CAJ | 학술논문

目的对比分析彩色多普勒超声引导下微创经皮肾镜取石术(MPCNL)和经尿道逆行输尿管镜气压弹道碎石术(URSL)治疗幼儿输尿管中上段结石的疗效. 方法回顾性分析2008年1月至2011年11月89例采用MPCNL或URSL治疗的5岁以下输尿管中上段结石患儿的临床资料.双侧输尿管结石及采用多种方式碎石者不纳入本研究.比较不同术式的手术时间、结石取净率、术前术后血红蛋白变化、术后发热和术后平均住院日. 结果 MPCNL及URSL组结石长径分别为(13.7±5.1) mm和(12.9±3.2)mm,差异无统计学意义.患者民族构成类似.53例采用MPCNL,均一期建立通道并碎石,通道建立时间(9.5±4.9) min,手术时间(35.8±7.6) min,一期手术结石取净率100.0％,血红蛋白下降(6.72±1.63) g/L,血细胞比容下降(2.34±0.57)％.术后12例(22.6％)发热(体温≥38.5℃),平均住院日8.5 d,无失肾、死亡病例,无输血、感染性休克及邻近脏器损伤病例.36例采用URSL,手术时间(66.8±28.5) min,一期手术结石取净率63.9％(23/36),血红蛋白下降(4.42±1.52) g/L,血细胞比容下降(1.85±0.13)％.术后19例(52.8％)发热(≥38.5℃),平均住院日为13.2 d.输尿管近开口处损伤穿孔7例,发生菌血症、败血症1例.89例随访16～ 38个月,平均24个月.URSL组发生输尿管狭窄3例(8.3％),MPCNL组无输尿管狭窄病例. 结论 MPCNL治疗5岁以下幼儿输尿管中上段结石较URSL手术时间更短、结石取净率更高、并发症发生率低,是此类患者安全高效的治疗方法.
목적 대비분석채색다보륵초성인도하미창경피신경취석술(MPCNL)화경뇨도역행수뇨관경기압탄도쇄석술(URSL)치료유인수뇨관중상단결석적료효. 방법 회고성분석2008년1월지2011년11월89례채용MPCNL혹URSL치료적5세이하수뇨관중상단결석환인적림상자료.쌍측수뇨관결석급채용다충방식쇄석자불납입본연구.비교불동술식적수술시간、결석취정솔、술전술후혈홍단백변화、술후발열화술후평균주원일. 결과 MPCNL급URSL조결석장경분별위(13.7±5.1) mm화(12.9±3.2)mm,차이무통계학의의.환자민족구성유사.53례채용MPCNL,균일기건립통도병쇄석,통도건립시간(9.5±4.9) min,수술시간(35.8±7.6) min,일기수술결석취정솔100.0％,혈홍단백하강(6.72±1.63) g/L,혈세포비용하강(2.34±0.57)％.술후12례(22.6％)발열(체온≥38.5℃),평균주원일8.5 d,무실신、사망병례,무수혈、감염성휴극급린근장기손상병례.36례채용URSL,수술시간(66.8±28.5) min,일기수술결석취정솔63.9％(23/36),혈홍단백하강(4.42±1.52) g/L,혈세포비용하강(1.85±0.13)％.술후19례(52.8％)발열(≥38.5℃),평균주원일위13.2 d.수뇨관근개구처손상천공7례,발생균혈증、패혈증1례.89례수방16～ 38개월,평균24개월.URSL조발생수뇨관협착3례(8.3％),MPCNL조무수뇨관협착병례. 결론 MPCNL치료5세이하유인수뇨관중상단결석교URSL수술시간경단、결석취정솔경고、병발증발생솔저,시차류환자안전고효적치료방법.
Objective To compare the efficacy,safety,and morbidity of minimally invasive percutaneous nephrolithotomy under Doppler ultrasound guidance (MPCNL) and retrograde ureteroscopic lithotrispy (URSL) for upper and middle ureteral stones in children younger than 5 years.Methods Eightynine cases of children younger than 5 years from January 2008 to November 2011 were reviewed.There were 53 patients accepted MPCNL and 36 patients undergoing URSL.Patients who needed more than one percutaneous tract or had simultaneously undergone the two techniques on the same kidney or need more than one session surgery were excluded from the study.Results The two groups had comparable stone burden of (13.7±5.1) mm and (12.9±3.2) mm in MPCNL and URSL group respectively.The demographic data were similar as well.In MPCNL group,percutaneous-renal access was established and lithotripsy was preformed in one session,with the access time of (9.5±4.9) min and operative time of (35.8±7.6) min.The stone-free rate was 100.0％.The hemoglobin and hematocrit dropped by (6.72± 1.63) g/L and (2.34±0.57)％ respectively.The mean hospital stay after surgery was 8.5 d.The complication in MPCNL group was postoperative fever in 12 (22.6％) cases.No perioperative bleeding,renal lost or septic shock was recorded,and no transfusion was required.No perirenal organ injury was recorded.In URSL group,the operative time was (66.8 ± 28.5) min with the stone-free rate of 63.9％ in single session.The hemoglobin and hematocrit dropped by (4.42±1.52) g/L and (1.85±0.13)％ respectively.The mean hospital stay after surgery was 13.2 d.The complications of URSL group included postoperative fever in 19 (52.8％) cases,ureteral perforation in 7 cases.The mean follow-up duration was 24 months (range,16-38 months).Three (8.3％) ureteral stricture cases were recorded in URSL group postoperatively,which was not reported in MPCNL group.The MPCNL group was significant better than URSL group in terms of stone-free rate in one session,operative time and hospital stay (P＜0.05).Conclusion MPCNL could be safe and effective for managing proximal and middle ureteral stone in pediatric patients with significantly higher stone-free rate,shorter operative time and lower incidence of bleeding and less complications compared with URSL.