低灌注压下微造瘘经皮肾镜取石术治疗学龄前儿童上尿路结石的安全性和有效性  

Mini-percutaneous nephrolithotomy(MPCNL)under low perfusion pressure for the treatment of upper urinary tract calculi in preschool-age children

作　　者：郭全斌[1] 阿布力克木·扎克尔 史旭文 侯江江 陈畅 艾散江·麦麦提 艾克拜尔江·麦麦提 艾尼瓦尔·阿不都卡德尔 邱智[2] Guo Quanbin;Ablikim·Zakir;Shi Xuwen;Hou Jiangjiang;Chen Chang;Hasanjan·Mamat;Akbarjan·Mamat;Anwar·Abdukadir;Qiu Zhi(Department of Urology,People’s Hospital of Xinjiang Hotan Region,Hotan 848000,China;Department of Urology,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]新疆和田地区人民医院泌尿外科,新疆和田848000 [2]首都医科大学附属北京朝阳医院泌尿外科,北京100020

出　　处：《中华泌尿外科杂志》2020年第12期927-930,共4页Chinese Journal of Urology

摘　　要：目的:探讨低灌注压下微造瘘经皮肾镜取石术(mini-percutaneous nephrolithotomy,MPCNL)治疗学龄前儿童上尿路结石的安全性和有效性。方法:回顾性分析新疆和田地区人民医院2015年1月至2020年1月收治的690例上尿路结石学龄前患儿的临床资料。男466例,女224例。平均年龄(3.7±1.6)(0.6~6.0)岁。690例结石位于左侧293例,右侧282例,双侧115例,共805侧。结石部位:上盏41例(5.9%)、中盏14例(2.0%)、下盏62例(9.0%)、肾盂90例(13.1%)、肾盂输尿管连接处81例(11.7%)、多部位402例(58.3%)。平均结石数量(1.5±1.3)(1~6)枚。结石负荷(2.8±2.1)cm 2,CT值(834.6±478.5)HU。79例存在先天畸形:孤立肾35例(5.1%)、马蹄肾24例(3.5%)、肾旋转不良9例(1.3%),后位结肠11例(1.6%)。690例均全麻下行MPCNL。输尿管镜下于患侧输尿管内置入F5双J管,经尿管持续滴注无菌盐水,建立人工肾积水。超声引导下于腋前线和肩胛下线之间,取第11肋间或第12肋下穿刺目标肾盏的穹窿部。穿刺目标盏:上盏45侧(5.6%)、中后盏719侧(89.3%)、下盏41侧(5.1%)。780侧(96.9%)采用单通道,25侧(3.1%)采用双通道。穿刺成功后扩张建立通道,F12、F14、F16、F18通道分别为56侧(7.0%)、113侧(14.0%)、557侧(69.2%)、79侧(9.8%)。采用生理盐水悬吊在50~70 cm高度重力自然灌注。使用F11.5小儿肾镜行钬激光或气压弹道碎石。16例术后半无管化(不留置肾造瘘,留置双J管)。结果:本组805侧中,一期手术779侧(96.8%);二期手术26侧(3.2%),其中11侧因结石负荷较大,一期术后1周行二期手术,15侧因一期术后1年复查残留结石>1 cm行二期手术。115例双侧肾结石患儿中,28例行一期双侧MPCNL,余87例分期手术。手术时间平均(35.0±15.3)(15~110)min。血红蛋白平均下降(1.3±0.9)g/L。术后出现发热48例(7.0%)、感染中毒性休克3例(0.4%),予亚胺培南、去甲肾上腺素治疗后好转;肾周积液33例(4.8%)、腹腔积液10例(1.4%),予超声引导�Objective To explore the safety and efficacy of mini-percutaneous nephrolithotomy(MPCNL)under low perfusion pressure for the treatment of upper urinary tract calculi in preschool-age children.Methods A retrospective analysis was performed using the clinical data from the MPCNL of 805 upper urinary tract calculi in 690 preschool-age children who were admitted to the Hotan People's Hospital of Xinjiang Uyghur Autonomous Region,China,from January 2015 to January 2020.The mean age of the 690 patients was(3.7±1.6)(1-6)years.The stone burden was(2.8±2.1)cm2,and the CT value was(834.6±478.5)HU.A middle posterior calyceal puncture was created in 719(89.3%)kidneys.The single-tract approach was applied for 780(96.9%)kidneys,and the double-tract approach was applied for 25(3.1%)kidneys.The F12,F14,F16,and F18 tracts were made for 56(7.0%),113(14.0%),557(69.2%),and 79(9.8%)kidneys,respectively.Under a ureteroscope,a F5 double-J catheter was inserted to establish artificial hydronephrosis by the reflux of saline from the bladder to the renal pelvis.Under B-ultrasound guidance,the target calyx connected to the location of the calculus was punctured.The guidewire was placed,followed by dilation of the fascia using a set of coaxial dilators to establish a F12-18 skin-to-kidney tract for the insertion of the peel-away access sheath.Continuous irrigation of 0.9%sodium chloride solution was provided by gravity,instead of by a pump,from a height of 50-70 cm above the operation table.The F11.5 pediatric nephroscope was inserted to lithotripsy by pneumatic ballistics or holmium laser.Result The total of 805 MPCNL of upper urinary tract calculi were operated.The operation times were 15-110 minutes,with an average of(35.0±15.3)minutes.Among all patients,the mean decrease in hemoglobin level was(1.3±0.9)g/L,and the incidence rates of fever,sepsis,perirenal effusion,and intraperitoneal effusion were 48(7%),3(0.4%),33(4.8%)and 10(1.4%),respectively.The length of postoperative hospital stay was 3-14 days,with an average of(6.8±4.3)day

关 键 词：尿路结石 经皮肾镜取石术 儿童 超声 

分 类 号：R726.9[医药卫生—儿科]