Reis L O, Zani E L, Ikari O, Gugliotta A
Servicio de Urología, Universidad Estatal de Campinas, Unicamp, Brasil.
Actas Urol Esp. 2010 Jan;34(1):78-81. doi: 10.1016/s2173-5786(10)70013-5.
To determine the effectiveness of extracorporeal shock-wave lithotripsy (ESWL) and possible deleterious effects on renal parenchyma of children subjected to treatment of renal lithiasis, using renal scintigraphy with 99mTc dimercapto-succunic acid (DMSA).
From January 2004 to November 2007, 18 children (age 3-10 years) underwent ESWL (Philips-Dornier) for kidney urolithiasis. All patients underwent preoperative evaluation, including physical examination, urine culture, image exams and renal scintigraphy with Tc99-DMSA. Evaluation after treatment consisted of a clinical examination, blood pressure measurement, urine culture, renal ultrasound and Tc99-DMSA, repeated at 3, 6 and 12 months, which were compared to the scans obtained before ESWL to determine possible morphological or functional changes.
Success in the stones fragmentation was achieved in all cases - in 9 patients (50%) with one session of ESWL, in 6 (33%) with two sessions and in 3 patients (17%) with 3 sessions of ESWL. Only one patient (5%), after three sessions of ESWL and 6 months of follow-up showed change in size of right kidney with a decrease in tubular function, without hypertension or other major changes. In the other cases, there was absence of hypertension up to 12 months of follow-up, absence of renal hematomas detected by ultrasound or significant renal scars in scintigraphic examinations.
ESWL is effective and safe for treating renal lithiasis in children. Renal parenchyma lesions may occur early after treatment, but these lesions are transients and resolve spontaneously in virtually all cases; generally, there are no irreversible renal lesions associated with ESWL, even after the follow-up period with clinical examination, ultrasound examination and 99mTc-DMSA scintigraphy.
采用99mTc二巯基丁二酸（DMSA）肾闪烁显像，确定体外冲击波碎石术（ESWL）治疗儿童肾结石的有效性以及对肾实质可能产生的有害影响。
2004年1月至2007年11月，18名年龄在3至10岁的儿童因肾结石接受了ESWL（飞利浦 - 多尼尔）治疗。所有患者均接受了术前评估，包括体格检查、尿培养、影像检查以及用Tc99 - DMSA进行肾闪烁显像。治疗后的评估包括临床检查、血压测量、尿培养、肾脏超声检查以及Tc99 - DMSA检查，分别在3个月、6个月和12个月时重复进行，并与ESWL治疗前获得的扫描结果进行比较，以确定是否存在可能的形态或功能变化。
所有病例的结石均成功破碎——9例（50%）患者仅接受一次ESWL治疗，6例（33%）接受两次治疗，3例（17%）接受三次ESWL治疗。仅1例患者（5%）在接受三次ESWL治疗并随访6个月后，右肾大小出现变化，肾小管功能下降，但无高血压或其他重大变化。在其他病例中，随访至12个月均未出现高血压，超声检查未发现肾血肿，闪烁显像检查也未发现明显的肾瘢痕。
ESWL治疗儿童肾结石有效且安全。治疗后早期可能会出现肾实质损伤，但这些损伤是短暂的，几乎所有病例都会自发消退；一般来说，即使经过临床检查、超声检查和99mTc - DMSA闪烁显像的随访期，ESWL也不会导致不可逆的肾脏损伤。
