经皮肾镜碎石术治疗儿童上尿路结石的进展、安全性和有效性的分析

doi:10.3969/j.issn.1671-167X.2017.04.014

摘要/Abstract

摘要： 目的：探讨经皮肾镜碎石术（percutaneous nephrolithotomy，PNL）治疗儿童上尿路结石的进展、安全性和有效性。方法：回顾性分析自2005年1月至2016年12月北京大学人民医院泌尿外科应用微通道及标准通道的PNL治疗儿童上尿路结石患者77例的临床资料，共87侧上尿路结石,其中肾结石69侧，上段输尿管结石6侧，肾合并上段输尿管结石12侧；单发结石35侧，多发结石43侧，鹿角型结石9侧，统计并分析患儿基本情况、术前及术后临床指标并复习相关文献，研究目前儿童PNL的进展、疗效，并利用Clavien分级系统研究PNL并发症。结果：77例患儿共行PNL 手术87例次。单通道PNL 81例次(93.1%)，2通道5例次(5.7%)，3通道1例次(1.2%)。平均手术时间（77.0±29.8） min。一期手术清石率：单发结石为100%，多发结石与鹿角型结石为71.2%，5例(5.8%) 再次接受后续治疗清除残余结石，最终清石率88.5%。儿童PNL的并发症主要是发热，术后中等发热（38~39 ℃）16例次(18.4%)，高热（39~40 ℃）5例次(5.7%)，无败血症、感染中毒性休克等感染严重并发症。术后血红蛋白下降（10.3±16.1） g/L，术后血肌酐升高（7.0±13.3） μmol/L。术后残石堵塞输尿管接受输尿管镜碎石手术解除梗阻1例次（1.2%）。无毗邻脏器损伤，无腹膜后尿外渗病例。根据手术并发症Clavien分级系统评估87例次儿童PNL手术的术后并发症，总体并发症22例次（25.3%），其中Ⅰ级并发症14例次（16.1%），Ⅱ级并发症7例次（8.0%），Ⅲ级并发症1例次（1.2%），无Ⅳ级、Ⅴ级并发症病例。结论：PNL治疗儿童上尿路结石是有效的，根据Clavien分级系统分析PNL并发症均为轻度并发症，PNL治疗儿童上尿路结石是安全的。

关键词: 儿童尿石症, 经皮肾镜碎石术, Clavien分级系统, 并发症

Abstract: Objective： To evaluate the development, safety and efficacy of percutaneous nephrolithotomy(PNL) for management of upper urinary tract calculi in pediatric patients. Methods: In the study, 77 pediatric patients undergoing 87 PNLs through mini or standard tract for upper urinary tract calculi between January 2005 and December 2016 in Peking University People’s hospital were reviewed, including 69 renal calculi, 6 upper ureteral calculi, 12 renal and upper ureteral calculi, 35 single calculi, 43 multiple calculi and 9 staghorn calculi. The development and efficacy of PNL in pediatric patients were studied by analyzing the characteristics and clinical indexes, and by reviewing the associated literature. The Clavien classification system was used to evaluate the complications after PNL. Results: A total of 87 PNLs were performed in 77 pediatric patients. Eighty-one upper urinary tract calculi were managed through a single tract(93.1%), 5 pediatric patients were managed through 2 tracts(5.7%), and 1 pe-diatric patient was managed through 3 tracts(1.2%). The mean operating time was (77.0±29.8) min. The stone-free rate after one session was 100% for single calculi and 71.2% for multiple or staghorn calculi, 5(5.8%) children underwent auxiliary procedure to remove the residual calculi and the final stone-free rate of PNL was 88.5%. One of the main complications of pediatric PNL was fever. Sixteen(18.4%) had moderate fever(38-39 ℃), 5(5.7%) had high fever(39-40 ℃) and there were no severe complications of infection, such as sepsis or septic shock. The mean hemoglobin loss was （10.3±16.1） g/L and the serum creatinine rise was (7.0±13.3) μmol/L. One(1.2%) pediatric patient suffered ureteroscopic lithotripsy because of the obstruction by the residual stone in ureter. No injury of organs or retroperitoneal urinary extravasation occurred. General assessment of the complications showed Clavien grade Ⅰ complications in 14 (16.1%) pediatric patients, grade Ⅱ in 7(8.0%) children and grade Ⅲ in 1(1.2%) children. There was no grade Ⅳ or Ⅴ complications. The overall complication rate was 25.3%. Conclusion: PNL for management of upper urinary tract calculi in pediatric patients is effective. Complications after PNL, as assessed with Clavien classification system, are mild and PNL in pediatric patients is safe.

Key words: Pediatric urolithiasis, Percutaneous nephrolithotomy, Clavien classification system, Complication.

中图分类号:

R691.4

于路平，徐涛. 经皮肾镜碎石术治疗儿童上尿路结石的进展、安全性和有效性的分析[J]. 北京大学学报(医学版), 2017, 49(4): 626-631.

YU Lu-ping， XU Tao. Analysis of development, safety and efficacy of percutaneous nephrolithotomy for management of upper urinary tract calculi in pediatric patients[J]. Journal of Peking University(Health Sciences), 2017, 49(4): 626-631.

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