-
摘要: 目的:探讨应用可视化穿刺经皮肾镜系统治疗婴幼儿肾结石的安全性和有效性。方法:回顾性分析我院2016年9月2017年11月采用可视化穿刺系统治疗29例婴幼儿肾结石患儿的临床资料,其中男19例,女10例;年龄536个月,平均(20.7±10.6)个月;<1岁的婴儿9例,13岁的幼儿20例;单侧肾结石20例,双侧肾结石9例;结石最大直径0.54.9cm,平均(1.7±0.9) cm。23例患儿术前2周留置4.7Fr双J管,手术前2d使用静脉抗生素。手术采用全身麻醉,留置尿管后俯卧位。在超声引导下采用4.8Fr可视化穿刺系统行经皮肾穿刺。穿刺过程中自18G穿刺针侧面连接带有延长管的20ml注射器,必要时推注生理盐水以观察前端周围组织。通过可视化穿刺系统可以观察到穿刺针最终进入目标肾盏。更换穿刺针内芯并置入200μm钬激光光纤粉末化碎石,术后不留置肾造瘘管。如结石较大可沿4.8Fr穿刺鞘留置加硬导丝,扩张通道至12Fr,采用8Fr配套经皮肾镜和550μm钬激光光纤碎石,术后留置10Fr肾造瘘管。结果:29例患儿共接受34次碎石手术。单纯采用可视化穿刺系统行Microperc 22例(Microperc组),行Microperc+PCNL 7例(Microperc+PCNL组)。Microperc组手术时间10110min,平均(41.8±25.6) min;Microperc+PCNL组手术时间15120min,平均(66.4±33.8) min;Microperc组术后血色素下降(1.10±1.90) g/dl,Microperc+PCNL组术后血色素下降(1.85±1.39) g/dl;两组均无输血病例;Microperc组冲洗液用量(240±294) ml,Microperc+PCNL组冲洗液用量(3 200±2374) ml;Microperc组术后住院时间(43.0±15.4) h,Microperc+PCNL组术后住院时间(68.5±31.7) h。Microperc组完全清石率达77.2%,Microperc+PCNL组完全清石率达71.4%。结论:应用可视化穿刺系统治疗婴幼儿肾结石具有较高的清石率和安全性,是婴幼儿肾结石手术的较好选择。Abstract: Objective:To evaluate the safety and efficacy of visual puncture system in the treatment of kidney stone in infants.Method:The clinical data of 29 infants with renal calculi admitted to our hospital from September2016 to November 2017 were retrospectively analyzed.There were 19 males and 10 females.The children were 5-36 months old, with an average of (20.7±10.6) months, including 9 infants aged<1 years and 20 children aged1-3 years.There were 20 cases of unilateral renal calculi and 9 cases of bilateral renal calculi.The stones diameter were from 0.5 to 4.9 cm, with an average of (1.7±0.9) cm.Double J tube of 4.7 Fr should be placed two weeks before the operation, and intravenous antibiotics should be used two days before operation.General anesthesia was adopted and prone position was placed after indwelling catheter.Percutaneous renal biopsy was performed by ultrasound guided 4.8 Fr visualization system.During the puncture, a 20 ml syringe with an extended tube was attached to the side of the 18 Gneedle, and saline was injected to keep the visual field clear.Through the visualization system, it can be observed that the needle tip enters the target renal pelvis successively through each anatomical layer.Then we used 200 μm holmium laser fiber to crush stones without nephrostomy tube.If the stones were large, we can indwell guidewire along the 4.8 Fr trocar, expand the channel to 12 Fr, use 8 Fr percutaneous nephroscope and 550 μm laser fiber for nephrolithotomy, 10 Fr nephrostomy tube was indwelt after operation.Result:Twenty-nine patients received 34 times of lithotripsy.Twenty-two cases of Microperc were performed by visual puncture system and 7 cases were treated with Microperc+PCNL.The operation time of group Microperc was 10-110 min, with an average of (41.8±25.6) min.The operation time of group Microperc+PCNL was 15-120 min, with an average of (66.4±33.8) min.The average decrease of hemoglobin in group Microperc was (1.10±1.90) g/dl after operation, and in group Microperc+PCNL was (1.85±1.39) g/dl.There were no cases of blood transfusion in all two groups.The average dosage of flushing fluid was (240±294) ml in group Microperc and (3 200±2 374) ml in group Microperc+PCNL.The average time of hospitalization was (43.0±15.4) h in group Microperc, and the average time of group Microperc+PCNL was (68.5±31.7) h.The stone clearing rate in group Microperc reached 77.2%, and in group Microperc+PCNL was 71.4%.Conclusion:The application of visual puncture system in the treatment of kidney stone in infants has a high rate of stone removal and safety, and it is a better choice for infants with kidney stone.
-
Key words:
- visual puncture system /
- infant /
- kidney stone
-
-
[1] Sinha R K, Mukherjee S, Jindal T, et al.Evaluation of stone-free rate using Guy's Stone Score and assessment of complications using modified Clavien grading system for percutaneous nephro-lithotomy[J].Urolithiasis, 2015, 43 (4):349-353.
[2] 李钧, 肖荆, 陈恒润, 等.输尿管软镜钬激光碎石术治疗儿童和婴幼儿上尿路结石:单中心92例经验总结[J].中华泌尿外科杂志, 2016, 37 (11), 851-854.
[3] Gunes A, Yahya Ugras M, Yilmaz U, et al.Percutaneous nephrolithotomy for pediatric stone disease-our experience with adult-sized equipment[J].Scand J Urol Nephrol, 2003, 37 (6):477-481.
[4] Unsal A, Resorlu B, Kara C, et al.Safety and efficacy of percutaneous nephrolithotomy in infants, preschool age, and older children with different sizes of instruments[J].Urology, 2010, 76 (1):247-252.
[5] Bader M J, Gratzke C, Seitz M, et al.The"all-seeing needle":initial results of an optical puncture system confirming access in percutaneous nephrolithotomy[J].Eur Urol, 2011, 59 (6):1054-1059.
[6] Caballero-Romeu J P, Budia-Alba A, Galan-Llopis J A, et al.Microureteroscopy in Children:Two First Cases[J].J Endourol Case Rep, 2016, 2 (1):44-47.
[7] Dede O, Sancaktutar A A, Bas O, et al.Micro-percutaneous nephrolithotomy in infants:a single-center experience[J].Urolithiasis, 2016, 44 (2):173-177.
[8] Dundar G, Gokce G, Gokcen K, et al.Microperc Versus Miniperc for Treatment of Renal Stones Smaller Than 2cm in Pediatric Patients[J].Urol J, 2016, 13 (5):2829-2832.
[9] Karatag T, Tepeler A, Silay M S, et al.A Comparison of 2 Percutaneous Nephrolithotomy Techniques for the Treatment of Pediatric Kidney Stones of Sizes 10-20mm:Microperc vs Miniperc[J].Urology, 2015, 85 (5):1015-1018.
[10] Bas O, Dede O, Aydogmus Y, et al.Comparison of Retrograde Intrarenal Surgery and Micro-Percutaneous Nephrolithotomy in Moderately Sized Pediatric Kidney Stones[J].J Endourol, 2016, 30 (7):765-770.
[11] 周密, 俞蔚文, 何翔, 等.可视穿刺联合球囊扩张PCNL治疗无积水肾结石的应用体会[J].临床泌尿外科杂志, 2018, 33 (2):101-103.
[12] Daggülli M, UtangaöM M, Dede O, et al.Micro-percutaneous nephrolithotomy in the treatment of pediatric nephrolithiasis:A single-center experience[J].J Pediatr Surg, 2016, 51 (4):626-629.
-
计量
- 文章访问数: 258
- PDF下载数: 328
- 施引文献: 0
下载: