Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213-3232, USA.
Urol Clin North Am. 2010 May;37(2):253-67. doi: 10.1016/j.ucl.2010.03.006.
With miniaturization of instruments and refinement of surgical technique, the management of pediatric stone disease has undergone a dramatic evolution. While shock wave lithotripsy (SWL) is still commonly used to treat upper tract calculi, the use of ureteroscopy (URS) has dramatically increased and is now the procedure of choice for upper tract stone burdens less than 1.5cm at centers with significant experience. Percutaneous nephrolithotomy (PCNL) has replaced open surgical techniques for the treatment of large stone burdens greater than 2cm, with efficacy and complication rates similar to the adult population. Large institutional series demonstrate comparable stone-free and complication rates with SWL, URS, and PCNL, but concerns remain with these techniques regarding renal development and damage to the pediatric urinary tract. Randomized controlled trials comparing the efficacy of SWL and URS for upper tract stone burdens are needed to reach consensus regarding the most effective primary treatment modality in children.
随着仪器的微型化和手术技术的精细化，小儿结石病的治疗已经发生了巨大的变化。虽然体外冲击波碎石术（SWL）仍然常用于治疗上尿路结石，但输尿管镜检查（URS）的应用已经显著增加，并且在经验丰富的中心，对于上尿路结石负担小于 1.5cm 的患者，它已成为首选治疗方法。对于大于 2cm 的大结石负担，经皮肾镜碎石术（PCNL）已取代了开放手术技术，其疗效和并发症发生率与成人相似。大型机构系列研究表明，SWL、URS 和 PCNL 的结石清除率和并发症发生率相当，但这些技术仍存在对儿童肾脏发育和尿路损伤的担忧。需要进行随机对照试验来比较 SWL 和 URS 治疗上尿路结石负担的疗效，以达成关于儿童最有效初始治疗方式的共识。
