Bodakci Mehmet Nuri, Daggülli Mansur, Sancaktutar Ahmet Ali, Söylemez Haluk, Hatipoglu Namık Kemal, Utangaç Mehmet Mazhar, Penbegül Necmettin, Ziypak Tevfik, Bozkurt Yaşar
Medical Faculty, Department of Urology, Dicle University, Diyarbakir, Turkey.
Urolithiasis. 2014 Oct;42(5):427-33. doi: 10.1007/s00240-014-0677-9. Epub 2014 Jul 9.
The objective of the study is to evaluate the effectiveness and safety of miniaturized percutaneous nephrolithotomy (mini-PNL) method in infantile patients <3 years of age diagnosed with renal stones. We studied 48 renal units in 40 patients of infantile patients <3 years of age who underwent mini-PCNL at our institute. The mean age of the patients was 24.02 (5-36) months. The mean diameter of the stones was 22.3 mm (11-45 mm). Intrarenal access was achieved under fluoroscopic (n = 43) or ultrasonographic (n = 5) guidance under general anesthesia. A 20 Fr peel-away sheath, a 17 Fr rigid nephroscope and a pneumatic intracorporeal lithotripsy were used. Mean operative time for PNL was 85 (25-135) min. Mean fluoroscopy time was estimated as 3.7 min. The mean hospital stay was 4.3 days (2-10). Mean hemoglobin loss was 0.89 g/L (11.56-10.67) and three of the patients, including one case during the perioperative period, required blood transfusions. Colonic perforation developed in one case. In two patients, urinary drainage persisted for more than 24 h after withdrawal of the nephrostomy tube. Seven patients developed urinary tract infections (UTI). At the end of the postoperative first week, the stone-free rate was estimated to be 81.2 %. In conclusion, for percutaneous management of renal stones in the infantile age group, mini-PNL is an applicable treatment modality that can be applied through small incisions. It has higher stone-free rates, shorter hospital stays, and excellent esthetic outcomes. In this age group especially, surgical exposure to hypothermia and radiation should be avoided.
本研究的目的是评估微创经皮肾镜取石术（mini-PCNL）方法对3岁以下诊断为肾结石的婴幼儿患者的有效性和安全性。我们研究了在我院接受mini-PCNL的40例3岁以下婴幼儿患者的48个肾单位。患者的平均年龄为24.02（5 - 36）个月。结石的平均直径为22.3 mm（11 - 45 mm）。在全身麻醉下，通过荧光镜引导（n = 43）或超声引导（n = 5）实现肾内穿刺。使用了20 Fr可剥离鞘、17 Fr硬性肾镜和气压弹道碎石术。经皮肾镜取石术的平均手术时间为85（25 - 135）分钟。平均透视时间估计为3.7分钟。平均住院时间为4.3天（2 - 10天）。平均血红蛋白丢失为0.89 g/L（11.56 - 10.67），3例患者需要输血，其中1例为围手术期输血。1例发生结肠穿孔。2例患者在拔除肾造瘘管后尿液引流持续超过24小时。7例患者发生尿路感染（UTI）。术后第一周结束时，无结石率估计为81.2%。总之，对于婴幼儿年龄组的肾结石经皮治疗，mini-PCNL是一种可通过小切口应用的适用治疗方式。它具有较高的无结石率、较短的住院时间和良好的美容效果。尤其在这个年龄组，应避免手术暴露于低温和辐射。
