Zeng Guohua, Jia Jianye, Zhao Zhijian, Wu Wenqi, Zhao Zhigang, Zhong Wen
Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China.
Urol Res. 2012 Oct;40(5):599-603. doi: 10.1007/s00240-012-0478-y. Epub 2012 May 13.
The objective of the study is to compare the efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) and mini-percutaneous nephrolithotomy (MPCNL) in treating renal stones sizing 15-25 mm in infants <3 years. Forty-six infants with renal stones sizing 15-30 mm were treated by either ESWL (22 renal units in 22 infants) using Dornier compact delta lithotripter or MPCNL (25 renal units in 24 infants) using 14F-18F renal access under general anesthesia. The operation time, stone-free rate, re-treatment rate, and complications between the two groups were compared with the χ(2), Mann-Whitney U, and Student's t tests. No significant differences in mean age and stone size were observed between the two groups. The 1- and 3-month postoperative stone-free rates were 84 and 96% in MPCNL group and were 31.8 and 86.4% in ESWL group. The re-treatment and complication rates were significantly higher in ESWL group than in MPCNL group (50 vs. 12%, P = 0.004; 16.0 vs. 45.5%, P = 0.028). The stone recurrence rate was similar between the two groups. No significant changes of serum creatinine (Cr) level and glomerular filtration rate were observed in both groups. In conclusion, MPCNL is an effective and feasible alternative monotherapy for large renal stones (15-25 mm) in infants, with a higher stone-free rate and a lower complication rate when compared with ESWL.
本研究的目的是比较体外冲击波碎石术（ESWL）和微创经皮肾镜取石术（MPCNL）治疗3岁以下婴儿15 - 25mm肾结石的疗效和安全性。46例肾结石大小为15 - 30mm的婴儿，其中22例婴儿的22个肾单位采用多尼尔紧凑型德尔塔碎石机进行ESWL治疗，24例婴儿的25个肾单位在全身麻醉下采用14F - 18F肾通道进行MPCNL治疗。两组之间的手术时间、结石清除率、再次治疗率和并发症采用χ(2)检验、曼 - 惠特尼U检验和学生t检验进行比较。两组之间在平均年龄和结石大小方面未观察到显著差异。MPCNL组术后1个月和3个月的结石清除率分别为84%和96%，ESWL组分别为31.8%和86.4%。ESWL组的再次治疗率和并发症发生率显著高于MPCNL组（50%对12%，P = 0.004；16.0%对45.5%，P = 0.028）。两组之间的结石复发率相似。两组血清肌酐（Cr）水平和肾小球滤过率均未观察到显著变化。总之，对于婴儿大肾结石（15 - 25mm），MPCNL是一种有效且可行的替代单一疗法，与ESWL相比，结石清除率更高，并发症发生率更低。
