Rizvi S A, Naqvi S A, Hussain Z, Hashmi A, Hussain M, Zafar M N, Sultan S, Mehdi H
Sindh Institute of Urology and Transplantation, Dow Medical College, Karachi, Pakistan.
J Urol. 2003 Feb;169(2):634-7. doi: 10.1097/01.ju.0000041402.50707.c0.
We evaluated the efficacy and safety of different modalities for pediatric urolithiasis in a developing country in 2 eras, namely before and after the advent of minimally invasive surgery.
We retrospectively reviewed the records of 1,440 children younger than 14 years treated with various modalities during a 14-year period. From 1987 to 1995, 486 and 50 patients were treated with open surgery, and extracorporeal shock wave lithotripsy (ESWL, Dornier Medical Systems, Inc., Marietta, Georgia) and minimally invasive methods, respectively. Between 1996 and 2000, 518 and 386 children were treated with surgery and minimally invasive methods, respectively.
Of the 1,440 children 795 (55.2%) had renal, 198 (13.8%) had ureteral and 447 (31%) had bladder calculi. Of the renal stones 556 (70%), 177 (22%) and 62 (7.8%) were treated with open surgery, ESWL and percutaneous nephrolithotomy, respectively. Of the ureteral calculi 85 (43%), 37 (18.6%) and 76 (38%) were managed by ESWL, ureterorenoscopy and open surgery, respectively. Of the bladder calculi 307 (68%), 77 (17.2%) and 63 (14%) were treated with open vesicolithotomy, transurethral pneumatic cystolithotripsy and ESWL, respectively. The renal stone clearance rate was 98% after open surgery, 84% after ESWL and 68% after percutaneous nephrolithotomy monotherapy at 3 months of followup. Similarly the ureteral stone-free rate was 54% after ESWL and 86.9% after ureterorenoscopy. Of the patients with bladder calculi 48% and 93% become stone-free after ESWL and transurethral pneumatic cystolithotripsy, respectively.
The use of ESWL, percutaneous nephrolithotomy and ureterorenoscopy has resulted in treating a large number of children with a short hospital stay and early return to school. Open surgery is reserved only for complex stones.
我们评估了在一个发展中国家的两个时期，即微创手术出现之前和之后，不同治疗方式对小儿尿路结石的疗效和安全性。
我们回顾性分析了14年间接受各种治疗方式的1440例14岁以下儿童的病历。1987年至1995年，分别有486例和50例患者接受开放手术、体外冲击波碎石术（ESWL，多尼尔医疗系统公司，佐治亚州玛丽埃塔）和微创治疗。1996年至2000年，分别有518例和386例儿童接受手术和微创治疗。
在1440例儿童中，795例（55.2%）有肾结石，198例（13.8%）有输尿管结石，447例（31%）有膀胱结石。肾结石患者中，分别有556例（70%）、177例（22%）和62例（7.8%）接受开放手术、ESWL和经皮肾镜取石术治疗。输尿管结石患者中，分别有85例（43%）、37例（18.6%）和76例（38%）接受ESWL、输尿管镜检查和开放手术治疗。膀胱结石患者中，分别有307例（68%）、77例（17.2%）和63例（14%）接受开放膀胱结石切除术、经尿道气压弹道碎石术和ESWL治疗。随访3个月时，开放手术后肾结石清除率为98%，ESWL后为84%，经皮肾镜取石术单一治疗后为68%。同样，ESWL后输尿管结石清除率为54%，输尿管镜检查后为86.9%。膀胱结石患者中，ESWL和经尿道气压弹道碎石术后结石清除率分别为48%和93%。
ESWL、经皮肾镜取石术和输尿管镜检查的应用使大量儿童住院时间缩短并能早日返校。开放手术仅用于复杂结石。
