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目的探讨儿童上尿路结石的外科诊断和治疗经验。方法回顾性地研究分析了28例1995-2003年入住我科青春期前儿童肾结石和输尿管结石的诊断和治疗情况。本组研究包含17例男孩和11例女孩;年龄从10个月至14岁(平均8·6岁)。26例解剖正常,1例肾盂输尿管交界处狭窄,1例双侧输尿管口囊肿。术前行血生化检查。根据患儿病情分别采用ESWL、输尿管镜取石、溶石等方式进行了治疗。结果所有患儿均存在血生物化学检查的异常。9例患儿接受ESWL治疗后,结石完全排出8例,1例结石负荷降低;1例接受输尿管镜取石术,无术后感染和输尿管狭窄发生;1例患儿放置导管以进行溶石治疗;7例单个输尿管结石患儿接受排石治疗;6例多发性结石,或同时存在的解剖异常的患儿接受开放性手术手术治疗,均达到治疗效果;4例明确诊断后未作治疗自动出院。结论青春期前儿童上尿路结石形成可能与胆固醇及尿酸和钙磷代谢异常有关,治疗方式依据病情而定,ESWL和微创手术应是青春期前儿童上尿路结石治疗的首选方法。
Objective To investigate the surgical diagnosis and treatment of upper urinary tract stones in children. Methods A retrospective study was performed on the diagnosis and treatment of 28 cases of kidney stones and ureteral stones admitted to our department from 1995 to 2003. The study included 17 boys and 11 girls; their ages ranged from 10 months to 14 years (mean, 8.6 years). 26 cases of normal anatomy, 1 case of ureteropelvic junction stricture, 1 case of bilateral ureteral orifice cyst. Preoperative blood biochemical examination. According to the condition of children with ESWL, ureteroscopic lithotripsy, limestone, etc. were treated. Results All children had abnormal blood biochemical tests. After 9 cases received ESWL treatment, stones were completely discharged in 8 cases and stone load was reduced in 1 case. One patient underwent ureteroscopic lithotripsy without postoperative infection and ureteral stricture. One patient had a catheter placed for dissolution of stone. Seven patients with single ureteral calculi received row therapy. Six patients with multiple stones or concurrent anatomical abnormalities underwent open surgical treatment, all of which achieved therapeutic effect. Four patients were diagnosed without definite diagnosis and discharged automatically. Conclusion The formation of upper urinary tract calculi in pre-adolescent children may be related to the abnormal cholesterol and uric acid and calcium-phosphorus metabolism. The treatment method depends on the condition. ESWL and minimally invasive surgery should be the preferred method for upper urinary tract stones in pre-adolescent children.