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目的报告小儿结石ESWL治疗的10年经验,探讨ESWL治疗的效果和策略。方法回顾性研究67例小儿输尿管结石行ESWL治疗的结果,检测及记录患儿的代谢情况、生理解剖、结石的大小、位置以及各种并发症;其中术前置入输尿管导管52例;术后随访3~9个月。结果67例输尿管结石,首次碎石后,43例(64.2%)结石完全排空;7例(10.4%)经2次ESWL结石完全排空;2例(2.9%)经3次碎石结石完全排空;总结石完全排空率为77.6%。小于10mm结石首次碎石后的完全排空率为100%,37例大于10mm的结石患儿中,23例(62.2%)首次碎石后完全排空。上段结石的完全排空率为92.0%,而中下段结石的完全排空率仅为69.0%。其中11例输尿管中、下段结石和1例上段嵌顿结石ESWL失败者进行了输尿管镜治疗,用APL弹道碎石机击碎结石并取出;3例改行开放手术。结论ESWL是小儿输尿管结石的安全有效的治疗方法;对输尿管中、下段结石应用输尿管镜是ESWL的有效补充治疗;部分结石采用输尿管镜联合ESWL可获得较好的效果。
Objective To report 10-year experience of pediatric ESWL therapy and explore the effect and strategy of ESWL therapy. Methods A retrospective study of 67 children with ureteral calculi ESWL treatment results, detection and record of children with metabolic status, physiological anatomy, stone size, location and various complications; preoperative ureteral catheterization in 52 cases; postoperative Follow-up 3 to 9 months. RESULTS: 67 cases of ureteral calculi were completely obstructed in 43 cases (64.2%) of stones after the first gravel, 7 cases (10.4%) were completely emptied after 2 times of ESWL stones, and 2 cases (2.9% Emptying; the total stone void rate was 77.6%. The complete emptying rate of the stones less than 10mm after the first gravel was 100%. Among 37 children with stones larger than 10mm, 23 (62.2%) were completely emptying after the first gravel. The complete emptying rate of upper stones was 92.0% while the complete emptying rate of middle and lower stones was only 69.0%. Among them, 11 cases of ureteral calculi in the lower ureter and 1 case of incarcerated ESWL stones in the upper ureter were treated by ureteroscopy. The stones were removed by APL ballistic crusher and removed. Three cases were diverted to open surgery. Conclusions ESWL is a safe and effective treatment for ureteral calculi in children. Ureteroscopy is an effective supplementary treatment of ESWL in the middle and lower ureter stones. Some ureteral stones combined with ESWL can obtain good results.