Utanğaç Mehmet Mazhar, Dağgülli Mansur, Dede Onur, Sancaktutar Ahmet Ali, Bozkurt Yaşar
Department of Urology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey.
Department of Urology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey.
J Pediatr Urol. 2017 Feb;13(1):37.e1-37.e6. doi: 10.1016/j.jpurol.2016.10.016. Epub 2016 Nov 19.
In recent years, the incidence of urinary stone disease reportedly has been increasing. The use of shockwave lithotripsy has seen low success rates, the inefficacy of a single session, and the need for general anaesthesia in children; additionally, children are exposed to radiation. These suboptimal treatment conditions have all led to ureteroscopy (URS) becoming the treatment method of choice for paediatric ureter stones. The aim of this study is to examine the effectiveness of 4.5-Fr URS when used on children younger than 1 year of age.
The operation results of 34 patients (12 girls and 22 boys) who had undergone intervention for ureter stones at our clinic were retrospectively evaluated. For URS, a 4.5-Fr semi-rigid ureteroscope was used; a Holmium:YAG laser machine was used as a lithotripter.
The mean patient age was 9.6 months (range 4-12 months) (Table). The mean stone surface area was 25.39 mm (range 11.84-84.78 mm). In six cases, a ureteral catheter was inserted, because of minimal oedema in the ureters; in nine cases, a Double J (DJ) stent was inserted. The mean operation time was 45.3 min (range 22-87 min). In the first week of control with urinary ultrasonography and kidney-ureter and bladder radiograph, a stone-free condition was determined in 28 (82.3%) patients. In two cases-in which sufficient fragmentation could not be achieved, because of minimal bleeding during operation-during the exertion of a DJ stent, another URS was performed. In the first postoperative month, a stone-free condition was established in 32 (94.1%) patients. The mean hospital stay period was 28.6 h (range 12-72 h). There were seven cases (20.5%) with Clavien II-III complications.
Use of a ureteroscope is safe and effective with paediatric patients: we found that a 4.5-Fr ureteroscope can be safely used on children under 1 year of age. We therefore consider a 4.5-Fr ureteroscopic instrument to be an appropriate tool for treating URS in children within this age range.
据报道，近年来尿石症的发病率一直在上升。冲击波碎石术成功率低，单次治疗无效，且儿童需要全身麻醉；此外，儿童还会受到辐射。这些不理想的治疗条件都导致输尿管镜检查（URS）成为小儿输尿管结石的首选治疗方法。本研究的目的是检验4.5F输尿管镜用于1岁以下儿童的有效性。
回顾性评估了在我院接受输尿管结石干预治疗的34例患者（12例女孩和22例男孩）的手术结果。对于URS，使用了4.5F半硬性输尿管镜；使用钬激光碎石机进行碎石。
患者平均年龄为9.6个月（范围4 - 12个月）（表）。结石平均表面积为25.39平方毫米（范围11.84 - 84.78平方毫米）。6例因输尿管轻度水肿插入输尿管导管；9例插入双J（DJ）支架。平均手术时间为45.3分钟（范围22 - 87分钟）。在术后第一周通过超声检查及肾脏 - 输尿管和膀胱X线片进行复查时，28例（82.3%）患者结石清除。2例因术中出血少未能充分碎石，在置入DJ支架时，再次进行了URS。术后第一个月，32例（94.1%）患者结石清除。平均住院时间为28.6小时（范围12 - 72小时）。有7例（20.5%）出现Clavien II - III级并发症。
输尿管镜对小儿患者的使用是安全有效的：我们发现4.5F输尿管镜可安全用于1岁以下儿童。因此，我们认为4.5F输尿管镜器械是治疗该年龄范围内小儿URS的合适工具。
