Ristau B T, Dudley A G, Casella D P, Dwyer M E, Fox J A, Cannon G M, Schneck F X, Ost M C
Department of Urology, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Floor 3, Pittsburgh, PA 15224, USA.
Department of Urology, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Floor 3, Pittsburgh, PA 15224, USA.
J Pediatr Urol. 2015 Dec;11(6):339.e1-5. doi: 10.1016/j.jpurol.2015.08.008. Epub 2015 Sep 30.
Despite the increasing incidence of pediatric nephrolithiasis, there is little data quantifying the radiation exposure associated with treatment of this disease. In this study, pediatric patients with nephrolithiasis who were managed at a single institution were identified, and the average fluoroscopy time and estimated radiation exposure associated with their procedures were reported.
Stone procedures performed on pediatric patients between 2005 and 2012 were retrospectively identified. Procedures were classified as primary ureteroscopy (URS), stent placement prior to ureteroscopy (SURS), percutaneous nephrolithotomy (PCNL), and bilateral ureteroscopy (BLURS). Patient demographic information, stone size, stone location, number of radiographic images, and fluoroscopy times were analyzed.
A total of 152 stone procedures were included in the final analysis (92 URS, 38 SURS, eight BLURS and 14 PCNL). Mean patient age at time of stone treatment was 15.94 ± 4.1 years. Median fluoroscopy times were 1.6 (IQR 0.8-2.4), 2.1 (IQR 1.6-3.0), 2.5 (IQR 2.0-2.9), and 11.7 (IQR 5.0-18.5) minutes for URS, SURS, BLURS and PCNL, respectively. There was a moderate correlation between stone size and fluoroscopy time (r = 0.33). When compared with ureteroscopic procedures, PCNL was associated with a significantly higher fluoroscopy time (11.7 vs 2.1 min, P < 0.001). The estimated median effective dose was 3 mSv for ureteroscopic procedures and 16.8 mSv for PCNL. In addition to radiation exposure during treatment, patients in this cohort were exposed to an average of one (IQR1-3) CT scan and three (IQR 1-8) abdominal X-rays. No new malignancies were identified during the limited follow-up period.
Radiation exposure during treatment of pediatric stone disease is not trivial, and is significantly greater when PCNL is performed. Given the recommended maximum effective dose of 50 mSv in any one year, urologists should closely monitor the amount of fluoroscopy used, and consider the potential for radiation exposure when choosing the operative approach. Prospective studies are currently underway to elucidate precise dose measurements and localize sites of radiation exposure in children during stone treatment.
尽管小儿肾结石的发病率不断上升，但量化该疾病治疗相关辐射暴露的数据却很少。在本研究中，我们确定了在单一机构接受治疗的小儿肾结石患者，并报告了与其手术相关的平均透视时间和估计辐射暴露量。
回顾性确定2005年至2012年期间对小儿患者进行的结石手术。手术分为初次输尿管镜检查（URS）、输尿管镜检查前支架置入（SURS）、经皮肾镜取石术（PCNL）和双侧输尿管镜检查（BLURS）。分析患者的人口统计学信息、结石大小、结石位置、射线照片数量和透视时间。
最终分析共纳入152例结石手术（92例URS、38例SURS、8例BLURS和14例PCNL）。结石治疗时患者的平均年龄为15.94±4.1岁。URS、SURS、BLURS和PCNL的透视时间中位数分别为1.6（四分位间距0.8 - 2.4）、2.1（四分位间距1.6 - 3.0）、2.5（四分位间距2.0 - 2.9）和11.7（四分位间距5.0 - 18.5）分钟。结石大小与透视时间之间存在中等程度的相关性（r = 0.33）。与输尿管镜手术相比，PCNL的透视时间明显更长（11.7 vs 2.1分钟，P < 0.001）。输尿管镜手术的估计有效剂量中位数为3 mSv，PCNL为16.8 mSv。除了治疗期间的辐射暴露外，该队列中的患者平均接受了一次（四分位间距1 - 3）CT扫描和三次（四分位间距1 - 8）腹部X光检查。在有限的随访期内未发现新的恶性肿瘤。
小儿结石病治疗期间的辐射暴露并非微不足道，进行PCNL时辐射暴露明显更大。鉴于建议的任何一年最大有效剂量为50 mSv，泌尿外科医生应密切监测透视使用量，并在选择手术方式时考虑辐射暴露的可能性。目前正在进行前瞻性研究，以阐明精确的剂量测量方法并确定小儿结石治疗期间的辐射暴露部位。
