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目的探讨微创经皮肾镜碎石取石术(MPCNL)治疗4岁以下婴幼儿及儿童肾结石合并同侧输尿管上段结石的临床疗效和安全性。方法回顾性分析2011年1月至2013年4月新疆维吾尔自治区喀什地区第二人民医院MPCNL治疗的婴幼儿及儿童肾结石合并同侧输尿管上段结石患者共27例,其中男性20例、女性7例。患儿年龄5~48个月。27例患儿中,右肾结石合并右侧输尿管上段结石16例,左肾结石合并左侧输尿管上段结石11例。肾结石最大直径为1.1~2.4 cm,合并输尿管结石最大直径为0.6~1.0 cm。结果 27例患儿的手术均获得成功,手术时间为30~70 min。术后复查腹部平片,25例患儿未见结石残留,一期结石清除率为92.59%。术后发热3例,所有患儿均无周围脏器损伤、胸腔积液、肠道损伤、感染性休克、大出血行血管介入栓塞治疗、肾脏切除等严重并发症发生,术后无输血,无低钠低钾血症发生。结论 MPCNL治疗4岁以下婴幼儿及儿童复杂性上尿路结石是一种安全、有效的方法。
Objective To investigate the clinical efficacy and safety of minimally invasive percutaneous nephrolithotomy (MPCNL) in the treatment of urinary calculi in children and children younger than 4 years old with lithiasis and ipsilateral ureteral calculi. Methods A retrospective analysis of 27 patients with nephrolithiasis and ipsilateral ureteral calculi in the treatment of MPCNL in the Second People’s Hospital of Kashgar Prefecture in Xinjiang Uyghur Autonomous Region from January 2011 to April 2013 was retrospectively reviewed. Among them, there were 20 males and 7 females . Children aged 5 to 48 months. Twenty-seven children were diagnosed as having right kidney stones with upper right ureteral calculi in 16 cases, left renal calculi with left ureteral calculi in 11 cases. The maximum diameter of kidney stones is 1.1 ~ 2.4 cm, the maximum diameter of ureteral stones is 0.6 ~ 1.0 cm. Results All the 27 cases were successful in operation, the operation time was 30-70 minutes. Postoperative abdominal plain film, no residual stones in 25 children, a stone clearance rate of 92.59%. Postoperative fever in 3 cases, all children had no peripheral organ damage, pleural effusion, intestinal injury, septic shock, hemorrhage with vascular interventional embolization, renal resection and other serious complications, no blood transfusion, no low postoperative Sodium hypokalemia occurs. Conclusion MPCNL is a safe and effective method for the treatment of upper urinary tract calculi in infants and children under 4 years of age.