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目的探讨微创经皮肾镜钬激光碎石术(MPCNL)治疗婴幼儿上尿路结石的安全性及疗效。方法2007年至2009年采用MPCNL技术对6例10～36个月的婴幼儿上尿路结石进行了治疗。全麻插管成功后,患肾逆行插管,俯卧位,垫高腹部,注入造影剂使肾脏各盏显影。C臂X线引导下,穿刺肾下盏或中盏,建立14F工作通道。6～7.5F细输尿管镜经工作鞘进入肾内,钬激光击碎结石。常规留置双J管和肾造瘘管。结果6例患儿顺利接受了手术,手术时间26～45min,术中均无明显出血。术后2周复查超声或KUB,结石完全取净,无并发症发生。结论MPCNL治疗婴幼儿上尿路结石具有较好的临床安全性和较高的结石取净率。采用14F的手术通道下的细输尿管镜钬激光碎石,可有效减少组织的损伤和提高清石率。
Objective To investigate the safety and efficacy of minimally invasive percutaneous nephrolithotomy with holmium laser lithotripsy (MPCNL) in the treatment of upper urinary tract stones in infants. Methods From 2007 to 2009, 6 cases of upper urinary tract stones were treated by MPCNL in 10 to 36 months. After successful intubation of general anesthesia, retrograde intubation of the kidney, prone position, high abdomen, injection of contrast agent to the kidney of each development. C-arm X-ray guidance, puncture the kidney under the lamp or in the light, the establishment of 14F working channel. 6 ~ 7.5F fine ureteroscope into the kidney by the working sheath, holmium laser crushed stones. Conventional indwelling double J tube and renal fistula. Results Six children underwent surgery successfully. The operation time was 26-45 minutes. There was no obvious bleeding during operation. 2 weeks after ultrasound or KUB review, completely remove the stones net, no complications. Conclusion MPCNL treatment of upper urinary tract stones in children with better clinical safety and higher rate of stone removal. The use of 14F fine ureteroscopic holmium laser lithotripsy, which can effectively reduce the tissue damage and improve the rate of clear stone.