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逆行性肾内手术治疗小儿肾结石的疗效与可靠性

Efficacy and Reliability of Retrograde Intrarenal Surgery in Treatment of Pediatric Kidney Stones.

作者信息

Ekici Musa, Ozgur Berat Cem, Senturk Aykut Bugra, Aydin Cemil, Akdaglı Ekici Arzu, Yaytokgil Muhammet, Baykam Mehmet M

机构信息

Urology, Hitit University, Erol Olcok Training and Research Hospital, Corum, TUR.

Urology, Health Sciences University, Ankara Training and Research Hospital, Ankara, TUR.

出版信息

Cureus. 2018 Dec 11;10(12):e3719. doi: 10.7759/cureus.3719.

Abstract

Introduction  Surgical treatment of pediatric kidney stones has dramatically changed in recent years due to the miniaturization of surgical instruments and the availability of intracorporeal lithotriptors. Retrograde intrarenal surgery (RIRS) technique is now considered an effective and minimally invasive procedure in renal stones. However, in the pediatric age group, the number of studies on this subject is very limited. The aim of this study was to evaluate the efficacy and safety of the RIRS in the treatment of kidney stones in children. Material and methods  The data of 25 pediatric stone patients who underwent RIRS with the diagnosis of kidney stones were analyzed retrospectively. Demographic characteristics, operative data, and success rates of the patients were recorded. Results  Fourteen (56%) of the cases were male and 11 (46%) were female. The mean age was 10.43 ± 4.26 (3-15) in boys and 10.18 ± 4.92 (4-16) in girls. Eleven stones (46%) were in the left kidney and 14 (56%) in the right kidney. The mean stone size was 10.08 ± 4.33 mm (4-23). Stone localizations were renal pelvis in 15 (60%) cases, upper calyx in four (16%) cases, middle calyx in five (20%) cases, and lower calyx in one (4%) case. The mean operation time was 41.20 ± 6.96 minutes (30-60), the mean duration of scope was 17.40 ± 3.85 seconds (10-30), and the mean hospital stay was 2.32 ± 0.63 days (2-4). Three patients (12%) had undergone percutaneous nephrolithotomy (PCNL), and two (8%) patients underwent shockwave lithotripsy (ESWL) before this surgery. In six (24%) patients, a double J (DJ) catheter was inserted due to stenosis at the lower end of the ureter. Body mass index (BMI) of these patients was below 18. An access sheath was implanted in six (24%) patients in the second operation. In 18 cases, the first operation was performed with a direct flexible renoscope. In all cases, a postoperative DJ catheter was inserted. Postoperative fever was observed in one (4%) patient, and ureteric steinstrasse was observed in one (4%) patient. The stone-free rate was achieved as 17% (68%) after the first operation and 100% after the second RIRS session. Conclusion  RIRS appears to be an effective and reliable method in the pediatric age group. However, there is a need for multicentre studies involving more cases.

摘要

引言 近年来,由于手术器械的小型化和体内碎石器的应用,小儿肾结石的外科治疗发生了巨大变化。逆行肾内手术(RIRS)技术现已被认为是治疗肾结石的一种有效且微创的方法。然而,在儿童年龄组中,关于这一主题的研究数量非常有限。本研究的目的是评估RIRS治疗儿童肾结石的疗效和安全性。

材料与方法 回顾性分析25例诊断为肾结石并接受RIRS治疗的小儿结石患者的数据。记录患者的人口统计学特征、手术数据和成功率。

结果 14例(56%)为男性,11例(46%)为女性。男孩的平均年龄为10.43±4.26岁(3 - 15岁),女孩为10.18±4.92岁(4 - 16岁)。11枚结石(46%)位于左肾,14枚(56%)位于右肾。结石平均大小为10.08±4.33毫米(4 - 23毫米)。结石位置:肾盂15例(60%),上盏4例(16%),中盏5例(20%),下盏1例(4%)。平均手术时间为41.20±6.96分钟(30 - 60分钟),平均镜检时间为17.40±3.85秒(10 - 30秒),平均住院时间为2.32±0.63天(2 - 4天)。3例(12%)患者在此手术前曾接受经皮肾镜取石术(PCNL),2例(8%)患者接受过体外冲击波碎石术(ESWL)。6例(24%)患者因输尿管下端狭窄插入了双J(DJ)导管。这些患者的体重指数(BMI)低于18。6例(24%)患者在第二次手术中植入了接入鞘。18例患者首次手术使用直接可弯曲肾镜。所有病例术后均插入DJ导管。1例(4%)患者术后出现发热,1例(4%)患者出现输尿管石街。首次手术后结石清除率为17%(68%),第二次RIRS术后结石清除率为100%。

结论 RIRS似乎是儿童年龄组中一种有效且可靠的方法。然而,需要开展涉及更多病例的多中心研究。

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