Landa-Juárez Sergio, Rivera-Pereira Bárbara M, Castillo-Fernández Ana M
1 Department of Pediatric Urology, Pediatric Hospital CMN SXXI , IMSS, Mexico City, Mexico .
2 Department of Pediatric Surgery, Instituto Mexicano del Seguro Social , Mexico City, Mexico .
J Laparoendosc Adv Surg Tech A. 2018 Jun;28(6):766-769. doi: 10.1089/lap.2016.0652. Epub 2018 Feb 6.
Minimally invasive procedures have become the standard option for treatment of urinary stones; the use of more invasive techniques is not a common practice currently. This emergent technology is not always available and laparoscopy is the alternative option. There are few reports of laparoscopic management for urinary lithiasis in pediatric patients. This study is about the use of laparoscopic surgery combined with pyeloscopy as a feasible first-line treatment for pediatric urolithiasis in renal and proximal ureteral locations.
We reviewed the records of 14 patients with renal and proximal ureteral stones who underwent laparoscopic pyelolithotomy and pyeloscopy in a period from January 2011 to July 2016. The outcome measures were needed for auxiliary procedures, treatment success, and complication rates.
A total of 16 procedures were carried out in 14 patients, 15 transperitoneal and 1 retroperitoneal laparoscopic pyelolithotomies were done. It was necessary to perform upper ureterolithotomies to remove ureteral stones in 2 cases. The holmium laser and/or pneumatic lithotripter were used to fragment staghorn calculi. Some of the complications were blood transfusion in 12.5% and self-limited urinary leak in 18.7% of the patients. The success rate after undergoing one procedure was 92.8%.
Transperitoneal or retroperitoneal laparoscopic lithotomy is a safe and feasible procedure for the treatment of pediatric urolithiasis. It can be an alternative to shock-wave lithotripsy and percutaneous nephrolithotomy when these are not feasible or possible.
微创手术已成为治疗尿路结石的标准选择；目前较少采用更具侵入性的技术。这种新兴技术并非总能获得，腹腔镜检查是替代选择。关于小儿患者尿路结石的腹腔镜治疗报道较少。本研究旨在探讨腹腔镜手术联合肾盂镜检查作为小儿肾及输尿管上段结石一线治疗方法的可行性。
我们回顾了2011年1月至2016年7月期间14例接受腹腔镜肾盂切开取石术及肾盂镜检查的肾及输尿管上段结石患者的病历。观察指标包括辅助手术需求、治疗成功率及并发症发生率。
14例患者共进行了16次手术，其中15例为经腹腹腔镜肾盂切开取石术，1例为后腹腔镜肾盂切开取石术。2例患者需行输尿管上段切开取石术以取出输尿管结石。使用钬激光和/或气压弹道碎石机粉碎鹿角形结石。部分并发症包括12.5%的患者需要输血，18.7%的患者出现自限性尿漏。单次手术后的成功率为92.8%。
经腹或后腹腔镜取石术是治疗小儿尿路结石的一种安全可行的方法。当冲击波碎石术和经皮肾镜取石术不可行或不可能时，它可作为替代方法。
