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儿童经皮肾镜取石术:计算机断层扫描是必需的吗?

Percutaneous nephrolithotomy in pediatric patients: is computerized tomography a must?

作者信息

Gedik Abdullah, Tutus Ali, Kayan Devrim, Yılmaz Yakup, Bircan Kamuran

机构信息

Department of Urology, Medical School, Dicle University, 21280, Diyarbakir, Turkey.

出版信息

Urol Res. 2011 Feb;39(1):45-9. doi: 10.1007/s00240-010-0272-7. Epub 2010 Apr 16.

Abstract

The aim of this study was to retrospectively evaluate the results of pediatric percutaneous nephrolithotomy (PNL) cases, and discuss the results and necessity of non-contrast computerized tomography (CT) in these cases. In all, 48 pediatric patients who underwent PNL were retrospectively evaluated. Before PNL, either intravenous urography or CT was performed. In all patients, we evaluated the PNL time, scopy time with stone burden, and complications. During the PNL procedure, we switched to open surgery in two cases: in one because of renal pelvis perforation and in the other because of transcolonic access. In one patient who was scheduled to undergo PNL, we performed open surgery, primarily because we detected a retrorenal colon with CT. The stone burden in 45 patients who underwent PNL was 445 ± 225 mm(2), the PNL time was 51 ± 23 min, and the scopy time was 6.1 ± 2.7 min. We removed nephrostomy tubes 1-4 days after the procedure. In two patients, 24 h after removal of nephrostomy tubes, we inserted double J stents because of prolonged urine extravasation from the tract. In all, 34 of the 45 patients were stone-free, 5 patients had clinically insignificant stone fragments, and 6 patients had residual stones. PNL is a safe and effective method in the treatment of pediatric patients with kidney stones. Clinical experience is the most important factor in obtaining stone-free results. CT should be performed in all pediatric patients in order to prevent colon perforation.

摘要

本研究的目的是回顾性评估小儿经皮肾镜取石术(PNL)病例的结果,并讨论这些病例中无对比剂计算机断层扫描(CT)的结果及必要性。总共对48例行PNL的小儿患者进行了回顾性评估。在PNL术前,均行静脉肾盂造影或CT检查。对所有患者,我们评估了PNL时间、结石负荷的镜检时间及并发症。在PNL手术过程中,有2例转为开放手术:1例因肾盂穿孔,另1例因经结肠入路。在1例计划行PNL的患者中,我们进行了开放手术,主要是因为CT检查发现了肾后结肠。45例行PNL患者的结石负荷为445±225 mm²,PNL时间为51±23分钟,镜检时间为6.1±2.7分钟。术后1 - 4天拔除肾造瘘管。2例患者在拔除肾造瘘管24小时后,因造瘘口持续尿外渗而置入双J管。45例患者中,34例结石清除,5例有临床意义不显著的结石碎片,6例有残余结石。PNL是治疗小儿肾结石的一种安全有效的方法。临床经验是获得结石清除结果的最重要因素。为预防结肠穿孔,所有小儿患者均应行CT检查。

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