北京大学学报(医学版) ›› 2017, Vol. 49 ›› Issue (4): 626-631. doi: 10.3969/j.issn.1671-167X.2017.04.014

• 论著 • 上一篇    下一篇

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

于路平,徐涛△   

  1. (北京大学人民医院泌尿外科, 北京100044)
  • 出版日期:2017-08-18 发布日期:2017-08-18
  • 通讯作者: 徐涛 E-mail: xutao@medmail.com.cn

Analysis of development, safety and efficacy of percutaneous nephrolithotomy for management of upper urinary tract calculi in pediatric patients

YU Lu-ping, XU Tao△   

  1. (Department of Urology, Peking University People’s Hospital, Beijing 100044, China)
  • Online:2017-08-18 Published:2017-08-18
  • Contact: XU Tao E-mail: xutao@medmail.com.cn

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
[1] 万利, 张周沧, 丁嘉祥, 王梅. 中心静脉导管拔除后静脉空气栓塞1例[J]. 北京大学学报(医学版), 2024, 56(5): 938-941.
[2] 许素环,王蓓蓓,庞秋颖,钟丽君,丁炎明,黄燕波,车新艳. 等体温膀胱冲洗对经尿道前列腺电切术患者干预效果的meta分析[J]. 北京大学学报(医学版), 2023, 55(4): 676-683.
[3] 李辉,高阳旭,王书磊,姚红新. 恶性肿瘤患儿完全植入式静脉输液港手术并发症[J]. 北京大学学报(医学版), 2022, 54(6): 1167-1171.
[4] 姜保国,张培训. 老年髋部骨折的围手术期风险评估[J]. 北京大学学报(医学版), 2022, 54(5): 803-809.
[5] 于博,赵扬玉,张喆,王永清. 妊娠合并感染性心内膜炎1例[J]. 北京大学学报(医学版), 2022, 54(3): 578-580.
[6] 吴俊慧,武轶群,吴瑶,王紫荆,吴涛,秦雪英,王梦莹,王小文,王伽婷,胡永华. 北京城镇职工2型糖尿病患者缺血性脑卒中发病率及主要危险因素[J]. 北京大学学报(医学版), 2022, 54(2): 249-254.
[7] 李伟浩,李伟,张学民,李清乐,焦洋,张韬,蒋京军,张小明. 去分支杂交手术和传统手术治疗胸腹主动脉瘤的结果比较[J]. 北京大学学报(医学版), 2022, 54(1): 177-181.
[8] 王成,孟令宇,陈拿云,李玳,王健全,敖英芳. 前交叉韧带重建术后膝关节感染的诊断和治疗策略[J]. 北京大学学报(医学版), 2021, 53(5): 850-856.
[9] 耿志宇,高为华,王东信. 全身麻醉气管插管患者术后声带运动不良的临床结局[J]. 北京大学学报(医学版), 2021, 53(2): 337-340.
[10] 董文敏,王明瑞,胡浩,王起,许克新,徐涛. Allium覆膜金属输尿管支架长期留置治疗输尿管-回肠吻合口狭窄的初期临床经验及随访结果[J]. 北京大学学报(医学版), 2020, 52(4): 637-641.
[11] 高健,胡立宝,陈尘,郅新,徐涛. 经皮肾镜去石术后出血的介入治疗[J]. 北京大学学报(医学版), 2020, 52(4): 667-671.
[12] 马凯,曲星珂,许清泉,熊六林,叶雄俊,安立哲,陈伟男,黄晓波. 肾移植术后移植肾输尿管膀胱吻合口狭窄的腔内治疗:13例报道[J]. 北京大学学报(医学版), 2019, 51(6): 1155-1158.
[13] 齐伟,李健男,赵静仁,邢海霞,潘洁. 角形切口设计和愈合方式与下颌阻生智齿拔除术后并发症[J]. 北京大学学报(医学版), 2019, 51(5): 949-953.
[14] 许庭珉,张晓威,张国喜,白文俊,李清,徐涛. 应用脱细胞异体真皮补片行阴茎增粗术的并发症及处理[J]. 北京大学学报(医学版), 2019, 51(4): 636-640.
[15] 梁晨,张维宇,胡浩,王起,方志伟,许克新. 膀胱扩大术两种不同术式的疗效及并发症比较[J]. 北京大学学报(医学版), 2019, 51(2): 293-297.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!