Van Kote G, Lottmann H, Fremond B, Mourey E, Dore B, Daoud S, Valla J S, Garcia S, Beurton D, Poddevin F, Biserte J, Villar F, Lacombe A
Service de Chirurgie Viscérale-Fondation Hôpital Saint-Joseph, Paris.
Ann Urol (Paris). 1999;33(5):308-14.
The authors present the results of a survey conducted among French paediatric urologists belonging to the Groupe d'Etudes en Urologie Pédiatrique (GEUP) (Paediatric Urology Study Group). This study, based on 122 cases observed in 13 centres, is not exhaustive, but is nevertheless statistically significant. The preoperative assessment confirms the usual findings of urinary stones in children: pyelonephritis, haematuria and abdominal pain, the usual presenting complaint, concomitant malformative uropathy (10% of cases) and a predominance of calcium stones. More than 200 stones were treated, larger than 10 millimeters in diameter in one-third of cases. Renal stones, mainly caliceal (more than 50%), included 11 staghorn calculi. This study also included 22 ureteric stones, mainly in the pelvic ureter, and 2 bladder stones. Lithotripsy was ultrasound-guided in 2/3 of cases and required general anaesthesia in about 3/4 of cases. Ureteric catheterization was required in 19 infants preoperatively, but in only 2 infants (stein strasse) postoperatively. One or two lithotripsy sessions were sufficient in most cases, but 4 sessions were necessary in 5 patients, to the same kidney in 1 case. The mean hospital stay was 2 to 3 days, but the procedure was performed on an outpatient basis in 15 cases. The immediate postoperative course was uneventful and asymptomatic. This survey revealed about 10% of complete failures, corresponding to solitary caliceal stones in 2/3 of cases; 29 partial failures were essentially due to lower caliceal stones and staghorn calculi; 84 successes (stone-free), mainly pelvic or simple caliceal stones. Scintigraphy did not reveal any immediate postoperative impairment of renal function. This study reported a success rate of about 70%, regardless of the type of apparatus used. Assessment of the results of ESWL requires sufficient follow-up both concerning the outcome of fragmented stones and evaluation of possible functional repercussions. This survey defines the main indications: although ESWL can be applied to most stones, some stones constitute poor indications (cystine stones, stenotic malformative uropathy) or dubious indications: small lower caliceal stones, densely calcified staghorn calculi in older children. This study confirmed the efficacy and low morbidity of ESWL in children. A prospective study needs to be conducted according to a rigorous protocol in order to refine the technique and indications while reducing the possible long-term risks.
作者介绍了一项对法国儿科泌尿外科医生进行的调查结果，这些医生隶属于儿科泌尿外科研究组（GEUP）。该研究基于13个中心观察到的122例病例，虽不详尽，但仍具有统计学意义。术前评估证实了儿童尿路结石的常见表现：肾盂肾炎、血尿和腹痛，这是常见的就诊主诉，伴有畸形性泌尿系统疾病（10%的病例）以及以钙结石为主。治疗了200多颗结石，三分之一的病例结石直径大于10毫米。肾结石主要位于肾盏（超过50%），包括11例鹿角形结石。该研究还包括22例输尿管结石，主要位于盆腔段输尿管，以及2例膀胱结石。三分之二的病例采用超声引导下碎石术，约四分之三的病例需要全身麻醉。19例婴儿术前需要输尿管插管，但术后仅2例（石街）需要。大多数病例进行一到两次碎石术就足够了，但5例患者需要进行4次，其中1例是对同一侧肾脏。平均住院时间为2至3天，但15例患者在门诊进行了该手术。术后即刻过程平稳且无症状。该调查显示约10%的完全失败病例，其中三分之二为孤立性肾盏结石；29例部分失败病例主要是由于下极肾盏结石和鹿角形结石；84例成功病例（结石清除），主要是盆腔或单纯肾盏结石。肾闪烁显像未显示术后即刻肾功能损害。该研究报告的成功率约为70%，与所使用的设备类型无关。评估体外冲击波碎石术（ESWL）的结果需要对碎石结果和可能的功能影响进行充分的随访。该调查明确了主要适应证：虽然ESWL可应用于大多数结石，但一些结石是不良适应证（胱氨酸结石、狭窄性畸形性泌尿系统疾病）或可疑适应证：下极小肾盏结石、大龄儿童中致密钙化的鹿角形结石。该研究证实了ESWL在儿童中的有效性和低发病率。需要根据严格的方案进行前瞻性研究，以完善技术和适应证，同时降低可能的长期风险。
