微创经皮肾镜钬激光碎石术治疗婴幼儿上尿路结石临床效果

摘要

目的 探讨微创经皮肾镜钬激光碎石术治疗婴幼儿上尿路结石的临床效果及安全性.方法 选择我院2013年1月-2016年1月收治的婴幼儿上尿路结石180例,均行微创经皮肾镜钬激光碎石术,记录手术时间、术中出血量、住院时间、结石清除率、临床总有效率和并发症发生情况.结果 本组手术均成功,手术时间60～100(68.24±20.36)min,术中出血量40～120(68.64±18.32)ml,住院时间7～15(10.20±3.64)d.术中出现明显出血6例,其中2例因出血致视野模糊终止手术,后行二期碎石治疗;4例术中予及时止血至手术结束.术后6例出现发热,经退热、抗感染等治疗后恢复正常;14例可见轻微血尿,后自行缓解.本组一期结石清除148例(82.22％),二期结石清除22例(12.22％),残留结石10例(5.56％);临床总有效率97.78％(176/180).随访3个月,所有患儿均未出现其他严重并发症.结论 微创经皮肾镜钬激光碎石术治疗婴幼儿上尿路结石临床效果好,安全性高.%Objective To investigate clinical efficacy and safety of minimally invasive percutaneous nephrolithotomy with holmium in treatment of infants with upper urinary calculi.Methods A total of 180 infants and young children with upper urinary calculi admitted during January 2013 and January 2016 underwent minimally invasive percutaneous nephrolithotomy with holmium, and operative time, intraoperative bleeding volume, length of stay, calculi removal rate, the total effective rate and incidence rate of complications were recorded.Results All patients underwent surgeries successfully, and the operative time was 60-100 (68.24±20.36) min;intraoperative bleeding volume was 40-120 (68.64±18.32)ml;length of stay was 7-15 (10.20±3.64) d.There were 6 patients with obvious bleeding, in which 2 patients had blurry visual fields induced by bleeding, and the surgery was stopped, and then the 2 patients underwent second lithotrity;other 4 patients were given hemostasis in time during surgery to the end of the surgery.After surgery, 6 patients had fever, and they returned to normal after treatments such as antipyretic and anti infection;14 patients had slight hematuria, and the symptom was relieved later.The number of first stage calculi removal was 148 cases (82.22％), and the number of second stage calculi removal was 22 cases (12.22％), and residual stone was found in 10 cases (5.56％).The total effective rate was 97.78％ (176/180).With 3 months of follow-up, no serious complications was found in all patients.Conclusion Minimally invasive percutaneous nephrolithotomy with holmium in treatment of infants with upper urinary calculi can achieve good effect and safety.