Bilen Cenk Yücel, Koçak Burak, Kitirci Gürcan, Ozkaya Ozan, Sarikaya Saban
Department of Urology, Ondokuz Mayis University School of Medicine, Samsun, Turkey.
J Urol. 2007 May;177(5):1867-71. doi: 10.1016/j.juro.2007.01.052.
We retrospectively compared morbidity and success rates in children who underwent percutaneous nephrolithotomy with 3 different sizes of instruments.
Percutaneous nephrolithotomy was performed using adult instruments via a 26Fr tract in 23 patients, using pediatric instruments via a 20Fr tract in 13 and using minimal access (14Fr) in 10. Percutaneous nephrolithotomy was performed using general anesthesia with parenteral antibiotic prophylaxis. Cystoscopy and retrograde pyelography were performed, and 5Fr to 6Fr soft ureteral catheters were placed during each procedure initially. Percutaneous access was established via fluoroscopic guidance with the patient in the prone position. Pneumatic, ultrasonic and holmium laser lithotriptors were used for in situ lithotripsy. A 14Fr nephrostomy catheter was placed at the end of the procedure in the 26Fr and 20Fr groups, and in the minimal access group the ureteral stent was left indwelling in cases of atraumatic procedure with no residual fragments.
Mean patient age was 13.2, 5.9 and 6.3 years, respectively, in the 26Fr, 20Fr and minimal access groups (p=0.000). Sex distribution, previous surgery, stone size, surgery and fluoroscopy times, mean hemoglobin decrease and hospitalization time did not differ between the groups. However, blood transfusion rate was higher in groups 1 and 2. Stone-free rates were 69.5%, 80% and 90%, respectively, in groups 1 to 3. Overall, adjuvant shock wave lithotripsy treatment was needed in 3 children.
Smaller instrument size to 20Fr did not significantly increase the operative time, and resulted in the same success rates as the adult sized devices. However, low blood transfusion rates were only reached in the minimal access percutaneous nephrolithotomy group.
我们回顾性比较了接受三种不同尺寸器械经皮肾镜取石术的儿童的发病率和成功率。
23例患者通过26F通道使用成人器械进行经皮肾镜取石术，13例通过20F通道使用小儿器械，10例采用微创通道（14F）。经皮肾镜取石术采用全身麻醉并预防性使用肠外抗生素。进行膀胱镜检查和逆行肾盂造影，每次手术开始时均放置5F至6F的软输尿管导管。在透视引导下，患者取俯卧位建立经皮通道。使用气动、超声和钬激光碎石机进行原位碎石。26F和20F组在手术结束时放置14F肾造瘘导管，在微创通道组中，若手术无创伤且无残留碎片，则留置输尿管支架。
26F、20F和微创通道组患者的平均年龄分别为13.2岁、5.9岁和6.3岁（p = 0.000）。各组之间的性别分布、既往手术史、结石大小、手术和透视时间、平均血红蛋白下降情况及住院时间无差异。然而，第1组和第2组的输血率较高。第1至3组的结石清除率分别为69.5%、80%和90%。总体而言，3名儿童需要辅助冲击波碎石治疗。
器械尺寸减小至20F并未显著增加手术时间，且成功率与成人尺寸器械相同。然而，仅在微创经皮肾镜取石术组中实现了低输血率。
