Schuster Tina K, Smaldone Marc C, Averch Timothy D, Ost Michael C
Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
J Endourol. 2009 Oct;23(10):1699-705. doi: 10.1089/end.2009.0198.
To review the history of percutaneous nephrolithotomy (PCNL) in children, describe technical considerations, including advancements in equipment, and discuss future directions.
A comprehensive literature review was performed using MEDLINE/PubMed to evaluate the use of PCNL in the pediatric population, including historical background, indications, operative techniques, and outcomes.
PCNL was first applied to the pediatric population in the 1980s using adult-size instruments. Although there is still concern for potential renal damage in relatively small kidneys, initial investigations have demonstrated its safety and efficacy in children. Operative techniques are similar to those used in adult patients, but considerations specific to pediatric populations must be addressed. Modifications in technique including "mini-perc" access have reduced postoperative morbidity without an appreciable difference in outcomes. Technologic improvements, including miniaturization of endoscopes and advances in energy sources for stone fragmentation, have facilitated stone-free rates comparable to those of adult populations with PCNL monotherapy and sandwich shockwave lithotripsy therapy with minimal postoperative morbidity.
Technologic advancements and refinements in technique have facilitated the successful application of PCNL in the pediatric population. As a result, PCNL has now replaced open surgery as the treatment of choice for large stone burdens in children of all ages.
回顾儿童经皮肾镜取石术（PCNL）的历史，描述技术要点，包括设备的进步，并探讨未来发展方向。
使用MEDLINE/PubMed进行全面的文献综述，以评估PCNL在儿科患者中的应用，包括历史背景、适应症、手术技术和结果。
20世纪80年代，PCNL首次使用成人尺寸的器械应用于儿科患者。尽管对于相对较小的肾脏仍存在潜在肾损伤的担忧，但初步研究已证明其在儿童中的安全性和有效性。手术技术与成人患者相似，但必须考虑儿科患者的特殊情况。包括“迷你经皮”入路在内的技术改进降低了术后发病率，而结果并无明显差异。技术进步，包括内窥镜的小型化和结石破碎能量源的进展，使无石率与接受PCNL单一疗法和三明治式冲击波碎石疗法的成人患者相当，且术后发病率最低。
技术进步和技术改进促进了PCNL在儿科患者中的成功应用。因此，PCNL现已取代开放手术，成为各年龄段儿童大结石负荷的首选治疗方法。
