Minimally invasive treatment and curative effect observation of kidney stone in children
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摘要: 目的 针对小儿尿石症(特别是肾结石)发病率逐年升高的情况，拟对比微通道经皮肾镜取石术(mini-percutaneous nephrolithotomy，mini-PCNL)与经尿道输尿管软镜碎石术(retrograde intrarenal surgery，RIRS)的手术疗效差异，为小儿肾结石的微创手术治疗提供可借鉴的临床经验。方法 本中心结合既往小儿肾结石的微创手术技术总结，回顾性分析2015年1月—2023年1月华中科技大学同济医学院附属协和医院收治的8例行mini-PCNL和5例行RIRS患儿的围手术期资料，并对比分析了其手术疗效和随访结果。结果 mini-PCNL的一期清石率(87.5%)优于RIRS组(60.0%)，但失血量(37.9 mL)略高于RIRS组(17.1 mL)。术前结石最大径、患儿年龄、性别等差异均无统计学意义，术后2组的肾功能恢复情况接近，均未见并发症。结论 mini-PCNL的一期清石效果较RIRS更为显著，对于单发、结石负荷较小的肾结石，也可考虑RIRS。
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关键词:
- 小儿 /
- 肾结石 /
- 经皮肾镜取石术 /
- 经尿道输尿管软镜碎石术
Abstract: Objective In view of the increasing incidence of urolithiasis(especially renal calculi) in children, the purpose of this study is to compare the difference of surgical efficacy between mini-percutaneous nephrolithotomy(mini-PCNL) and retrograde intrarenal surgery(RIRS), so as to provide clinical experience for minimally invasive surgical treatment of renal calculi in children.Methods Combined with the summary of previous minimally invasive surgical techniques in children with renal calculi, the perioperative data of 8 cases of mini-PCNL and 5 cases of RIRS were analyzed retrospectively from January 2015 to January 2023, and the surgical effects were compared and analyzed.Results The first-stage stone removal rate of mini-PCNL(87.5%) was higher than that of RIRS group(60.0%), but the blood loss of mini-PCNL group(37.9 mL) was slightly more than that of RIRS group(17.1 mL). There was no significant difference in the preoperative maximum diameter, age or sex of children. The recovery of renal function was similar between the two groups after operation, and no complications were found.Conclusion The effect of one-stage stone removal rate of mini-PCNL is more significant than that of RIRS, but RIRS can also be considered for single renal calculus with low stone load.-
Key words:
- children /
- kidney stone /
- percutaneous nephrolithotomy /
- retrograde intrarenal surgery
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表 1 2组患儿围手术期观察指标的比较
X±S 指标 mini-PCNL组(8例) RIRS组(5例) P值 年龄/岁 5.6±4.0 10.3±5.3 0.29 性别 0.13 男 5 1 女 3 4 结石最大径/mm 9.8±3.6 10.3±4.9 0.89 结石部位 0.71 左肾 4 3 右肾 3 2 双肾 1 0 结石个数 0.25 单发 7 3 多发 1 2 
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表 2 2组患儿术后一般情况比较
X±S 指标 mini-PCNL组(8例) RIRS组(5例) P值 术后平均住院天数/d 3.7±0.7 4.3±2.1 0.48 术前血红蛋白/(g/L) 117.3±11.9 125.4±2.1 0.60 术后血红蛋白/(g/L) 111.7±14.2 122.5±2.8 0.27 术后-术前血红蛋白差值/(g/L) -5.6 -2.9 0.57 术前肌酐/(mmol/L) 33.8±11.1 65.6±14.9 0.07 术后肌酐/(mmol/L) 32.3±16.2 41.2±1.1 0.52 术后-术前肌酐差值/(mmol/L) -1.5 -24.4 0.11 术前尿素氮/(mmol/L) 3.9±1.3 3.0±0.1 0.43 术后尿素氮/(mmol/L) 2.8±0.8 3.6±0.1 0.36 术后-术前尿素氮差值/(mmol/L) -1.1 0.6 0.06 一期清石率/% 87.5 60.0 0.25 并发症发生率/% 0 0 - 术中失血量/mL 37.9±2.6 17.1±0.8 < 0.05 输血/例 0 0 - 注：术中失血量(mL)=(术前红细胞压积Hct-术中血气分析的红细胞压积Hct)/术前红细胞压积Hct×体重(kg)×7%×1 000[4]。
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