上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2020, Vol. 40 ›› Issue (3): 408-.doi: 10.3969/j.issn.1674-8115.2020.03.022

• 短篇论著 • 上一篇    下一篇

输尿管软镜联合钬激光碎石术治疗婴幼儿上尿路结石：单中心32例研究

李彭举，钟 量，孙 杰   

  1. 上海交通大学医学院附属上海儿童医学中心泌尿外科，上海200127
  • 出版日期:2020-03-28 发布日期:2020-04-09
  • 通讯作者: 孙 杰，电子信箱：sunjie@scmc.com.cn。
  • 作者简介:李彭举（1994—），男，硕士生；电子信箱：1138727245@qq.com。

Flexible ureteroscopy combined with holmium laser lithotripsy for infants with upper urinary tract calculi: single-center experience of 32 cases

LI Peng-ju, ZHONG Liang, SUN Jie   

  1. Department of Urology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2020-03-28 Published:2020-04-09

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摘要： 目的·探讨输尿管软镜联合钬激光碎石术治疗3岁及以下婴幼儿上尿路结石的效果和安全性。方法·收集2016年1月—2019年3月于上海交通大学医学院附属上海儿童医学中心泌尿外科采用输尿管软镜联合钬激光碎石术治疗上尿路结石的3岁及以下患儿病例。患儿一期留置输尿管支架管（DJ管）0.5～3个月，待尿路感染控制后再二期行输尿管软镜联合钬激光碎石术；手术采用OLYMPUS输尿管软镜和200 μm钬激光光纤，根据结石大小和硬度选择钬激光功率（20～30 Hz/0.5～1.0 J）进行结石粉末化，退镜后留置DJ管，结束手术。结果·共有32例3岁及以下上尿路结石患儿纳入研究，其中男性21例，女性11例；中位月龄26个月（7～36个月）。32例患儿均成功实施了输尿管软镜联合钬激光碎石术，22例患儿一次手术取净结石，一次手术的无结石成功率为68.8%。手术时长中位数为53 min（15～110 min），术后住院天数中位数为3 d（2～12 d），术后拔除DJ管天数中位数为60 d（18～100 d）；术后4例患儿出现尿路感染，另有2例患儿出现高热伴尿路感染，分别给予抗感染和对症处理后好转。结论·输尿管软镜联合钬激光碎石术治疗婴幼儿上尿路结石有较好的效果和安全性，可在临床上推广使用。

关键词: 输尿管软镜, 钬激光, 婴幼儿, 上尿路结石

Abstract:

Objective · To estimate the efficacy and safety of flexible ureteroscopy combined with holmium laser lithotripsy in the treatment of upper urinary tract calculi in infants aged 3 years old and below. Methods · January 2016 to March 2019, the cases of infants aged 3 years old and below who were treated with flexible ureteroscopy combined with holmium laser lithotripsy for upper urinary tract calculi in Department of Urology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine were collected. The double J (DJ) stents were placed in the cases for 0.5-3 months, followedflexible ureteroscopy combined with holmium laser lithotripsy after urinary tract infection was controlled. OLYMPUS flexible ureteroscope and 200 μm holmium laser fiber were used in the operation. Holmium laser power was 20-30 Hz/0.5-1.0 J according to the size and hardness of the stones, and then DJ stent was retained after retraction of the ureteroscope to finish the operation. Results · A total of 32 infants aged 3 and below with upper urinary tract stones were included in the study, including 21 males and 11 females, and the median age was 26 months (7-36 months). All 32 cases were successfully treated with flexible ureteroscopy combined with holmium laser lithotripsy. Among them calculi in 22 cases were removed after one operation, and the calculi-free rate after one operation was 68.8%. The median duration of operation was 53 min (15-110 min); the median hospitalization after operation was 3 d (2-12 d); the median days of DJ stent removal after operation was 60 d (18-100 d). Urinary tract infection occurred in 4 cases, and high fever with urinary tract infection occurred in 2 cases. Anti-infection and other symptomatic treatments were given respectively to improve the symptoms. Conclusion · Flexible ureteroscopy combined with holmium laser lithotripsy is effective and safe in the treatment of upper urinary tract calculi in infants, which can be widely used in clinic.

Key words: flexible ureteroscopy, holmium laser, infant, upper urinary tract calculi