Jayanthi V R, Arnold P M, Koff S A
Section of Urology, Columbus Children's Hospital, Ohio State University, USA.
J Urol. 1999 Sep;162(3 Pt 2):1234-7. doi: 10.1016/S0022-5347(01)68144-8.
Pediatric urolithiasis is relatively uncommon and there is little information on the application of modern surgical procedures in young children. We present a single center experience with the surgical management of upper tract calculi in this age group.
We reviewed presentation, co-morbidity, treatment, outcome and complications in all prepubertal patients who required surgical treatment for ureteral or renal calculi during a 4-year period. The series consists of 24 girls and 17 boys 17 months to 14 years old (mean age 7.5 years). A total of 26 children were anatomically normal, and 4 had myelomeningocele, 4 had ureteropelvic junction obstruction (in a pelvic kidney in 1), 2 had cloacal anomalies, 2 had vesicoureteral reflux, and 1 each had nonrefluxing megaureter, orthotopic ureterocele and a functioning renal transplant.
Extracorporeal shock wave lithotripsy was performed in 24 patients. Stents or nephrostomy tubes were only used in the 4 patients who presented with pyonephrosis. Of the 41 cases 17 were rendered stone-free, 3 had a decreased stone burden and 4 were failures. Ureteroscopic extraction of distal ureteral calculi was successful in 11 of 12 children, of whom the youngest was 2.5 years old. No child had postoperative infection or evidence of ureteral obstruction. Stent placement facilitated stone passage or dissolution in 2 patients, a renal calculus was percutaneously extracted in 2 and 7 required open surgery, mostly for correcting simultaneous anatomical abnormalities or after minimally invasive surgery failed. Some metabolic abnormality was detected in 80% of the children tested.
The surgical management of upper urinary tract calculi in young children parallels that in adults. Minimally invasive surgical methods may be safely used even in young infants. Most children do not need elective stenting before lithotripsy. Open procedures are still required in 17% of cases. The majority of children have definable metabolic abnormalities.
小儿尿路结石相对少见，关于现代外科手术在幼儿中的应用信息较少。我们介绍了本中心对该年龄组上尿路结石进行手术治疗的经验。
我们回顾了4年间所有青春期前因输尿管或肾结石需要手术治疗的患者的临床表现、合并症、治疗、结局及并发症。该系列包括24名女孩和17名男孩，年龄在17个月至14岁之间（平均年龄7.5岁）。共有26名儿童解剖结构正常，4名患有脊髓脊膜膨出，4名患有输尿管肾盂连接部梗阻（其中1例为盆腔肾），2名患有泄殖腔畸形，2名患有膀胱输尿管反流，各有1名患有非反流性巨输尿管、原位输尿管囊肿和功能性肾移植。
24例患者接受了体外冲击波碎石术。仅4例脓肾患者使用了支架或肾造瘘管。41例中，17例结石清除，3例结石负荷减轻，4例治疗失败。12例儿童中有11例输尿管镜下取出远端输尿管结石成功，其中最年幼者为2.5岁。无儿童术后感染或输尿管梗阻迹象。2例患者放置支架有助于结石排出或溶解，2例经皮取出肾结石，7例需要开放手术，主要用于纠正同时存在的解剖异常或微创手术失败后。80%接受检测的儿童发现有某种代谢异常。
小儿上尿路结石的手术治疗与成人相似。即使是幼儿也可安全使用微创手术方法。大多数儿童在碎石术前无需选择性放置支架。17%的病例仍需要开放手术。大多数儿童有明确的代谢异常。
