28例青春期前儿童上尿路结石诊断治疗的临床分析  

Diagnosis and treatment of upper urinary tract calculi in children

作　　者：王坚[1] 李普云[1] 柳建军[1] 吴宏[1] 洪伟平[1] 黄兴端[1] 许志坚[1] 吴舟[1] 苏劲[1] 

机构地区：[1]广东医学院附属医院泌尿外科,湛江524001

出　　处：《第三军医大学学报》2005年第14期1497-1499,共3页Journal of Third Military Medical University

摘　　要：目的探讨儿童上尿路结石的外科诊断和治疗经验。方法回顾性地研究分析了28例1995-2003年入住我科青春期前儿童肾结石和输尿管结石的诊断和治疗情况。本组研究包含17例男孩和11例女孩;年龄从10个月至14岁(平均8·6岁)。26例解剖正常,1例肾盂输尿管交界处狭窄,1例双侧输尿管口囊肿。术前行血生化检查。根据患儿病情分别采用ESWL、输尿管镜取石、溶石等方式进行了治疗。结果所有患儿均存在血生物化学检查的异常。9例患儿接受ESWL治疗后,结石完全排出8例,1例结石负荷降低;1例接受输尿管镜取石术,无术后感染和输尿管狭窄发生;1例患儿放置导管以进行溶石治疗;7例单个输尿管结石患儿接受排石治疗;6例多发性结石,或同时存在的解剖异常的患儿接受开放性手术手术治疗,均达到治疗效果;4例明确诊断后未作治疗自动出院。结论青春期前儿童上尿路结石形成可能与胆固醇及尿酸和钙磷代谢异常有关,治疗方式依据病情而定,ESWL和微创手术应是青春期前儿童上尿路结石治疗的首选方法。Objective To present the experience of the surgical management in the upper tract calculi in children. Methods The diagnosis, treatment and outcome in all prepubertal patients who required surgical treatment for ureteral or renal calculi from 1995 to 2003 were retrospectively reviewed. The series consisted of 17 boys and 11 girls from 10 months to 14 years old (mean age 8.6 years). A total of 26 children were anatomically normal, 1 had ureteropelvic junction obstruction, and 1 had double-side cystis of ureterostoma. Results Extracorporeal shock wave lithotripsy was performed in 9 patients, of which 8 were rendered stone-free and 1 had a decreased stone burden. Ureteroscopic extraction of distal ureteral calculi was successful in 1 child. No postoperative infection or ureteral obstruction occurred. Ureteral catheters were placed in 1 patient suffered from double renal calculus and double ureteral calculus for dissolution therapy. Seven cases with ureteral calculi which diameter was less than 0.5 cm received discharge therapy. Open surgery was performed mostly for multiple calculus or with simultaneous anatomical abnormalities. Some metabolic abnormality was detected in all cases. Conclusion Upper urinary tract calculi in prepubertal children should receive biochemistry examination. Their management of the upper tract calculi is similar to that for adults. Microinvasive surgery may be safely used in pediatrics.

关 键 词：肾 输尿管 结石碎石术 代谢 

分 类 号：R726.924[医药卫生—儿科] R726.934[医药卫生—临床医学]