Etemadian Masoud, Maghsoudi Robab, Shadpour Pejman, Mokhtari Mohammad Reza, Rezaeimehr Behkam, Shati Mohsen
Hasheminejad Clinical Research Development Center (HCRDC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.
Urol J. 2012 Spring;9(2):465-71.
To evaluate the safety and efficacy of pediatric percutaneous nephrolithotomy (PCNL) using adult sized instruments in the management of pediatric urolithiasis.
We retrospectively reviewed the medical records of 38 children younger than 15 years who had undergone 45 PCNLs with adult sized instruments in our center between August 2007 and February 2010.
There were 26 boys and 12 girls, with a mean age of 8.4 ± 4.24 years (range, 12 months to 13 years). Twelve patients had complete staghorn stone. Mean stone burden was 2.93 ± 0.89 cm. The tract was dilated between 26 and 30F. Standard PCNL was performed in 8 patients and tubeless PCNL in the next 37 subjects. Simultaneous transurethral lithotripsy was done in 9 patients. Stone clearance rate was 67%. Mean pre and postoperative hemoglobin levels were 12.67 ± 1.7 and 11.39 ± 1.6 g/dL, respectively. Mean hospitalization was 3.5 ± 1.1 days. Eight subjects had postoperative fever beyond day 1. Blood transfusion was required in only one patient. In one patient (3 years old) with a staghorn stone, hyponatremia and seizure occurred, which were treated conservatively without any adverse sequela. There was a significant difference in hospital stay between tubeless and standard PCNL groups (P < .02).
We concluded that PCNL using adult sized instruments was relatively safe in children, with a clearance rate of 67%. We suggest prospective randomized studies to compare mini-perc and adult sized instruments use in pediatric PCNL.
评估使用成人尺寸器械进行小儿经皮肾镜取石术（PCNL）治疗小儿尿路结石的安全性和有效性。
我们回顾性分析了2007年8月至2010年2月间在本中心接受45次使用成人尺寸器械的PCNL治疗的38例15岁以下儿童的病历。
其中男孩26例，女孩12例，平均年龄8.4±4.24岁（范围12个月至13岁）。12例患者为完全鹿角形结石。平均结石负荷为2.93±0.89厘米。通道扩张至26至30F。8例患者进行了标准PCNL，接下来的37例患者进行了无管PCNL。9例患者同时进行了经尿道碎石术。结石清除率为67%。术前和术后平均血红蛋白水平分别为12.67±1.7和11.39±1.6克/分升。平均住院时间为3.5±1.1天。8例患者术后第1天以后出现发热。仅1例患者需要输血。1例3岁鹿角形结石患者发生低钠血症和癫痫发作，经保守治疗无任何不良后遗症。无管PCNL组和标准PCNL组的住院时间有显著差异（P<.02）。
我们得出结论，使用成人尺寸器械进行PCNL在儿童中相对安全，结石清除率为67%。我们建议进行前瞻性随机研究，比较小儿PCNL中使用微型经皮肾镜和成人尺寸器械的情况。
