Samad Lubna, Qureshi Samia, Zaidi Zafar
Division of Urology, The Kidney Centre Postgraduate Training Institute, 197 Rafiqui Shaheed Road, Karachi 75530, Pakistan.
J Pediatr Urol. 2007 Feb;3(1):36-9. doi: 10.1016/j.jpurol.2006.02.001. Epub 2006 Apr 5.
To determine the frequency of renal parenchymal damage following percutaneous nephrolithotomy (PCNL) in children.
Fifty-six children undergoing PCNL in 60 renal units between January 2000 and December 2004 were included in this prospective study, and were subjected to postoperative technetium-99m dimercaptosuccinic acid ((99m)Tc-DMSA). Using a standard questionnaire, demographics, number, size and location of stones, procedure details, outcome as indicated by clearance with PCNL alone or additional procedures, and follow up were documented. Presence of focal renal damage and its association with the PCNL tract were examined.
Out of 60 renal units, cortical defects on (99m)Tc-DMSA scan were seen in 10 renal units (17%). In three of these kidneys, the site of focal defect corresponded to the access site for tract formation during PCNL. Two additional kidneys had scarring at multiple sites, one of which corresponded to the access site during PCNL. In the remaining five kidneys no association between focal renal damage and nephrostomy tract site could be ascertained. No association was seen between renal damage and the size of nephroscope used during PCNL.
There exists a risk of focal damage to renal parenchyma from the formation of the nephrostomy tract. In our series, focal damage was seen in 5% of patients; this may be an overestimate since preoperative (99m)Tc-DMSA scans were not available for our patients. Meticulous technique is important combined with a smaller nephroscope to minimize renal damage. Long-term follow up of such children is required to assess how many are left with permanent renal scars.
确定儿童经皮肾镜取石术（PCNL）后肾实质损伤的发生率。
本前瞻性研究纳入了2000年1月至2004年12月期间接受PCNL治疗的60个肾单位的56例儿童，并在术后进行了锝-99m二巯基丁二酸（（99m）Tc-DMSA）检查。使用标准问卷记录人口统计学资料、结石数量、大小和位置、手术细节、仅通过PCNL清除结石或额外手术所显示的结果以及随访情况。检查局灶性肾损伤的存在及其与PCNL通道的关系。
在60个肾单位中，10个肾单位（17%）的（99m）Tc-DMSA扫描显示皮质缺损。其中3个肾脏的局灶性缺损部位与PCNL期间通道形成的穿刺部位相对应。另外2个肾脏有多处瘢痕，其中一处与PCNL期间的穿刺部位相对应。在其余5个肾脏中，无法确定局灶性肾损伤与肾造瘘通道部位之间的关联。肾损伤与PCNL期间使用的肾镜大小之间未发现关联。
肾造瘘通道的形成存在导致肾实质局灶性损伤的风险。在我们的系列研究中，5%的患者出现了局灶性损伤；由于我们的患者术前未进行（99m）Tc-DMSA扫描，这可能是一个高估。精细的操作技术与较小的肾镜相结合对于将肾损伤降至最低很重要。需要对这些儿童进行长期随访，以评估有多少人会留下永久性肾瘢痕。
