CAJ | 학술논문

目的探讨微造瘘经皮肾镜碎石取石技术(mini PCNL)治疗3岁以下婴幼儿肾结石的手术技巧和临床应用价值.方法回顾性分析本中心2006至2012年收治的298例3岁以下婴幼儿319侧肾结石行mini PCNL术的临床资料,比较术前术后血红蛋白变化,手术时间,术后并发症如出血、尿外渗、发热等指标.患儿平均年龄21.7个月(7～36个月),平均结石直径1.8 cm(1.0～4.5 cm).手术指征:结石直径≥1 cm,合并肾积水,反复尿路感染.手术过程为在B型超声引导下穿刺目标肾盏,扩张至14～16F通道后,用小儿肾镜使用钬激光碎石取石.结果本组患儿均成功建立通道,一期清石299侧肾结石(93％),20侧肾脏残留结石,其中12侧肾脏残石1年内自行排出,8侧残石1年后增大再次手术取净.12例双侧肾结石一期行mini PCNL.35例手术后无管化.手术时间31～135 min,平均(53±7.5)min,血红蛋白平均下降(8±2.5)g/L,术后发热的有18.6％(57/307),肾周积液的有21.6％(69/319),腹腔积液的有2.3％(7/298),无输血患儿.住院4～10d,平均6.3d.197例随访6～24个月,未发现结石复发和手术相关长期并发症.结论 mini PCNL技术治疗3岁以下婴幼儿肾结石具有创伤小,恢复快和并发症少等优点,是一种安全、可行的治疗方法.
목적 탐토미조루경피신경쇄석취석기술(mini PCNL)치료3세이하영유인신결석적수술기교화림상응용개치.방법 회고성분석본중심2006지2012년수치적298례3세이하영유인319측신결석행mini PCNL술적림상자료,비교술전술후혈홍단백변화,수술시간,술후병발증여출혈、뇨외삼、발열등지표.환인평균년령21.7개월(7～36개월),평균결석직경1.8 cm(1.0～4.5 cm).수술지정:결석직경≥1 cm,합병신적수,반복뇨로감염.수술과정위재B형초성인도하천자목표신잔,확장지14～16F통도후,용소인신경사용화격광쇄석취석.결과 본조환인균성공건립통도,일기청석299측신결석(93％),20측신장잔류결석,기중12측신장잔석1년내자행배출,8측잔석1년후증대재차수술취정.12례쌍측신결석일기행mini PCNL.35례수술후무관화.수술시간31～135 min,평균(53±7.5)min,혈홍단백평균하강(8±2.5)g/L,술후발열적유18.6％(57/307),신주적액적유21.6％(69/319),복강적액적유2.3％(7/298),무수혈환인.주원4～10d,평균6.3d.197례수방6～24개월,미발현결석복발화수술상관장기병발증.결론 mini PCNL기술치료3세이하영유인신결석구유창상소,회복쾌화병발증소등우점,시일충안전、가행적치료방법.
Objective To evaluate the surgical techniques and clinical efficacies of mini-percutaneous nephrolithotomy (mini-PCNL) for kidney stones in infants aged under 3 years.Methods A total of 319 children aged under 3 years (average:7-36 months) with kidney stone (average:1.0-4.5 cm) underwent mini-PCNL from December 2006 to December 2012.Their pre-operative/post-operative hemoglobin levels,hospital stay,operative duration and complications were retrospectively reviewed.Surgical indications included stone diameter ≥ 1 cm,hydronephrosis and recurrent urinary tract infections.The target calyx was punctured under the guidance of type B ultrasound and channel expanded to 14-16F.Then Holmium laser was used for shattering stones extracted under pediatric nephrolithotomy.Results All channels were successfully established.Complete stone clearance was achieved in 299 kidney units (93％).The procedures were simultaneous bilateral (n =12) and tubeless (n =35) mini-PCNL.Among 20 cases of residual stone,12 were self-discharged within 1 year and 8 extracted because of expanding within 1 year.The mean operative duration was 53-± 7.5 (31-135) min,mean hemoglobin decreased to 0.8-± 0.52 (0.2-1.46) g/dl,postoperative fever in 57/307(18.6％),perirenal fluid in 69/319(21.6％),ascites in 7/298(2.3％) and no blood transfusion.The average hospital stay was 6.3 (4-10) days.And 197 cases were followed up for 6-24 months and there was no stone recurrence or long-term complications associated with surgery.Conclusions Mini-PCNL has multiple advantages of less trauma,faster recovery and fewer complications,etc.Thus it is both safe and effective for kidney stones in infants aged under 3 years.