探讨4.8 F可视肾镜在治疗小儿输尿管中下段结石的安全性和临床疗效。

回顾分析我科从2017年5月至2019年12月收治的25例小儿输尿管中下段结石患者资料，均采用4.8 F可视肾镜治疗，其中男性16例，女性9例，年龄2～12岁，平均年龄（5.0±2.6）岁，术前经彩超、CTU等检查后确诊。结石直径5～21 mm，平均（12±6）mm。单侧输尿管结石23例，双侧输尿管结石2例，输尿管中段结石10例，下段结石15例。6例接受过ESWL治疗，8例常规输尿管镜碎石失败。截石位，4.8 F可视肾镜接0.9%氯化钠液，直视下通过尿道进入膀胱后，再进入患侧输尿管，找到结石后用钬激光将其粉碎。

本组25例均一期顺利碎石成功，手术时间15～50 min，平均（32±10）min。住院时间4～7 d，中位时间6 d。无一例结石上移逃逸，2例术后膀胱刺激症状明显，拔除尿管后缓解。2例出现发热，T>38.5℃，经调整抗生素后体温正常。无一例输尿管穿孔、黏膜撕脱等严重并发症发生。所有患者术后3 d复查彩超及腹部平片，净石率88%，随访1个月复查彩超均无结石残留，净石率100%。

采用4.8 F可视肾镜治疗小儿输尿管中下段结石安全、微创、有效。

To evaluate the clinical safety and efficacy of using the visual puncture micro-percutaneous nephrolithotomy to treat the mid and distal calculi in children.

From May 2017 to December 2019, 25 children patients with mid and distal ureteric calculi were enrolled into this retrospective study. There were16 males and 9 femals (age range from 2 to 12 years) who were diagnosed by colour doppler ultrasound, CTU, et al. The average stone size was (12±6) mm in diameter (range from 5 to 21 mm). 23 cases got stones in the unilateral ureter and 2 cases in the bilateral ureters, 10 cases in the mid ureter, 15 cases in the distal ureter. 6 cases received ESWL and 3 cases received ureteroscopic lithotripsy, but they were failed. In the lithotomy position, the visual puncture micro-percutaneous nephrolithotomy linked with 0.9% sodium chloride was applied to enter into ureter through urethra. Holmium laser was used for lithotripsy.

All the 25 patients were operated successful onestage. The operation time was 15-50 min (32±10) min. All patients were recovery and discharged from hospital 4-7 (6) days later. No calculi moved up and escaped. Serious irritative symptoms of bladder occurred in 2 patients who recovered after pulled out the catheter. Fever (T>38.5℃) occurred in 2 patients who, and they became normal by changed sensitive antibiotic. No severe complications such as ureteral perforation and extravasation occurred. All patients were rechecked by ultrasound and KUB 3 days later, the stone clearance rate was 88%. One month later ultrasound was rechecked, no stone was residual, the stone clearance rate was 100%.

As a worth promoting treatment for the mid and distal calculi in children, the visual puncture micro-percutaneous nephrolithotomy is safe, minimally invasive, and effective.