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目的:对比研究儿童及成人肾结石采用经皮肾镜取石术(PCNL)治疗的手术风险及疗效。方法:回顾性分析比较2000~2012年经PCNL治疗的331例儿童及7 089例(8 537侧)成人的临床资料。结果:儿童相比成人结石较小(2.3cm∶3.1cm),但结石数量和肾内的位置分布相似。儿童所需的经皮通道数量较少、通道大小较小、手术时间较短及血红蛋白(Hb)下降较少。经单次PCNL后儿童结石清除率为80.4%,成人为78.6%(P<0.05),经辅助手术治疗后,两组总结石清除率无明显差异(94.7%∶93.5%,P>0.05),而总并发症(15.6%∶16.3%)及总输血率(3.1%∶2.9%)均差异无统计学意义(P>0.05)。相比成人,多通道的PCNL的儿童输血率更高(18.8%∶4.5%,P=0.007)。结论:PCNL治疗儿童和成人肾结石一样安全有效。儿童采用多通道时仍需谨慎出血的风险。
Objective: To compare the surgical risk and efficacy of percutaneous nephrolithotomy (PCNL) in children and adults with kidney stones. Methods: The clinical data of 331 children treated with PCNL and 7 089 adults (8 537 adults) from 2000 to 2012 were analyzed retrospectively. Results: Children had smaller stones (2.3 cm: 3.1 cm) than adults, but the number of stones was similar to that in the kidney. Children require fewer percutaneous channels, smaller tunnels, shorter procedures, and fewer decreases in hemoglobin (Hb). Children with primary PCNL had a clear stone clearance rate of 80.4% and an adult rate of 78.6% (P <0.05). There was no significant difference in total stone clearance between the two groups (94.7% vs 93.5%, P> 0.05) after adjuvant surgery. The total complication (15.6%: 16.3%) and total transfusion rate (3.1%: 2.9%) showed no significant difference (P> 0.05). Children with multi-channel PCNL had higher rates of transfusions (18.8% vs. 4.5%, P = 0.007) compared to adults. Conclusions: PCNL is as safe and effective as children and adult kidney stones. Children still need to be cautious about the risk of bleeding when using multiple channels.