经内镜肾输尿管结石术对儿童肾血流的影响：一项前瞻性试验。
The effect of endoscopic renal and ureteral stone surgeries on renal blood flow in children: a prospective trial.
机构信息
Department of Urology, School of Medicine, Marmara University, Istanbul, Turkey.
Department of Urology, Division of Pediatric Urology, School of Medicine, Marmara University, Istanbul, Turkey.
出版信息
Urolithiasis. 2024 Jun 7;52(1):84. doi: 10.1007/s00240-024-01578-z.
AIM
To assess the impact of endoscopic stone surgeries on renal perfusion and blood flow in children.
MATERIALS AND METHODS
Children who underwent percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), ureterorenoscopy (URS), endoscopic combined intrarenal surgery (ECIRS) were included to the study. Renal Doppler ultrasonography (RDUS) was performed one day before the operation, and on the postoperative 1st day and 1st month. Peak systolic velocity (PSV) and end-diastolic velocity (EDV) were measured, and resistive index (RI) was calculated with the (PSV-EDV)/PSV formula. RDUS parameters were compared before and after surgery and between ipsilateral and contralateral kidneys.
RESULTS
A total of 45 children with a median age was 8 (2-17) years were included (15 (33.3%) girls, 30 (66.7%) boys). PCNL was performed in 13 children (28.9%), RIRS 11 (24.4%), URS 12 (26.7%), and ECIRS 9 (20%). There was no significant difference in renal and segmental PSV, EDV and RI values of operated kidney in the preoperative, postoperative periods. There was no significant difference between RDUS parameters of the ipsilateral and contralateral kidneys in preoperative or postoperative periods. PSV and EDV values were significantly higher in the 1st postoperative month in the group without preoperative DJ stent than in the group with DJ stent (p = 0,031, p = 0,041, respectively). However, RI values were similar. The mean RI were below the threshold value of 0.7 in each period.
CONCLUSION
RDUS parameters didn't show a significant difference in children. Endoscopic surgeries can be safely performed in pediatric stone disease.
目的
评估内镜碎石术对儿童肾灌注和血流的影响。
材料与方法
纳入行经皮肾镜碎石术（PCNL）、逆行肾内手术（RIRS）、输尿管镜检查（URS）、内镜联合肾内手术（ECIRS）的儿童患者。手术前一天、术后第 1 天和第 1 个月进行肾脏多普勒超声检查（RDUS）。测量收缩期峰值速度（PSV）和舒张末期速度（EDV），并根据公式（PSV-EDV）/PSV 计算阻力指数（RI）。比较手术前后、同侧和对侧肾脏的 RDUS 参数。
结果
共纳入 45 例中位年龄为 8（2-17）岁的儿童（15 例女孩[33.3%]，30 例男孩[66.7%]）。其中 13 例行 PCNL（28.9%），11 例行 RIRS（24.4%），12 例行 URS（26.7%），9 例行 ECIRS（20%）。手术侧肾脏术前、术后 PSV、EDV 和 RI 值无显著差异。术前、术后同侧和对侧肾脏的 RDUS 参数无显著差异。与有 DJ 支架的患儿相比，无术前 DJ 支架的患儿术后第 1 个月 PSV 和 EDV 值更高（p=0.031，p=0.041），但 RI 值相似。各期 RI 均值均低于 0.7 的阈值。
结论
RDUS 参数在儿童中无显著差异。内镜手术可安全用于小儿结石病。
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