Lottmann H B, Archambaud F, Hellal B, Pageyral B M, Cendron M
Department of Pediatric Urology, Hôpital St. Joseph, Paris, France.
J Urol. 1998 Feb;159(2):521-4. doi: 10.1016/s0022-5347(01)63975-2.
Extracorporeal shock wave lithotripsy (ESWL) has been reported as efficient and safe in children. Because of reports of renal parenchymal damage in adults, this study was designed to assess the effects of ESWL in pediatric kidneys evaluated before and after treatment with (99m)technetium dimercapto-succinic acid (DMSA) renal scan.
A total of 15 children, 9 months to 15 years old (mean age 6.5 years), underwent ESWL treatment for urolithiasis. Evaluation imaging included plain abdominal radiography, excretory urogram and/or renal sonography. DMSA renal scan was performed 24 hours before ESWL and at least 6 months after treatment.
ESWL was performed in 1 session for 8 patients, 2 sessions for 6 and 3 sessions for 1, delivering a range of 600 to 3,000 shock waves per session. Treatment was successful in achieving stone-free status in 87% of the cases. Long-term followup (1 to 5 years) showed no blood pressure changes. On DMSA renal scan no acquired parenchymal scar was identified at least 6 months after ESWL treatment.
The efficacy of ESWL in treating pediatric urolithiasis is confirmed. Renal parenchymal trauma associated with ESWL does not appear to cause long-term lesions identifiable by DMSA renal scan.
体外冲击波碎石术（ESWL）已被报道在儿童中是有效且安全的。鉴于有关于成人体内肾实质损伤的报道，本研究旨在通过用锝（99m）二巯基丁二酸（DMSA）肾扫描评估治疗前后的小儿肾脏，来评估ESWL的效果。
共有15名年龄在9个月至15岁（平均年龄6.5岁）的儿童因尿路结石接受了ESWL治疗。评估成像包括腹部平片、排泄性尿路造影和/或肾脏超声检查。在ESWL治疗前24小时和治疗后至少6个月进行DMSA肾扫描。
8名患者接受了1次ESWL治疗，6名接受了2次，1名接受了3次，每次治疗释放600至3000次冲击波。87%的病例治疗成功实现了无结石状态。长期随访（1至5年）显示血压无变化。在DMSA肾扫描中，ESWL治疗后至少6个月未发现获得性实质瘢痕。
ESWL治疗小儿尿路结石的疗效得到证实。与ESWL相关的肾实质创伤似乎不会导致DMSA肾扫描可识别的长期病变。
