Pediatric Surgery Service, Necker Hospital for Sick Children, Paris, France.
J Urol. 2010 Jun;183(6):2332-6. doi: 10.1016/j.juro.2010.02.030. Epub 2010 Apr 18.
This retrospective study was designed to assess the impact of shock wave lithotripsy on the pediatric kidney using pretreatment and posttreatment (99m)technetium dimercapto-succinic acid renal scintigram.
A total of 182 patients 5 months to 19.8 years old (mean 5.3 years) were treated for renal calculi with shock wave lithotripsy during a 20-year period. Pretreatment evaluation included clinical assessment, urine culture, renal ultrasound and plain abdominal radiograph with or without excretory urogram. Dimercapto-succinic acid scintigram was performed before and 6 months after completion of treatment in 94 patients (52%).
Patients underwent 1 to 4 sessions of shock wave lithotripsy per kidney with at least 1 month between treatments. Median number of shocks delivered per session was 3,000 (IQR 2,601 to 3,005). No new scars were observed on any posttreatment dimercapto-succinic acid scan. Regarding renal function, patients fell into 1 of 4 groups. Group 1 (66 patients, 70%) had normal function on dimercapto-succinic acid scan before and after treatment, group 2 (18, 19%) had decreased function in the affected kidney on pretreatment scan with no change after treatment, group 3 (2, 2%) had impaired function in the treated kidney that was transient (1) or permanent (1) and group 4 (7, 7%) had improved function in the treated kidney.
Shock wave lithotripsy is an effective treatment for renal calculi in children. Renal parenchymal trauma associated with extracorporeal shock wave lithotripsy does not seem to cause long-term alterations in renal function or development of permanent renal scars in children.
本回顾性研究旨在通过冲击波碎石术前后的 99m 锝二巯丁二酸肾闪烁扫描来评估其对小儿肾脏的影响。
在 20 年期间，共对 182 名 5 个月至 19.8 岁（平均 5.3 岁）的肾结石患者进行了冲击波碎石术治疗。预处理评估包括临床评估、尿培养、肾脏超声和腹部平片，有或无排泄性尿路造影。94 例患者（52%）在治疗完成前和治疗后 6 个月进行了二巯丁二酸闪烁扫描。
每位患者每侧肾脏接受 1 至 4 次冲击波碎石术治疗，每次治疗间隔至少 1 个月。每次治疗的平均冲击波次数为 3000 次（IQR 2601 至 3005）。任何治疗后的二巯丁二酸扫描均未发现新的瘢痕。关于肾功能，患者分为 4 组之一。第 1 组（66 例，70%）在治疗前后的二巯丁二酸扫描中肾功能正常，第 2 组（18 例，19%）在治疗前受影响的肾脏功能下降，治疗后无变化，第 3 组（2 例，2%）治疗后受影响的肾脏功能暂时（1 例）或永久（1 例）受损，第 4 组（7 例，7%）治疗后的肾脏功能改善。
冲击波碎石术是治疗儿童肾结石的有效方法。与体外冲击波碎石术相关的肾实质损伤似乎不会导致儿童肾功能长期改变或永久性肾瘢痕形成。
