使用成人尺寸器械对5岁以下儿童进行经皮肾镜取石术的经验。

Experience of percutaneous nephrolithotomy using adult-size instruments in children less than 5 years old.

作者信息

Nouralizadeh Akbar, Basiri Abbas, Javaherforooshzadeh Ahmad, Soltani Mohammad Hossein, Tajali Farzam

机构信息

Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University, M.C. (SBMU), Tehran, Islamic Republic of Iran.

出版信息

J Pediatr Urol. 2009 Oct;5(5):351-4. doi: 10.1016/j.jpurol.2008.12.009. Epub 2009 Feb 20.

DOI:10.1016/j.jpurol.2008.12.009

PMID:19230776

Abstract

OBJECTIVE

We present our experience with percutaneous nephrolithotomy (PCNL) for management of large renal calculi in children less than 5 years old, and determine its safety and efficacy when using an adult-size device.

PATIENTS AND METHODS

Twenty patients younger than 5 years old underwent PCNL between August 2003 and July 2008. After retrograde catheterization, the nephrostomy tract dilated up to 26Fr. Then a 24-Fr rigid nephroscope was used and stones were fragmented with a pneumatic lithotripter.

RESULTS

Twenty patients with a mean age of 3.1 years underwent 26 PCNL procedures on 24 renal units. Four patients had bilateral renal stones. Five patients (20%) had staghorn stones, as did five of the other cases with multiple stones. Four patients had undergone previous stone surgery on the same side. All of the patients were managed with only one tract. The mean stone size was 33 (20-46)mm and average operative time was 93.25 (78-174)min. Stones were completely cleared in 79.16% of patients, which increased to 91.67% with adjunctive shockwave lithotripsy. The overall complication rate was 15.38% and mean hospital stay was 5.26 (3-8) days.

CONCLUSION

PCNL is an effective and safe treatment for renal calculi in children less than 5 years old, even when using instruments designed for adults.

摘要

目的

我们介绍了经皮肾镜取石术（PCNL）治疗5岁以下儿童大肾结石的经验，并确定使用成人尺寸设备时其安全性和有效性。

患者与方法

2003年8月至2008年7月期间，20例5岁以下患者接受了PCNL。逆行插管后，将肾造瘘通道扩张至26Fr。然后使用24Fr硬性肾镜，并用气压弹道碎石机将结石击碎。

结果

20例平均年龄为3.1岁的患者在24个肾单位上进行了26次PCNL手术。4例患者有双侧肾结石。5例患者（20%）有鹿角形结石，其他5例多结石患者也有鹿角形结石。4例患者此前在同一侧接受过结石手术。所有患者均仅通过一个通道进行治疗。平均结石大小为33（20 - 46）mm，平均手术时间为93.25（78 - 174）分钟。79.16%的患者结石完全清除，辅助冲击波碎石后这一比例增至91.67%。总体并发症发生率为15.38%，平均住院时间为5.26（3 - 8）天。