Li Junhua, Yu Huiqin, Zhou Peng, Pan Huixian, Li Ruipeng, Wang Yanbin, Song Chen, Lou Yangfeng, Zhu Jingyu
Department of Urology, Third Hospital of Hangzhou, No. 38 West Lake Road Hangzhou, Zhejiang, P. R. China
Department of Urology, Third Hospital of Hangzhou, No. 38 West Lake Road Hangzhou, Zhejiang, P. R. China.
Urol J. 2019 Aug 18;16(4):343-346. doi: 10.22037/uj.v0i0.4640.
To investigate the efficacy and safety of retrograde intrarenal surgery (RIRS) for the treatment of pediatric patients.
A total of 45 patients with upper urinary stones treated using flexible ureteroscopy combined with holmium laser lithotripsy at our department between June 2015 and January 2017 were examined in this study.
The operative success rate of treatment using holmium laser lithotripsy via flexible ureteroscopy was 97.8% (44/45); one patient (1/45, 2.2%) was converted to laparoscopic pyelolithotomy, and the calculus was successfully removed. Lithotripsy via flexible ureteroscopy was successful during the first phase in 38 patients (38/45, 84.4%), and second or third phase lithotripsy was needed for six patients (6/45, 13.3%). Intraoperative ureteral fracture in the middle and lower sections occurred in one pediatric patient who was converted to laparoscopic pyelolithotomy and ureter bladder reimplantation. This patient was discharged after recovery at 2 weeks postoperative and showed no significant renal dysfunction over the 12-month follow-up period. Severe postoperative gross hematuria occurred in one patient, who improved after hemostasis and other symptomatic treatments. High fever occurred in two patients (body temperature >39°C), who later improved. These pediatric patients were discharged after active anti-infection and other conservative treatments for 4 days. All of the included patients were followed up for 2-15 months, with an average follow-up period of 8 months. The total calculus clearance rate was 100% (45/45), with no recurrence of the calculus.
In this study, most upper urinary stones in children and infants were treated successfully with holmium laser lithotripsy applied via flexible ureteroscopy.
探讨逆行性肾内手术（RIRS）治疗小儿患者的疗效及安全性。
本研究纳入了2015年6月至2017年1月间在我科采用软性输尿管镜联合钬激光碎石术治疗的45例上尿路结石患儿。
软性输尿管镜下钬激光碎石术的手术成功率为97.8%（44/45）；1例患者（1/45，2.2%）转为腹腔镜肾盂切开取石术，结石成功取出。软性输尿管镜下碎石术一期成功38例（38/45，84.4%），6例患者（6/45，13.3%）需要二期或三期碎石。1例小儿患者术中输尿管中下段断裂，转为腹腔镜肾盂切开取石术及输尿管膀胱再植术。该患者术后2周康复出院，随访12个月肾功能无明显异常。1例患者术后出现严重肉眼血尿，经止血及其他对症治疗后好转。2例患者出现高热（体温>39°C），后好转。这些小儿患者经积极抗感染及其他保守治疗4天后出院。所有纳入患者均随访2 - 15个月，平均随访8个月。结石总清除率为100%（45/45），无结石复发。
本研究中，大多数婴幼儿上尿路结石采用软性输尿管镜下钬激光碎石术治疗成功。
