Rashid Aso Omer, Amin Shakhawan Hama, Al Kadum Mohammed Abed, Mohammed Sarbaz Kamal, Buchholz Noor
Medical College, University of Sulaimany, Sulaimany, Iraq.
Department of Urology, Sulaimany University Hospital, Sulaimany, Iraq.
Urol Int. 2019;102(3):356-359. doi: 10.1159/000499491. Epub 2019 Mar 27.
To evaluate the safety and efficacy of percutaneous mini-nephrolithotomy (mini-PCNL) in children with complex staghorn stones.
We analyzed prospectively data of 28 children undergoing pediatric mini-PCNL during a period of 18 months. Stone complexity was defined according to the validated Guy's stone score (GSS). Our patients were GSS III and IV. All PCNL procedures were performed in the prone position, under fluoroscopic guidance, and in the same standardized fashion with F12 and F17 mini-nephroscopes.
Eleven children were boys (total n = 28). Mean age was 7.25 ± 3.27 (2-14) years. Mean stone burden was 36.89 ± 8.002 (30-60) mm. GSS was in 57% grade III and in 43% grade IV. The initial stone-free rate was 78%, which increased to 89% after few ancillary procedures. Seventeen percent of children had major complications (1 hydrothorax, 4 blood transfusions). On statistical analysis, stone clearance rates were found inversely dependent on stone complexity (GSS; p < 0.025). Stone burden, number of tracts, and procedure time were associated with stone complexity (p < 0.000). In turn, stone complexity (p < 0.015) and the number of tracts (p < 0.049) were significantly associated with complications.
Mini-PCNL is effective and safe for treating complex renal stones in pediatric patients. Complication rates are acceptable and predictably stable on comparison with the literature.
评估经皮微创肾镜取石术（mini-PCNL）治疗复杂性鹿角形肾结石患儿的安全性和有效性。
我们前瞻性分析了18个月内接受小儿mini-PCNL的28例患儿的数据。结石复杂性根据经过验证的盖伊结石评分（GSS）定义。我们的患者为GSS III级和IV级。所有PCNL手术均在俯卧位、透视引导下进行，采用相同的标准化方式，使用F12和F17微型肾镜。
11例患儿为男孩（共28例）。平均年龄为7.25±3.27（2 - 14）岁。平均结石负荷为36.89±8.002（30 - 60）mm。GSS III级占57%，IV级占43%。初始无石率为(78%)，经过几次辅助手术后升至(89%)。(17%)的患儿出现严重并发症（1例气胸，4例输血）。经统计分析，发现结石清除率与结石复杂性（GSS；(p < 0.025)）呈负相关。结石负荷、通道数量和手术时间与结石复杂性相关（(p < 0.000)）。反过来，结石复杂性（(p < 0.015)）和通道数量（(p < 0.049)）与并发症显著相关。
Mini-PCNL治疗小儿复杂性肾结石有效且安全。与文献相比，并发症发生率可接受且可预测地稳定。
