输尿管镜检查是否应作为儿童近端输尿管结石的首选治疗方法？

Should ureteroscopy be considered as the first choice for proximal ureter stones of children?

机构信息

Department of Urology, Yuzuncu Yil University, Van, Turkey.

出版信息

Eur Rev Med Pharmacol Sci. 2013 Jul;17(13):1839-44.

Abstract

OBJECTIVES

In this study, we aimed to analyze the ureter stones that had been treated using rigid ureteroscopy and pneumatic lithotripsy without mechanically dilating the ureteral orifice.

PATIENTS AND METHODS

Records of 110 patients who had undergone rigid ureteroscopy and pneumatic lithotripsy due to ureteral stone between February 2005 and May 2011 were retrospectively analyzed. The location and size of the stone and additional anomalies in the urinary tract on the preoperative direct urinary system (DUS) X-Ray, urinary system ultrasonography (USG), intravenous pyelography (IVP) if performed, and computed tomography (CT), were found from the records of the patients.

RESULTS

The mean age of the patients was 5.2 (range 1-17 years). 74 (67.2%) of the patients were males and 36 (32.8%) were females. A total of 115 rigid ureteroscopies were performed on 110 patients. 72 (65%) of the stones were located in the lower ureter, 21 (19%) were located in the middle part of the ureter, and 17 (15.4%) were located in the upper ureter. The mean stone size was determined as 7.5 mm (range 5-15). The mean stone size was determined as 7.4 mm in the lower ureter, as 8.3 mm in the middle ureter, and 8.4 mm in the upper ureter. No difference was found between the sizes of the stones in different locations (p = 0.121). The stone free rate was found as 92.2% for all ureteral stones. The total stone free rate according to the location of the stones was determined as 79.2% in the upper ureter, as 94.4% in the middle ureter and 93,8% in the lower ureter (p = 0.022). The total complication rate was 7.6%. Complication rates were 7.2%, 4.1% and 10.7% for the lower, middle and upper ureter, respectively (p = 0.411) (Table I). No difference was found in terms of complication rates according to location of the stone in the ureter. No major perioperative or postoperative complications developed. A double J stent was inserted in 36 (32%) patients for 2-3 weeks.

CONCLUSIONS

We suggest that rigid ureteroscopy may be considered as the first choice for treatment of not only distal-middle ureter stones, but also for proximal ureter stones.

摘要

目的

本研究旨在分析经硬性输尿管镜检查和气压弹道碎石术治疗而未机械扩张输尿管口的输尿管结石。

方法

回顾性分析 2005 年 2 月至 2011 年 5 月期间因输尿管结石接受硬性输尿管镜检查和气压弹道碎石术的 110 例患者的记录。从患者的记录中找到术前直接尿路系统（DUS）X 射线、尿路系统超声检查（USG）、如果进行静脉肾盂造影（IVP）以及计算机断层扫描（CT）上结石的位置和大小以及泌尿道的其他异常。

结果

患者的平均年龄为 5.2 岁（范围 1-17 岁）。74 例（67.2%）为男性，36 例（32.8%）为女性。110 例患者共进行了 115 次硬性输尿管镜检查。72 例（65%）结石位于下段输尿管，21 例（19%）位于输尿管中段，17 例（15.4%）位于上段输尿管。结石平均大小为 7.5mm（范围 5-15）。下段输尿管结石平均大小为 7.4mm，中段输尿管结石平均大小为 8.3mm，上段输尿管结石平均大小为 8.4mm。不同部位结石大小无差异（p=0.121）。所有输尿管结石的无石率为 92.2%。根据结石位置，上段输尿管的总无石率为 79.2%，中段输尿管为 94.4%，下段输尿管为 93.8%（p=0.022）。总并发症发生率为 7.6%。下段、中段和上段输尿管的并发症发生率分别为 7.2%、4.1%和 10.7%（p=0.411）（表 I）。输尿管结石部位的并发症发生率无差异。术中及术后无重大并发症发生。36 例（32%）患者置入双 J 支架 2-3 周。