CAJ | 학술논문

目的探讨软性输尿管镜技术在小儿上尿路结石治疗中的临床价值. 方法 2007年6月至2013年6月应用软性输尿管镜技术治疗小儿上尿路结石21例.男12例,女9例.年龄2.3～16.0岁,平均7.2岁.输尿管上段结石12例(原位10例,2例系输尿管中下段结石行硬性输尿管镜碎石移位所致)、肾结石9例,均合并同侧轻、中度肾积水.其中三聚氰胺所致输尿管上段结石3例、肾结石1例.左侧11例,右侧7例,双侧3例(均为输尿管上段结石).结石最大径0.6～1.5 cm,平均1.0 cm.分别施行经尿道(逆行)软性输尿管镜钬激光碎石术和经皮肾(顺行)软性输尿管镜碎石术治疗. 结果经尿道软性输尿管镜碎石术18例,1例因软性输尿管镜进镜失败,改行微创经皮肾镜取石术；2例未能置入输尿管输送鞘直接进镜,分2次碎石；17例结石寻及率100％；15例一次碎石成功,单次碎石成功率88％.行经皮肾软性输尿管镜碎石术3例均为单一皮肾通道,均寻及结石并成功碎石.手术时间20～ 70 min,平均35 min.术中、术后无严重并发症发生.术后住院时间3～7d,平均4.5 d.术后2～4周复查均无＞2 mm结石残留,拔除双J管.随访3～72个月,均无结石复发、尿道狭窄、输尿管狭窄、尿失禁及膀胱输尿管反流. 结论应用软性输尿管镜技术治疗小儿上尿路结石安全可行,创伤小,可作为小儿上尿路结石常用腔内技术治疗的有益补充,成为部分小儿上尿路结石微创治疗的新选择.
목적 탐토연성수뇨관경기술재소인상뇨로결석치료중적림상개치. 방법 2007년6월지2013년6월응용연성수뇨관경기술치료소인상뇨로결석21례.남12례,녀9례.년령2.3～16.0세,평균7.2세.수뇨관상단결석12례(원위10례,2례계수뇨관중하단결석행경성수뇨관경쇄석이위소치)、신결석9례,균합병동측경、중도신적수.기중삼취청알소치수뇨관상단결석3례、신결석1례.좌측11례,우측7례,쌍측3례(균위수뇨관상단결석).결석최대경0.6～1.5 cm,평균1.0 cm.분별시행경뇨도(역행)연성수뇨관경화격광쇄석술화경피신(순행)연성수뇨관경쇄석술치료. 결과 경뇨도연성수뇨관경쇄석술18례,1례인연성수뇨관경진경실패,개행미창경피신경취석술；2례미능치입수뇨관수송초직접진경,분2차쇄석；17례결석심급솔100％；15례일차쇄석성공,단차쇄석성공솔88％.행경피신연성수뇨관경쇄석술3례균위단일피신통도,균심급결석병성공쇄석.수술시간20～ 70 min,평균35 min.술중、술후무엄중병발증발생.술후주원시간3～7d,평균4.5 d.술후2～4주복사균무＞2 mm결석잔류,발제쌍J관.수방3～72개월,균무결석복발、뇨도협착、수뇨관협착、뇨실금급방광수뇨관반류. 결론 응용연성수뇨관경기술치료소인상뇨로결석안전가행,창상소,가작위소인상뇨로결석상용강내기술치료적유익보충,성위부분소인상뇨로결석미창치료적신선택.
Objective To evaluate the efficacy of flexible ureteroscopyfor the treatment of the upper urinary tract calculi in children.Methods There were 21 children with 12 males and 9 females included in this study.The mean age was 7.2 (range 2.3 to 16.0) years.Among them,12 had upper ureteral calculi (10 with calculi in situ,2 with middle/distal ureteral calculi shifting to upper ureteral after rigid ureteroscopic lithotripsy) and 9 had renal calculi.Ipsilateral mild to moderate hydronephrosis was found in all of the cases.Four children had melamine-induced stones (3 with upper ureteral calculi and 1 with renal calculi).The calculi were found on left side in 11 cases,on right side in 7,and on both sides in 3 (upper ureteral calculi).The mean stone size was i.0 (range 0.6 to 1.5) cm.Retrograde flexible ureteroscopy and anterograde flexible ureteroscopy in mini-percutaneous nephrolithotomy was performed.Results Eighteen cases were performed retrograde flexible ureteroscopic procedure.One case was conversed to mini-percutancous nephrolithotomy because the flexible ureteroscope could not be inserted into the upper ureter.The flexible ureteral access sheath was failed to insert into the upper ureter in 2 cases,then the flexible ureteroscope was inserted into ureter directly.The stones were successfully fragmented after two stages in these two cases.The successful rate of stone search was 100％ in 17 cases.Fifteen cases were successfully performed in one stage.The success rate of stone fragmentation was 88％ with the holmium laser lithotripsy.Three anterograde flexible ureteroscopy with mini-percutaneous nephrolithotomywere successfully performed,and the stones were successfully found and fragmentated after a single holmium laser lithotripsy.The mean operative time was 35 (range 20 to 70) min.There was no major perioperative complication.The patients were discharged from hospital after a mean of 4.5 days (range 3 to 7).Double-J stent was removed after 2 to 4 weeks when no residual stones more than 2.0 mm was found.No recurred stones,no urethra stricture,no ureter stricture,no urinary incontinence and no vesicoureteral reflux was found during the 3 to 72-months follow-up.Conclusions Flexible ureteroscopy could be a safe and feasible method for the treatment of the upper urinary tract calculi in children.It is suitable for the stones in the pelvis and calyceal where the rigid ureteroscopy could not reach.