Comparison of the efficiency between flexible ureteroscopy and Microperc in the treatment of kidney stones less than 2 cm in infants
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摘要: 目的:比较输尿管软镜和Microperc治疗婴幼儿≤2 cm肾结石的安全性和有效性。方法:回顾性分析2016年10月~2017年10月在我院行输尿管软镜和Microperc手术治疗婴幼儿肾结石的临床资料,依据手术方式分为两组。输尿管软镜组共38例,男25例,女13例,年龄(19.6±9.9)个月,结石最大直径(13.7±4.5) mm,结石数量(1.29±0.57)个。Microperc组共29例,男19例,女10例,年龄(20.7±10.6)个月,结石最大直径(13.9±4.5) mm,结石数量(1.31±0.54)个。所有患儿提前2周留置4.7Fr双J管。输尿管软镜采用全身麻醉,截石位。经输尿管硬镜拔除双J管。使用14G套管针行耻骨上膀胱穿刺造瘘。使用POLY组合式小儿输尿管软镜经导丝进入输尿管和肾盂内,注射器手动推水保持视野清晰,200μm钬激光光纤碎石。Microperc手术采用全身麻醉,留置尿管,俯卧位。B超引导下可视穿刺设备对目标肾盏行经皮肾穿刺建立操作通道。注射器手动推水保持视野清晰,200μm钬激光光纤碎石。结果:输尿管软镜组共进行41次(47侧)肾结石手术;Microperc组共进行32次(37侧)肾结石手术。输尿管软镜组手术时间(38.1±16.5) min,灌注液用量(193±117) ml,术后住院天数(2.45±1.05) d,完全清石率73.17%,并发症发生率34.1%;Microperc组手术时间(40.6±22.7) min,灌注液用量(210±133) ml,术后住院天数(2.29±0.92) d,完全清石率81.25%,并发症发生率15.6%,两组比较差异无统计学意义。输尿管软镜组术后第2天血红蛋白下降(0.48±0.26) g/dl,灌注量-引流量(49.5±43.4) ml;Microperc组术后第2天血红蛋白下降(0.65±0.33) g/dl,灌注量-引流量(20.8±13.6) ml,两组比较差异有统计学意义。结论:输尿管软镜和Microperc技术治疗婴幼儿≤2 cm肾结石均具有较高的安全性和有效性,但Microperc技术并发症发生率更低。Abstract: Objective: To compare the safety and efficacy between flexible ureteroscopy and Microperc in the treatment of kidney stones less than 2 cm in infants. Method: The clinical data of infants with flexible ureteroscopy and Microperc operation in our hospital from October 2016 to October 2017 were analyzed retrospectively, and two groups were divided according to the surgical methods. There were 38 cases in flexible ureteroscopy group, 25 males and 13 females. The average age was(19.6±9.9) months, the maximum diameter of the stone was(13.7±4.5) mm, and the number of stones was(1.29±0.57). There were 29 cases in group Microperc, 19 males and 10 females. The average age was(20.7±10.6) months, the maximum diameter of the stone was(13.9±4.5) mm, and the number of stones was(1.31±0.54).All patients were retained 4.7 Fr double J tube 2 weeks before operation. The flexible ureteroscopy was performed under general anesthesia and lithotomy position. Double J tube was removed by ureteroscopy. The 14 G trocar was used for the suprapubic bladder puncture. The POLY flexible ureteroscope was inserted into the ureter and renal pelvis by guidewire, manually push the water to keep a clear vision, used the YAG laser for lithotripsy. The Microperc operation was carried out under general anesthesia, indwelling catheter and prone position. The operation channel was established by B-ultrasound guided percutaneous renal puncture for the target renal calyx. Using a syringe manually push the water to keep a clear vision, used the YAG laser for lithotripsy. Result: Forty-one times and 47 sides of the kidney stones operation were performed in the flexible ureteroscopy group. A total of 32 times and 37 sides of the kidney stones operation in group Microperc. The operation time of flexible ureteroscope group was(38.1±16.5) min, perfusion fluid volume was(193±117) ml, postoperative hospital stay was(2.45±1.05) days, complete stone clearance rate was 73.17%, the complication rate was 34.1%; the operation time of Microperc group was(40.6±22.7) min, perfusion fluid volume was(210±133) ml, postoperative hospital stay was(2.29±0.92) days, complete stone clearance rate was 81.25%, the complication rate was 15.6%, the above indicators showed no significant difference between the two groups. On the second day after operation, the hemoglobin in the flexible ureteroscopy group decreased by(0.48±0.26) g/dl, and the volume of perfusion-drain fluid was(49.5±43.4) ml. In group Microperc, hemoglobin decreased by(0.65±0.33) g/dl, and the volume of perfusion-drain fluid was(20.8±13.6) ml.Conclusion: Both flexible ureteroscopy and Microperc technique show high safety and effectiveness in the treatment of kidney stones less than 2 cm in infants, but the complication rate of Microperc technique is lower.
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Key words:
- flexible ureteroscopy /
- Microperc /
- infant /
- kidney stone
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