B超引导微造瘘经皮肾镜碎石术治疗婴幼儿肾结石的临床观察  

Clinical observation of minimally invasive percutaneous nephrolithotomy in the treatment of infant renal calculi

作　　者：王录文 何士军[1] 朱清波[1] 张争春[1] 马龙[1] 闵小明 王卫妮[1] 

机构地区：[1]西安市第一医院,陕西西安710002

出　　处：《现代泌尿外科杂志》2014年第7期433-435,共3页Journal of Modern Urology

摘　　要：目的 观察B超引导微造瘘经皮肾镜碎石术（MPCNL）治疗婴幼儿肾结石的临床效果和安全性.方法 回顾分析2008年6月至2010年7月采取B超引导MPCNL治疗的24例婴幼儿肾结石患者的临床资料.其中男14例,女10例;年龄9～33月,平均（16.87±6.27）月;结石位于左侧12例,右侧9例,双侧3例;结石长径11～27 mm.所有患儿接受B超引导MPCNL治疗,选取气压弹道和钬激光作为碎石工具.手术后观察结石残留、肾功能恢复情况.比较气压弹道碎石和钬激光碎石的结石清除率;观察手术前、后患儿血红蛋白变化.采用SPSS17.0统计软件包分析数据.结果 24例患儿均顺利完成手术.其中23例行Ⅰ期MPCNL术;1例双肾结石伴急性肾功能不全,先行经皮肾穿刺微造瘘术,然后左、右肾分期行MPCNL术.气压弹道碎石11例,钬激光碎石13例,两组结石清除率没有明显差异（P＞0.05）.结石清除率为95.83％.所有患儿留置双“J”管,手术后1月拔除.手术前、后患儿血红蛋白值没有明显下降（P＞0.05）,没有出现严重并发症.结论 采用B超引导MPCNL治疗婴幼儿肾结石具有创伤小、出血少、手术后恢复快、结石清除率高的优势,是一种治疗婴幼儿肾结石安全有效的方法.Objective To observe the clinical efficacy and safety of minimally invasive percutaneous nephrolithotomy （MPCNL） under B-ultrasound guidance in the treatment of renal calculi in infants and young children.Methods Data of 24 patients （14 males and 10 females） with renal calculi treated with MPCNL under B-ultrasound guidance during June 2008 to July 2010 were retrospectively analyzed.The patients aged 9 to 33 months [mean （16.87±6.27）months].Among all patients,12 had calculi on the left side,9 on the right side,and 3 on both sides.All patients underwent MPCNL under B-ultrasound guidance.Pneumatic lithotripsy and holmium laser lithotripsy were applied.Calculi residual and renal function recovery were observed,and the clearance rate of pneumatic lithotripsy and holmium laser lithotripsy were compared after operation.The changes of hemoglobin before and after operation were observed.All data were analyzed by software package SPSS 17.0.Results All patients underwent surgery safely,23 received one-stage operation,and 1 patient with bilateral renal calculi complicated with acute renal insufficiency was first treated with percutaneous renal biopsy micro colostomy and then staging operation.The calculi clearance rate of pneumatic lithotripsy （11 patients） and holmium laser lithotripsy （13 patients） were 95.83％,with no difference （P＞0.05）.All patients had double J tubes which were removed one month after operation.There was no significant difference between preoperative and postoperative hemoglobin contents （P＞0.05）.No serious complications occurred.Conclusions MPCNL under B-ultrasound guidance to treat renal calculi in infants and young children is minimally invasive and effective,with advantages of little bleeding,quick recovery and high rate of the clearance rate.

关 键 词：婴幼儿 肾结石 经皮肾镜碎石术 B超 

分 类 号：R692.4[医药卫生—泌尿科学]