针状肾镜在儿童肾结石经皮肾镜碎石取石术中的初步应用

doi:10.3877/cma.j.issn.1674-3253.2022.03.007

目的

探讨针状肾镜应用于儿童肾结石经皮肾镜碎石取石术治疗的效果及安全性。

方法

2019年9月至2020年6月我院收治的儿童肾结石患者20例，均在全麻下行针状肾镜可视化经皮穿刺并钬激光碎石术，观察手术时间、术后血红蛋白下降值、术后疼痛评分、住院时间和并发症发生情况。

结果

20例22侧肾结石，全部穿刺成功，其中单次穿刺成功16侧，2次穿刺成功4侧，3次穿刺成功2侧。手术时间平均为（45±12）min，血红蛋白下降值平均为（5.5±0.8）g/L，术后疼痛评分平均为（3.5±0.5）分，术后住院时间平均为（3.7±0.9）d。术后出现ClavienⅠ级并发症（肾绞痛）3例，ClavienⅡ级并发症2例，为发热症状，体温≥38.0℃，给予抗生素治疗治愈，无输血病例，无ClavienⅢ级及以上并发症发生。术后1个月复查KUB，结石清除率为86.36%（19/22）。

结论

针状肾镜治疗儿童小体积结石安全有效，清石率高，并发症低，住院时间短。

关键词: 针状肾镜, 经皮肾镜, 儿童, 肾结石

Objective

To investigate the efficacy and safety of needle- perc nephroscope for treatment of renal calculi in pediatric patients.

Methods

From September 2019 to June 2020, 20 children with renal calculi were treated with needle-perc nephroscope and holmium laser lithotripsy under general anesthesia in our hospital. The operation time, postoperative hemoglobin decline, postoperative pain score, hospitalization time and complications were observed.

Results

Twenty two sides of 20 cases of renal calculi were successfully punctured, including 16 cases of single puncture, 4 cases of 2 times of puncture, and 2 sides of 3 times of puncture. The average operation time was (45±12) min, the average decrease of hemoglobin was (5.5±0.8) g/L, the average postoperative pain score was (3.5±0.5) points, and the average day of postoperative hospitalization was (3.7±0.9) d. There were 3 cases of Clavien grade I complications with renal colic and 2 cases of Clavien grade II complications with body temperature ≥38.0℃ after operation. No blood transfusion cases and no Clavien III complications occurred. The stone-free rate at one month was 86.36% (19/22).

Conclusion

Percutaneous nephrolithotomy with needle-perc nephroscope for the treatment of small renal calculi in pediatric patients is safe and effective, with high stone-free rate, low complications and short hospitalization time.

Key words: Needle-perc nephroscope, Percutaneous nephrolithotomy, Children, Renal calculi

图1 针状肾镜在儿童肾结石术中的应用及效果注：a为超声引导下针式肾镜穿刺；b为针式肾镜穿刺成功后置入钬激光碎石操作；c为针式肾镜下钬激光碎石图像；d为术毕拔出针式肾镜后留下针眼

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Primary application of needle-perc nephroscope for treatment of renal calculi in pediatric patients

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Primary application of needle-perc nephroscope for treatment of renal calculi in pediatric patients