El-Nahas Ahmed R, Shokeir Ahmed A, El-Kenawy Mahmoud R, Shoma Ahmed M, Eraky Ibrahim, El-Assmy Ahmed M, Ghaly Ahmed M, El-Kappany Hamdy A
Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
J Urol. 2008 Aug;180(2):676-80. doi: 10.1016/j.juro.2008.04.046. Epub 2008 Jun 12.
This study was conducted to evaluate the safety and efficacy of the supracostal approach for percutaneous nephrolithotomy in pediatric patients.
We retrospectively reviewed 60 percutaneous nephrolithotomy procedures done in 50 children (32 boys and 18 girls) between 2000 and 2007. Mean patient age was 7 +/- 4 years (range 9 months to 14 years). Noncontrast computerized tomography was the primary radiological investigation for most of the cases. The subcostal approach was used in 40 procedures, and the supracostal approach (above the 12th rib) was required in 20. We compared both approaches regarding preoperative characteristics, stone-free and complication rates, and the need for auxiliary procedures.
The preoperative characteristics of the patients, urinary tracts and stones were comparable for both treatment groups. There were no major complications. Significant bleeding requiring blood transfusion was observed in 3 patients (5%), transient fever in 3 (5%) and urinary leakage through the nephrostomy site in 3 (5%). The distribution of complications among subcostal and supracostal approaches was comparable. Of the 60 renal units 46 (77%) were stone-free after percutaneous nephrolithotomy at discharge from the hospital. Of the remaining 14 units 9 (15%) were stone-free after shock wave lithotripsy and 5 (8%) had insignificant residual stones. Therefore, the overall stone-free rate at 3 months was 92.5%. Comparing the subcostal and supracostal approaches, there were no significant differences between hospital stays, complication rates, unplanned auxiliary procedures, and stone-free rates at discharge home and at 3-month followup.
Percutaneous nephrolithotomy for treating renal stones in children provides a high degree of safety and efficacy whether a supracostal or subcostal approach is used.
本研究旨在评估肋上入路在小儿经皮肾镜取石术中的安全性和有效性。
我们回顾性分析了2000年至2007年间对50例儿童（32例男孩和18例女孩）实施的60例经皮肾镜取石术。患者平均年龄为7±4岁（范围9个月至14岁）。大多数病例的主要影像学检查为非增强计算机断层扫描。40例手术采用肋下入路，20例需要肋上入路（第12肋以上）。我们比较了两种入路在术前特征、结石清除率和并发症发生率以及辅助手术需求方面的情况。
两个治疗组患者、尿路和结石的术前特征具有可比性。无重大并发症。3例患者（5%）出现需要输血的严重出血，3例（5%）出现短暂发热，3例（5%）出现肾造瘘部位尿液渗漏。肋下入路和肋上入路并发症的分布情况具有可比性。60个肾单位中，46个（77%）在出院时经皮肾镜取石术后结石清除，其余14个单位中9个（15%）在冲击波碎石术后结石清除，5个（8%）有少量残留结石。因此，3个月时的总体结石清除率为92.5%。比较肋下入路和肋上入路，住院时间、并发症发生率、计划外辅助手术以及出院时和3个月随访时的结石清除率之间无显著差异。
无论采用肋上入路还是肋下入路，小儿经皮肾镜取石术治疗肾结石均具有高度的安全性和有效性。
