingya;AN Lizhe;ZHANG Fengshi;XU Tao(Urological and Lithotriptic Center,Peking University People＇s Hospital,100034,Beijing,China;Department of Urology,Peking University People＇s Hospital)
出处
《临床泌尿外科杂志》
2018年第7期542-544,550,共4页
Journal of Clinical Urology
关键词
经皮肾镜取石术
肾结石
输尿管结石
清石率
percutaneous nephrolithotomy
kidney calculi
ureterolithiasis
stone free rate
