摘要
目的报告小儿结石ESWL治疗的10年经验，探讨ESWL治疗的效果和策略。方法回顾性研究67例小儿输尿管结石行ESWL治疗的结果，检测及记录患儿的代谢情况、生理解剖、结石的大小、位置以及各种并发症；其中术前置人输尿管导管52例；术后随访3～9个月。结果67例输尿管结石，首次碎石后，43例（64．2％）结石完全排空；7例（10．4％）经2次ESWL结石完全排空；2例（2．9％）经3次碎石结石完全排空；总结石完全排空率为77．6％。小于10mm结石首次碎石后的完全排空率为100％，37例大于10mm的结石患儿中，23例（62．2％）首次碎石后完全排空。上段结石的完全排空率为92．0％，而中下段结石的完全排空率仅为69．0％。其中11例输尿管中、下段结石和1例上段嵌顿结石ESWL失败者进行了输尿管镜治疗，用APL弹道碎石机击碎结石并取出；3例改行开放手术。结论ESWL是小儿输尿管结石的安全有效的治疗方法；对输尿管中、下段结石应用输尿管镜是ESWL的有效补充治疗；部分结石采用输尿管镜联合ESWL可获得较好的效果。
Objective To evaluate the efficacy of extracorporeal shock wave lithotripsy （ESWL） in the management of pediatric ureteral calculi. Methods We reviewed the treatment and outcome of 67 patients with pediatric ureteral calculi. Clinical presentation, metabolic and anatomical anomalies, stone size and location, outcome and complications were analyzed. Ureteral stents were inserted in 52 patients for localization of the stone during ESWL. All the patients were followed-up for 3 to 9 months postoperatively. Results Of the 67 patients, 43 （64. 2%） were free of stones after 1 session of ESWL, 7（10. 4%） after 2 sessions and 2 （2.9%） after three. The total stone-free rate is 77. 6%. The stone-free rate following one .ESWL session was 100% for ureteral calculi of 10mm or less in diameter regardless of the location. Of the 37 patients with stones larger than 10mm, 23（62. 2%）were free of stones following one ESWL session. The stone-free rate in the upper ureter is 92. 0%, but in the mid and lower ureter, it was 69. 0%. Of all the patients, 11 underwent ureteroscopy and the residual stones were crushed by APL lithoclast. Three patients underwent ureterolithotomy after ESWL failure. Conclusions ESWL is an efficient and safe modality for the treatment of pediatric ureteral stones. Ureteroscope was effective in managing mid and lower ureteral residual stones after ESWL.
出处
《中华小儿外科杂志》
CSCD
北大核心
2006年第4期188-190,共3页
Chinese Journal of Pediatric Surgery
