儿童输尿管下段结石逆行输尿管镜取石术

Retrograde ureteroscopy for distal ureteric stone removal in children.

作者信息

De Dominicis Mauro, Matarazzo Ennio, Capozza Nicola, Collura Giuseppe, Caione Paolo

机构信息

Division of Paediatric Urology, Department of Nephrology and Urology, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy.

出版信息

BJU Int. 2005 May;95(7):1049-52. doi: 10.1111/j.1464-410X.2005.05464.x.

DOI:10.1111/j.1464-410X.2005.05464.x

PMID:15839930

Abstract

OBJECTIVE

To compare the efficacy and safety of ureteroscopy plus intracorporeal lithotripsy (ULT) with extracorporeal shock wave lithotripsy (ESWL) for treating distal ureteric calculi in childhood, as such stones are commonly treated by ESWL as the first option in adults but there is no agreement on the method of treating them in children.

PATIENTS AND METHODS

From July 2002 to July 2003, children presenting with ureteric stones were consecutively randomized for treatment using ULT or ESWL. The two groups were matched for age, sex and stone position in the distal ureter. A 7.5 F ureteroscope combined with a ballistic lithotripter or holmium-YAG laser was used for ULT. ESWL was administered using a second-generation lithotripter. The success rate, effectiveness quotient, complication rate and hospitalization were evaluated and compared using Student's t-test (chi-square) and Fisher's exact test as appropriate. In all, 31 patients (21 girls and 10 boys, mean age 7.2 years, range 2-17) were treated, by ULT in 17 (12 girls and five boys) and ESWL as a primary procedure in 14 (five boys and nine girls).

RESULTS

After one ULT, all the girls and four boys, and after ESWL, four girls and two boys, were rendered stone-free at the first treatment. The total stone-free rate was 16 of 17 for ULT and six of 14 for ESWL (P = 0.004). Eight patients had a second ESWL and three then became stone-free. The five patients in whom both ESWL treatments failed had a successful ULT. There was no significant difference between the groups in complication rate and hospitalization. General anaesthesia was required in all patients <12 years old treated by ULT or ESWL. The calculated efficiency quotient for treating distal ureteric calculi was significantly lower for ESWL than ULT (P < 0.05).

CONCLUSIONS

ULT should be recommended as the treatment of choice for distal ureteric calculi in children; using small ureteroscopes the target stone was treated safely and effectively.

摘要

目的

比较输尿管镜联合体内碎石术（ULT）与体外冲击波碎石术（ESWL）治疗儿童远端输尿管结石的疗效和安全性。在成人中，此类结石通常首选ESWL治疗，但对于儿童的治疗方法尚无共识。

患者与方法

2002年7月至2003年7月，连续纳入输尿管结石患儿，随机分为ULT组或ESWL组进行治疗。两组在年龄、性别及远端输尿管结石位置方面进行匹配。ULT采用7.5F输尿管镜联合弹道碎石器或钬激光。ESWL采用第二代碎石器。采用Student t检验（卡方检验）和Fisher精确检验评估并比较成功率、有效率、并发症发生率及住院情况。共治疗31例患者（21例女孩，10例男孩，平均年龄7.2岁，范围2 - 17岁），其中ULT治疗17例（12例女孩，5例男孩），ESWL作为初始治疗14例（5例男孩，9例女孩）。

结果

一次ULT治疗后，所有女孩及4例男孩结石清除；ESWL治疗后，4例女孩及2例男孩首次治疗结石清除。ULT组结石清除率为17例中的16例，ESWL组为14例中的6例（P = 0.004）。8例患者接受了第二次ESWL治疗，其中3例结石清除。ESWL两次治疗均失败的5例患者ULT治疗成功。两组并发症发生率及住院情况无显著差异。ULT或ESWL治疗的所有<12岁患者均需全身麻醉。ESWL治疗远端输尿管结石的计算有效率显著低于ULT（P < 0.05）。