Gofrit O N, Pode D, Meretyk S, Katz G, Shapiro A, Golijanin D, Wiener D P, Shenfeld O Z, Landau E H
Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
J Urol. 2001 Nov;166(5):1862-4.
We determined whether the thin ureter of the young child transports stone fragments after extracorporeal shockwave lithotripsy (ESWL) as efficiently as the adult ureter does. This determination was done by comparing the outcome after lithotripsy of renal stones greater than 10 mm. between young children and adults.
Our study group consisted of 38 children 6 months to 6 years old (median 3 years) with renal stones greater than 10 mm. in diameter. This group was further divided into 3 subgroups according to the longest stone diameter on plain abdominal film. There were 21 children with a renal stone diameter of 10 to 15 mm. (subgroup 1), 8, 16 to 20 mm. (subgroup 2) and 9 greater than 20 mm. (subgroup 3). The control group consisted of 38 adults older than 20 years randomly selected from the local ESWL registry. Each adult was matched with a child regarding stone diameter and localization. The control group was similarly divided into subgroups 1a, 2a and 3a. ESWL was performed with the unmodified Dornier HM-3 lithotriptor (Dornier Medical Systems, Inc., Marietta, Georgia). The stone-free rate, complication rate, and need for tubes, including stent or nephrostomy, and greater than 1 ESWL session were compared.
The stone-free rate was 95% in the study and 78.9% in the control group (p = 0.086). Stone-free rates were 95%, 100% and 89% in subgroups 1, 2 and 3, and 95%, 65% and 56% in subgroups 1a, 2a and 3a, respectively. There were 10 children and 4 adults who underwent greater than 1 ESWL session (p = 0.14). Then there were 10 children and 6 adults who required a tube before ESWL (p = 0.04), and almost all of them were included in subgroups 3 and 3a. Early complications were rare in both the study and control groups. Late complications had included 2 cases of Steinstrasse in the control and none in the study group.
The stone-free rate after ESWL for large renal stones is higher in young children compared to adults with matching stone size. Renal stones greater than 20 mm. often require more than 1 ESWL session. The pediatric ureter is at least as efficient as the adult for transporting stone fragments after ESWL.
我们确定幼儿的细输尿管在体外冲击波碎石术（ESWL）后输送结石碎片的效率是否与成人输尿管相同。通过比较幼儿和成人直径大于10mm的肾结石碎石术后的结果来进行此项判定。
我们的研究组由38名6个月至6岁（中位年龄3岁）、直径大于10mm的肾结石患儿组成。根据腹部平片上结石的最长直径，该组进一步分为3个亚组。有21名肾结石直径为10至15mm的患儿（亚组1），8名直径为16至20mm的患儿（亚组2），9名直径大于20mm的患儿（亚组3）。对照组由从当地ESWL登记处随机选取的38名20岁以上的成年人组成。每名成年人在结石直径和位置方面与一名儿童匹配。对照组同样分为亚组1a、2a和3a。使用未改良的多尼尔HM - 3碎石机（多尼尔医疗系统公司，佐治亚州玛丽埃塔）进行ESWL。比较结石清除率、并发症发生率以及放置支架或肾造瘘管等管道的需求情况，以及进行超过1次ESWL治疗的必要性。
研究组的结石清除率为95%，对照组为78.9%（p = 0.086）。亚组1、2和3的结石清除率分别为95%、100%和89%，亚组1a、2a和3a的结石清除率分别为95%、65%和56%。有10名儿童和4名成年人接受了超过1次的ESWL治疗（p = 0. — 14）。然后有10名儿童和6名成年人在ESWL前需要放置管道（p = 0.04），并且几乎所有这些人都包含在亚组3和3a中。研究组和对照组的早期并发症均很少见。晚期并发症包括对照组有2例石街形成，研究组无。
与结石大小匹配的成年人相比，幼儿大肾结石ESWL后的结石清除率更高。直径大于20mm的肾结石通常需要进行超过1次的ESWL治疗。小儿输尿管在ESWL后输送结石碎片的效率至少与成人相同。
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