超微经皮肾镜取石术与逆行输尿管软镜手术治疗儿童上尿路结石的对比研究  

Comparison of super-mini-percutaneous nephrolithotomy and flexible ureteroscopy for the management of upper urinary tract calculus in children

作　　者：贾宏亮[1] 李循[1] 曾国华[2] 李九智[1] 张培新[1] 艾尼瓦尔·玉素甫 Jia Hongliang;Li Xun;Zeng Guohua;Li Jiuzhi;Zhang Peixin;Aniwaer Yusufu(Urological Center,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院泌尿中心,乌鲁木齐830001 [2]广州医科大学附属第一医院微创外科中心泌尿外科

出　　处：《中华泌尿外科杂志》2018年第12期885-889,共5页Chinese Journal of Urology

摘　　要：目的比较超微经皮肾镜取石术(SMP)和逆行输尿管软镜手术(RIRS)治疗儿童上尿路结石的疗效和安全性。方法回顾性分析2016年4月至2018年6月行SMP和RIRS治疗的85例上尿路结石患儿的临床资料,根据手术方式不同分为SMP组和RIRS组。SMP组52例,男38例,女14例;年龄(4.6±2.7)岁;结石长径(15.3±4.8)mm;结石位于左侧17例,右侧35例;多发结石18例,单发结石34例。RIRS组33例,男18例,女15例;年龄(4.6±3.1)岁;结石大小(14.2±5.1)mm;结石位于左侧9例,右侧24例;多发结石11例,单发结石22例。两组患儿年龄、性别、结石大小、结石侧别、结石数量的差异均无统计学意义(P>0.05)。患儿术后1个月复查KUB或CT评估疗效。比较两组的净石率及并发症情况。结果SMP组较RIRS组有更短的手术时间[(57.9±27.8)min与(74.2±31.8)min,P=0.015)]和术后住院时间[(3.1±1.3)d与(4.8±2.8)d,P=0.003]。SMP组净石率高于RIRS组[90.4%(47/52)与48.5%(16/33),P<0.01]。SMP组患儿的再次治疗率显著低于RIRS组[1.9%(1/52)与36.4%(12/33),P<0.01]。SMP组术后3例发热(体温>38℃),1例出现胸腔积液及腹水,并发症发生率为7.7%(4/52);RIRS组术后9例发热(体温>38℃),并发症发生率为27.3%(9/33),RIRS组并发症发生率高于SMP组(P<0.05)。结论SMP治疗儿童上尿路结石的净石率优于RIRS,同时并发症及术后再次治疗率均低于RIRS。Objective To evaluate the efficacy and safety of super-mini-percutaneous nephrolithotomy (SMP),retrograde intrarenal surgery(RIRS)for children with upper urinary tract calculus. Methods Clinical data of 85children with upper urinary tract calculi treated by SMP or RIRS from April 2016 to June 2018 were retrospectively analyzed.Patients were divided into two groups according to operative method:group SMP and group RIRS.In group SMP:there were 38 male and 14 female patients;the mean age was(4.6±2.7)years;the mean stone size was (15.2±4.8)mm;17cases in left side,and 35 cases in right side;multiple stones were found in 18cases and single stone was found in 34cases.In group RIRS: there were 18 male and 15 female patients;the mean age was (4.6±3.1)years;the mean stone size was (14.2±5.1)mm ;9cases in left side,and 24cases in right side;multiple stones were found in 11cases and single stone was found in 22cases.No statistical significance was found between the two groups in sex,age, stone size,stone side (left/fight),percentage of multiple calculi (P >0.05).Patients were evaluated with KUB radiography or CT after 1 month.The overall stone-free rate and complications of the two groups were compared.Results Group RIRS compared to group SMP showed longer operative time [(74.2±31.8)min vs.(57.9±27.8)min,P =0.015],and hospital stay after operation [(4.8±2.8)days vs.(3.1±1.3)days,P =0.003].The overall stone-free rate was 90.4%(47/52)for group SMP,and 48.5% (16/33)for group RIRS (P <0.01).The re-treatment rate was significantly higher in group RIRS compared to group SMP[36.4%(12/33)vs.1.9%(1/52),P <0.01].The complication rate was 9.6(3/52)and 27.3%(9/33)for groups SMP and RIRS,respectively (P <0.05).Conclusions SMP was more effective than RIRS to obtain a better stone free rate,less complications and re-treatment rate in children with upper urinary tract renal calculus.

关 键 词：超微经皮肾镜取石术 输尿管软镜 上尿路结石 儿童 

分 类 号：R726.9[医药卫生—儿科]