顺、逆行腔内途径治疗幼儿输尿管中上段结石的疗效对比分析  

Treatment of pediatric promxial and middle ureteral stones： percutaneous nephrolithotomy versus retrograde ureteroscopic lithotrispy

作　　者：李九智[1] 王雪怡[2] 文彬[1] 李建兴[3] 罗勇[1] 安尼瓦尔·玉素甫 唐矛[1] 宋超[4] 

机构地区：[1]新疆维吾尔自治区人民医院泌尿外科,乌鲁木齐830001 [2]新疆维吾尔自治区人民医院CT室,乌鲁木齐830001 [3]北京大学人民医院泌尿外科 [4]武汉大学人民医院泌尿外科

出　　处：《中华泌尿外科杂志》2013年第11期831-835,共5页Chinese Journal of Urology

摘　　要：目的 对比分析彩色多普勒超声引导下微创经皮肾镜取石术（MPCNL）和经尿道逆行输尿管镜气压弹道碎石术（URSL）治疗幼儿输尿管中上段结石的疗效. 方法 回顾性分析2008年1月至2011年11月89例采用MPCNL或URSL治疗的5岁以下输尿管中上段结石患儿的临床资料.双侧输尿管结石及采用多种方式碎石者不纳入本研究.比较不同术式的手术时间、结石取净率、术前术后血红蛋白变化、术后发热和术后平均住院日. 结果 MPCNL及URSL组结石长径分别为（13.7±5.1） mm和（12.9±3.2）mm,差异无统计学意义.患者民族构成类似.53例采用MPCNL,均一期建立通道并碎石,通道建立时间（9.5±4.9） min,手术时间（35.8±7.6） min,一期手术结石取净率100.0％,血红蛋白下降（6.72±1.63） g/L,血细胞比容下降（2.34±0.57）％.术后12例（22.6％）发热（体温≥38.5℃）,平均住院日8.5 d,无失肾、死亡病例,无输血、感染性休克及邻近脏器损伤病例.36例采用URSL,手术时间（66.8±28.5） min,一期手术结石取净率63.9％（23/36）,血红蛋白下降（4.42±1.52） g/L,血细胞比容下降（1.85±0.13）％.术后19例（52.8％）发热（≥38.5℃）,平均住院日为13.2 d.输尿管近开口处损伤穿孔7例,发生菌血症、败血症1例.89例随访16～ 38个月,平均24个月.URSL组发生输尿管狭窄3例（8.3％）,MPCNL组无输尿管狭窄病例. 结论 MPCNL治疗5岁以下幼儿输尿管中上段结石较URSL手术时间更短、结石取净率更高、并发症发生率低,是此类患者安全高效的治疗方法.Objective To compare the efficacy, safety, and morbidity of minimally invasive percu- taneous nephrolithotomy under Doppler ultrasound guidance （MPCNL） and retrograde ureteroscopie litho- trispy （URSL） for upper and middle ureteral stones in children younger than 5 years. Methods Eighty- nine cases of children younger than 5 years from January 2008 to November 2011 were reviewed. There were 53 patients accepted MPCNL and 36 patients undergoing URSL. Patients who needed more than one pereuta- neous tract or had simultaneously undergone the two techniques on the same kidney or need more than one session surgery were excluded from the study. Results The two groups had comparable stone burden of （13.7±5.1） mm and （12.9±3.2） mm in MPCNL and URSL group respectively. The demographic data were similar as well. In MPCNL group, pereutaneous-renal access was established and lithotripsy was preformed in one session, with the access time of （9.5±4.9） min and operative time of （35.8±7.6） rain. The stone-free rate was 100.0%. The hemoglobin and hematoerit dropped by （6.72±1.63） g/L and （2.34±0.57）% respec- tively. The mean hospital stay after surgery was 8.5 d. The complication in MPCNL group was postoperative fever in 12 （22.6%） cases. No perioperative bleeding, renal lost or septic shock was recorded, and no transfusion was required. No perirenal organ injury was recorded. In URSL group, the operative time was （66.8 ±28.5） rain with the stone-free rate of 63.9% in single session. The hemoglobin and hematocrit dropped by （4.42±1.52） g/L and （1.85±0.13）% respectively. The mean hospital stay after surgery was 13.2 d. The complications of URSL group included postoperative fever in 19 （52.8%） cases, ureteral perfo- ration in 7 cases. The mean follow-up duration was 24 months （range, 16-38 months）. Three （8.3%） ure- teral stricture cases were recorded in URSL group postoperatively, which was not reported in MPCNL group. The MPCNL group was significant better than

关 键 词：婴儿 儿童 学龄前 输尿管结石 经皮肾镜取石术 输尿管镜检查 

分 类 号：R726.9[医药卫生—儿科]