可视穿刺经皮肾镜碎石技术治疗小儿上尿路结石的临床疗效  

Clinical efficacy of percutaneous nephrolithotomy with all-seeing needle system in treatment of upper urinary calculi in children

作　　者：占雄[1] 汪丹 朱建国[2] 彭金普 吴谋东 陆峰 何国庆[1] 安妮妮[1] Zhan Xiong;Wang Dan;Zhu Jianguo;Peng Jinpu;Wu Moudong;Lu Feng;He Guoqing;An Nini(Department of Pediatric Surgery,Guizhou Provincial People′s Hospital,Guiyang 550002,China;Department of Urology Surgery,Guizhou Provincial People′s Hospital,Guiyang 550002,China)

机构地区：[1]贵州省人民医院小儿外科,贵阳550002 [2]贵州省人民医院泌尿外科,贵阳550002

出　　处：《中华实用儿科临床杂志》2019年第20期1576-1578,共3页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的总结可视穿刺经皮肾镜碎石技术(Microperc)治疗小儿上尿路结石的临床效果及安全性。方法回顾性分析2016年11月至2018年1月在贵州省人民医院运用Microperc治疗的25例肾结石或输尿管上段结石患儿的临床资料。男18例,女7例;年龄(6.4±3.9)岁(10个月~14岁),4例年龄<3岁;其中输尿管上段结石3例,肾结石22例;结石的平均直径为14.5 mm(8~20 mm);碎石方式均采用200μm钬激光碎石。结果25例患儿均一期完成手术,其中6例使用4.8Fr可视穿刺针直接碎石,19例因结石负荷较大或出血转为微小通道(10~12Fr)经皮肾镜碎石。手术时间(60.8±15.1)min(40~100 min)。术后血红蛋白下降(7.5±5.4)g/L,无输血患儿。术后住院天数为(4.9±1.2)d(3~6 d)。1个月后复查有3例结石残留,术后清石率为88%(22/25例)。术后出现并发症4例(ClavienⅠ级),均为术后发热,经积极抗炎治疗后好转,无ClavienⅡ、Ⅲ级并发症发生。结论Microperc通过可视图像可快速、安全地建立手术通道。极大地降低了手术风险和操作难度,非常适合积水少的患者、初学者及儿童结石患者。Objective To evaluate the effectiveness and safety of percutaneous nephrolithotomy(PCNL)with the all-seeing needle system(Microperc)for the treatment of upper urinary calculi in children.Methods Retrospective analysis of 25 cases of upper urolithiasis treated with Microperc from November 2016 to January 2018 in Guizhou Provincial People′s Hospital was performed,including 18 boys and 7 girls.The age of patients was(6.4±3.9)years(10 months-14 years),and 4 cases were less than 3 years old.Among them,3 cases had upper ureteral calculi and 22 cases had renal calculi.The mean stone size was 14.5 mm(8-20 mm).Stone fragmentation was performed by using a 200μm holmium(YAG laser fiber).Results All patients were successfully treated in stage I.In 6 patients,access was achieved through the 4.8Fr all-seeing needle method.Conversion to mini-PCNL(10-12Fr)was required in 19 patients due to intraoperative bleeding and high stone burden.The duration of operation time was(60.8±15.1)min(40-100 min).The mean postoperative drop in hemoglobin was(7.5±5.4)g/L,and no patient required blood transfusion.The hospital stay was(4.9±1.2)days(3-6 days).There were residual fragments in 3 patients,and the overall stone-free rate at 4 weeks was 88%(22/25 cases).Four cases had a fever(Clavien gradeⅠ)complications,while no gradeⅡand gradeⅢcomplications were observed.Conclusions Microperc can establish a surgical channel through visual images quickly and safely,and it greatly reduces the risk and difficulty in doing operation.This technology is not only suitable for learner of surgery,but also for patients with mild hydronephrosis and children with calculus.

关 键 词：可视穿刺 经皮肾镜碎石技术 上尿路结石 儿童 

分 类 号：R69[医药卫生—泌尿科学]