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目的探讨腹腔镜治疗儿童上尿路结石的效果。方法回顾性分析2010年4月~2016年7月腹腔镜手术治疗上尿路结石患儿43例的临床资料。中位年龄77.5月(16~168个月)。肾结石9例,左侧3例,右侧5例,双侧1例,3例合并肾盂输尿管连接部梗阻。输尿管结石34例,左侧19例,右侧13例,双侧2例。结果肾结石中转开放率44%(4/9),4例均为肾盏结石,其中2例为多发结石;输尿管结石中转开放率3%(1/34)。腹腔镜肾盂切开取石术手术时间85~300 min,平均159 min,腹腔镜输尿管切开取石术手术时间25~300 min,平均117.5 min。输尿管支架管梗阻1例,双J管梗阻1例。肾结石取净率100%(5/5),输尿管结石取净率97%(32/33)。随访27例,随访时间1个月~6年,平均14个月,均未见结石复发。结论腹腔镜是一种安全、有效的治疗儿童上尿路结石的手术方式,且具有微创的优势,可用于全段输尿管结石及肾盂结石的治疗,但不适用于肾盏结石的治疗。
Objective To investigate the effect of laparoscopic treatment of upper urinary tract stones in children. Methods The clinical data of 43 cases of children with upper urinary tract stones underwent laparoscopic surgery from April 2010 to July 2016 were retrospectively analyzed. Median age 77.5 months (16 ~ 168 months). 9 cases of kidney stones, left in 3 cases, right in 5 cases, bilateral in 1 case, 3 cases with ureteropelvic junction obstruction. 34 cases of ureteral calculi, left in 19 cases, right in 13 cases, bilateral in 2 cases. Results The open conversion rate of renal stones was 44% (4/9). All 4 cases were calyceal calculus, of which 2 cases were multiple stones. The open conversion rate of ureteral stones was 3% (1/34). Laparoscopic pyelolithotomy operation time 85 ~ 300 min, an average of 159 min, laparoscopic ureterolithotomy operation time 25 ~ 300 min, an average of 117.5 min. Ureteral stent obstruction in 1 case, double J tube obstruction in 1 case. Nephrolithium take rate of 100% (5/5), ureteral calculi take rate of 97% (32/33). Follow-up in 27 cases, follow-up time of 1 month to 6 years, an average of 14 months, no recurrence of stones. Conclusion Laparoscopy is a safe and effective surgical treatment of upper urinary tract stones in children. It has the advantages of minimally invasive treatment and can be used for the treatment of ureteral calculi and renal pelvis stones. However, laparoscopy is not suitable for the treatment of calyceal calculus.