Dogan Bayram, Atmaca Ali Fuat, Canda Abdullah Erdem, Isgoren Abidin Egemen, Akbulut Ziya, Balbay Mevlana Derya
1st Urology Clinic, Ankara Ataturk Training and Research Hospital, Ankara, Turkey.
Urol Res. 2012 Jun;40(3):259-62. doi: 10.1007/s00240-011-0408-4. Epub 2011 Aug 5.
To evaluate the efficiency of percutaneous nephrolithotomy using adult-type instruments in children with kidney stones. Between September 2004 and October 2009, 18 children (19 renal units) underwent percutaneous nephrolithotomy using adult-type instruments. Following percutaneous access under fluoroscopy, 20-30F tract dilatation was performed (1,92,427F), and lithotripters were used. Postoperatively, kidney-ureter-bladder X-ray and antegrade pyelography were performed to evaluate residual stones and contrast passage to the bladder. 8 boys and 10 girls with a mean age of 9.8 ± 4.56 years were evaluated. Mean stone burden was 338 ± 196.21 mm². Stones were located in the left and right kidneys in 16 (84.2%) and 3 (16.8%) patients, respectively. Horse-shoe kidney was present in one patient. Mean operation (including cystoscopy) and fluoroscopy times were 106 ± 49.60 and 5.2 ± 2.14 min, respectively. Postoperatively, 10(52.6%) patients were stone free and 4 (21.1%) patients had clinically insignificant stones. Saline extravasation developed in three patients and surgery was aborted in one patient. Stone fragments migrated into the ureter in two patients and managed by additional endourological interventions. Nephrostomy catheters were kept for a mean of 2.6 ± 1.12 days. Four patients required blood transfusion due to bleeding. Postoperative fever of <39°C developed in five patients and >39°C in one patient. Mean hospitalization time was 5.3 ± 3.12 days. Overall, 73.7% of our patients were stone free, including patients with clinically insignificant stones. Particularly in children with a high-stone burden, the use of adult-type instruments might have a positive impact on stone-free rate, operation time and fluoroscopy time without increasing the complication rate.
评估使用成人型器械对儿童肾结石进行经皮肾镜取石术的效率。2004年9月至2009年10月期间，18名儿童（19个肾单位）接受了使用成人型器械的经皮肾镜取石术。在透视引导下建立经皮通道后，进行20 - 30F通道扩张（1,92,427F），并使用碎石器。术后，进行肾脏 - 输尿管 - 膀胱X线检查和顺行肾盂造影，以评估残余结石及造影剂向膀胱的通过情况。评估了8名男孩和10名女孩，平均年龄为9.8±4.56岁。平均结石负荷为338±196.21mm²。结石分别位于左肾和右肾的患者有16例（84.2%）和3例（16.8%）。1例患者存在马蹄肾。平均手术（包括膀胱镜检查）时间和透视时间分别为106±49.60分钟和5.2±2.14分钟。术后，10例（52.6%）患者结石清除，4例（21.1%）患者有临床意义不显著的结石。3例患者发生盐水外渗，1例患者手术中止。2例患者结石碎片移入输尿管，通过额外的腔内泌尿外科干预处理。肾造瘘管平均留置2.6±1.12天。4例患者因出血需要输血。5例患者术后发热低于39°C，1例患者发热高于39°C。平均住院时间为5.3±3.12天。总体而言，包括有临床意义不显著结石的患者在内，我们73.7%的患者结石清除。特别是对于结石负荷高的儿童，使用成人型器械可能对结石清除率、手术时间和透视时间有积极影响，而不增加并发症发生率。
