Kapoor Rahul, Solanki Fanindra, Singhania Piyush, Andankar Mukund, Pathak Hemant R
Department of Urology, B.Y.L. Nair Charitable Hospital, Mumbai, India.
J Endourol. 2008 Apr;22(4):637-40. doi: 10.1089/end.2007.0254.
We reviewed our experience with percutaneous nephrolithotomy (PCNL) in patients in the pediatric age group and compared its efficacy and safety over a 5-year period.
We studied retrospectively and prospectively 31 patients who were treated with PCNL for renal stones larger than 1.5 cm. Variables assessed were stone bulk, size, location, and type. Metabolic and anatomic factors were also assessed. PCNL punctures and number of tracts were recorded. Clearance with PCNL and ancillary procedures was recorded.
There were 31 renal units. Mean age of the patients was 9.6 years (range 1.5-15 years). Fifteen (48.4%) patients had single calculi; eight (25.8%) patients had staghorn calculi. Lower-pole access was the preferred route of entry, and upper-pole access was used only when necessary. We used a 22F nephroscope for the procedure. We dilated the tract to 30F in the majority of patients, but limited dilation to 24F when appropriate. If needed, we used a ureteroscope. Complete clearance was achieved in 83.9% of patients after PCNL and in 90.32% of patients after dual therapy (PCNL + shockwave lithotripsy). Average hemoglobin drop was less than 1 g/dl. Factors responsible were the size of the tract (larger than 24F) and the number of tracts. Six patients were treated for an anatomic abnormality. A metabolic abnormality was diagnosed in three patients.
PCNL is effective in children, with a clearance rate of 83% and, with dual therapy, more than 90%. We recommend that tract dilation be restricted to 24F or smaller whenever possible. Approximately 40% of patients had either an anatomic or metabolic abnormality.
我们回顾了小儿年龄组患者经皮肾镜取石术（PCNL）的经验，并比较了其在5年期间的疗效和安全性。
我们对31例因肾结石大于1.5 cm而接受PCNL治疗的患者进行了回顾性和前瞻性研究。评估的变量包括结石体积、大小、位置和类型。还评估了代谢和解剖因素。记录PCNL穿刺情况和通道数量。记录PCNL及辅助手术的结石清除情况。
共31个肾单位。患者平均年龄为9.6岁（范围1.5 - 15岁）。15例（48.4%）患者为单发结石；8例（25.8%）患者为鹿角形结石。下极入路是首选的进入途径，仅在必要时使用上极入路。我们在手术中使用了22F肾镜。大多数患者将通道扩张至30F，但在适当情况下将扩张限制在24F。如有需要，我们使用输尿管镜。PCNL术后83.9%的患者结石完全清除，联合治疗（PCNL + 冲击波碎石术）后90.32%的患者结石完全清除。平均血红蛋白下降小于1 g/dl。相关因素为通道大小（大于24F）和通道数量。6例患者因解剖异常接受治疗。3例患者被诊断为代谢异常。
PCNL对儿童有效，清除率为83%，联合治疗时超过90%。我们建议尽可能将通道扩张限制在24F或更小。约40%的患者存在解剖或代谢异常。
