Choong S, Whitfield H, Duffy P, Kellett M, Cuckow P, Van't Hoff W, Corry D
Institute of Urology & Nephrology, NHS Trust, London, UK.
BJU Int. 2000 Nov;86(7):857-60. doi: 10.1046/j.1464-410x.2000.00909.x.
To evaluate the efficacy and safety of the management of paediatric urolithiasis by extracorporeal shock wave lithotripsy (ESWL), endoscopic ureterolithotomy, percutaneous nephrolithotomy (PCNL) and open nephrolithotomy.
In a 3-year period (1997-1999), 59 children were treated for urolithiasis and underwent a total of 79 procedures. Thirty-two ESWL sessions were performed in 23 children (mean age 7.4 years, median 6.0). PCNL was undertaken in 30 renal units in 25 children (mean age 6.4 years, median 4.0). Eight patients (mean age 7.8 years, median 5) underwent 17 ureteroscopic procedures, six of which involved the use of a holmium laser. Three children with staghorn calculi underwent open nephrolithotomy under conditions of renal ischaemia and hypothermia.
Of the 23 children treated using ESWL, 21 (91%) became stone-free; 17 underwent one ESWL session (74%), three had two sessions and three (13%) had three sessions. All eight patients who underwent ureteroscopy became stone-free. Four patients in whom the stone could not be reached by ureteroscopy initially had a JJ stent inserted, and the stone and stent subsequently removed. Stones were cleared using PCNL in 27 of 30 renal units (90%); three patients who had residual stone fragments were rendered stone-free by ESWL. Two of three children undergoing open nephrolithotomy were stone-free after surgery and the remaining one rendered stone-free with ESWL. Metabolic evaluation showed that 25 of 45 children (55%) had a urinary infection, eight (18%) had hyperoxaluria, three (7%) had hypercalciuria, two (4%) had cystinuria, and no identifiable cause was found in seven (16%). Treatment by a single modality rendered 52 of the 59 children (88%) stone-free; when the different modalities were combined, 57 of 59 patients (97%) were cleared of their stones.
Technological advances in ESWL, ureteroscopy and PCNL have had a significant effect on the management of urolithiasis in children, allowing a safe and successful outcome. The comprehensive care of children with urolithiasis should include a full metabolic evaluation. Anatomical anomalies contribute to the complexity of many cases, necessitating a close liaison between adult and paediatric urologists, nephrologists and radiologists to optimize stone management in children.
评估体外冲击波碎石术（ESWL）、内镜输尿管切开取石术、经皮肾镜取石术（PCNL）及开放性肾切开取石术治疗小儿尿路结石的疗效及安全性。
在1997年至1999年的3年期间，59例小儿尿路结石患者接受了治疗，共进行了79次手术。23例患儿（平均年龄7.4岁，中位数6.0岁）接受了32次ESWL治疗。25例患儿（平均年龄6.4岁，中位数4.0岁）的30个肾单位接受了PCNL治疗。8例患者（平均年龄7.8岁，中位数5岁）接受了17次输尿管镜手术，其中6次使用了钬激光。3例鹿角形结石患儿在肾缺血和低温条件下接受了开放性肾切开取石术。
接受ESWL治疗的23例患儿中，21例（91%）结石清除；17例接受了1次ESWL治疗（74%），3例接受了2次治疗，3例（13%）接受了3次治疗。所有接受输尿管镜手术的8例患者结石均清除。4例最初输尿管镜无法到达结石部位的患者先置入了双J支架，随后取出结石及支架。30个肾单位中的27个（90%）通过PCNL清除了结石；3例残留结石碎片的患者通过ESWL实现了结石清除。3例接受开放性肾切开取石术的患儿中，2例术后结石清除，其余1例通过ESWL实现了结石清除。代谢评估显示，45例患儿中有25例（55%）存在泌尿系统感染，8例（18%）有高草酸尿症，3例（7%）有高钙尿症，2例（4%）有胱氨酸尿症，7例（16%）未发现明确病因。单一治疗方式使59例患儿中的52例（88%）结石清除；不同治疗方式联合应用时，59例患者中的
