Elsheemy Mohammed S, Maher Ahmed, Mursi Khaled, Shouman Ahmed M, Shoukry Ahmed I, Morsi Hany A, Meshref Alaa
Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt,
World J Urol. 2014 Aug;32(4):985-90. doi: 10.1007/s00345-013-1152-x. Epub 2013 Aug 25.
To evaluate the impact of age, stone size, location, radiolucency, extraction of stone fragments, size of ureteroscope and presence and degree of hydronephrosis on the efficacy and safety of holmium:YAG (Ho:YAG) laser lithotripsy in the ureteroscopic treatment of ureteral stones in children.
Between October 2011 and May 2013, a total of 104 patients were managed using semirigid Ho:YAG ureterolithotripsy. Patient age, stone size and site, radiolucency, use of extraction devices, degree of hydronephrosis and size of ureteroscope were compared for operative time, success and complications.
In all, 128 URS were done with a mean age of 4.7 years. The mean stones size was 11 mm. Success rate was 81.25 %. Causes of failure were 12.5 % access failure, 1.5 % extravasation and 4.7 % stone migration. Overall complications were 23.4 %. Failure of dilatation and extravasation were detected only in children <2 years old. Extravasation was significantly higher in smaller ureters and cases with stone size >15 mm. Stone migration was significantly higher in upper ureteric stones.
Failure and complications rates in Ho:YAG ureterolithotripsy were significantly affected by younger age (<2 years), upper ureteric stones and smaller ureters but were not related to stone radiolucency or degree of hydronephrosis. Larger stones (>15 mm) were associated with increased complications. After multivariate analysis, the age of the patients remained significant predictor for failure of dilatation and stone migration, while size of the ureter was the only significant predicting factor for failure.
评估年龄、结石大小、位置、透光性、结石碎片取出情况、输尿管镜尺寸以及肾积水的存在和程度对钬激光（Ho:YAG）碎石术治疗儿童输尿管结石疗效及安全性的影响。
2011年10月至2013年5月期间，共104例患者接受了半硬性Ho:YAG输尿管碎石术治疗。比较患者年龄、结石大小和部位、透光性、取出装置的使用、肾积水程度以及输尿管镜尺寸对手术时间、成功率和并发症的影响。
总共进行了128例输尿管镜检查，平均年龄为4.7岁。平均结石大小为11毫米。成功率为81.25%。失败原因包括12.5%的入镜失败、1.5%的外渗和4.7%的结石移位。总体并发症发生率为23.4%。仅在2岁以下儿童中发现扩张失败和外渗。较小输尿管及结石大小>15毫米的病例中外渗明显更高。上段输尿管结石的结石移位明显更高。
钬激光输尿管碎石术的失败率和并发症发生率受年龄较小（<2岁）、上段输尿管结石和较小输尿管的显著影响，但与结石透光性或肾积水程度无关。较大结石（>15毫米）与并发症增加相关。多因素分析后，患者年龄仍是扩张失败和结石移位的显著预测因素，而输尿管大小是失败的唯一显著预测因素。
