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目的总结小儿复杂肾结石微创治疗经验,探讨小儿肾结石微创经皮肾取石(mini-PCNL)的治疗效果。方法回顾了10年间(1995~2005年)行mini-PCNL的35例患儿的临床资料,男20例,女15例,平均年龄8岁(3.5~14岁),其中伴尿路畸形8例(22.9%),3例伴UPJ梗阻同时行顺行肾盂输尿管狭窄内切开术,1例UPJ梗阻输尿管镜扩张,4例联合ESWL。结果Ⅰ期mini-PCNL为26例(74.3%),Ⅱ期mini-PCNL为9例(25.7%);Ⅰ期结石完全清除25例(71.4%),Ⅱ期结石完全清除6例(17.1%),联合ESWL4例(11.4%),总的结石清除率为97.1%。手术时间平均40min(30~120min);平均住院时间7d(4~15d)。4例UPJ梗阻治疗效果良好。结论微创经皮肾取石治疗小儿复杂肾结石是安全有效的方法,但要根据结石和设备技术情况,联合ESWL成功率更高。
Objective To summarize the experience of minimally invasive treatment of pediatric complex nephrolithiasis and to explore the therapeutic effect of mini-percutaneous nephrolithotomy (mini-PCNL). Methods The clinical data of 35 patients with mini-PCNL in 10 years (1995-2005) were retrospectively analyzed. There were 20 males and 15 females with a mean age of 8 years (range, 3.5-14 years), including 8 cases of urinary malformations (22.9%). Three patients with UPJ obstruction underwent concurrent ureteropelvic stenosis. One patient underwent UPJ obstruction ureteroscopy dilatation and four patients combined with ESWL. Results There were 26 cases (74.3%) of mini-PCNL in stage Ⅰ, 9 cases (25.7%) of mini-PCNL in stage Ⅱ, 25 cases (71.4%) of stage Ⅰ complete removal, 6 cases , Combined with ESWL in 4 cases (11.4%), the total stone clearance rate was 97.1%. The average operation time was 40min (30 ~ 120min). The average length of stay was 7d (4 ~ 15d). 4 cases of UPJ obstruction treatment effect is good. Conclusion Minimally invasive percutaneous nephrolithotomy is a safe and effective method for the treatment of complex nephrolithiasis in children. However, the success rate of combined ESWL should be higher according to the technical conditions of stones and equipment.