据报道,2-3%的结石病人发生于儿童时期[1]。近期文献报道儿童期泌尿系结石发病率有所升高[2,3]。导致小儿泌尿系结石升高的原因尚不清楚,目前考虑和营养习惯、气候变暖、以及环境因素的改变有关[4]。当结石直径>4mm时,结石较难自行排出[5]。体外振波碎石(SWL)被认为是治疗小儿肾结石的一线治疗方案(<2cm)。虽然SWL是一种非侵入性治疗方案,但是SWL仍然具有一些缺点。1.成功率比较低,文献报道60.2~80.9%[6,7],并且需要较长的时间达到无石状态。2.另外,SWL治疗后有可能形成“石街”。Sayed等人报道1-2cm的肾结石SWL治疗后石街形成率为7%,2-3 cm的肾结石SWL治疗后石街形成率为12%[8];Bulent等学者报道小于1cm的肾结石经SWL治疗后石街形成率为1.9%,1-2 cm的肾结石SWL治疗后石街形成率为15.4%,而大于2cm的肾结石SWL治疗后石街形成率为19.5%[9]。一旦形成石街,需要行SWL或者输尿管镜碎石术(URL)解除输尿管梗阻。随着科技的进步,输尿管镜碎石术越来越多的应用于小儿泌尿系结石的治疗,并取得较好的结果。URL具有安全、有效、排石快的特点。除了URL已经应用于小儿输尿管结石的治疗外,目前已经有文献报道URL可以治疗小儿肾结石[10]。输尿管软镜可以治疗肾脏的各个部位结石,包括肾下盏结石,但是,部分病人需要进行一期输尿管置管,二期进行输尿管软镜碎石。总之,小儿泌尿系结石的治疗,应该根据具体情况,具体分析,大部分小儿泌尿系结石可以通过微创的治疗方式,达到治愈的效果。参考文献:1. Slavkovic A, Radovanovic M, Vlajkovic M, Novakovic D, Djordjevic N, Stefanovic V (2006) Extracorporeal shock wave lithotripsy in the management of pediatric urolithiasis. Urol Res 34 (5):315-320. doi:10.1007/s00240-006-0062-42. Penido MG, Srivastava T, Alon US (2013) Pediatric primary urolithiasis: 12-year experience at a Midwestern Children's Hospital. The Journal of urology 189 (4):1493-1497. doi:10.1016/j.juro.2012.11.1073. Dwyer ME, Krambeck AE, Bergstralh EJ, Milliner DS, Lieske JC, Rule AD (2012) Temporal trends in incidence of kidney stones among children: a 25-year population based study. The Journal of urology 188 (1):247-252. doi:10.1016/j.juro.2012.03.0214. altk Ylmaz A, Büyükkaragz B, Oguz U, elik B Influence of body mass index on pediatric urolithiasis. Journal of pediatric urology. doi:10.1016/j.jpurol.2015.04.0395. Van Savage JG, Palanca LG, Andersen RD, Rao GS, Slaughenhoupt BL (2000) Treatment of distal ureteral stones in children: similarities to the american urological association guidelines in adults. The Journal of urology 164 (3 Pt 2):1089-10936. Tan AH, Al-Omar M, Watterson JD, Nott L, Denstedt JD, Razvi H (2004) Results of shockwave lithotripsy for pediatric urolithiasis. J Endourol 18 (6):527-530. doi:10.1089/end.2004.18.5277. Cass AS (1996) Comparison of first-generation (Dornier HM3) and second-generation (Medstone STS) lithotripters: treatment results with 145 renal and ureteral calculi in children. J Endourol 10 (6):493-4998. Sayed MA, el-Taher AM, Aboul-Ella HA, Shaker SE (2001) Steinstrasse after extracorporeal shockwave lithotripsy: aetiology, prevention and management. BJU international 88 (7):675-6789. Onal B, Citgez S, Tansu N, Demirdag C, Dogan C, Gonul B, Demirkesen O, Obek C, Erozenci A (2012) Predictive factors and management of steinstrasse after shock wave lithotripsy in pediatric urolithiasis--a multivariate analysis study. Urology 80 (5):1127-1131. doi:10.1016/j.urology.2012.06.04310. Tan AH, Al-Omar M, Denstedt JD, Razvi H (2005) Ureteroscopy for pediatric urolithiasis: an evolving first-line therapy. Urology 65 (1):153-156. doi:S0090-4295(04)00972-0 [pii]10.1016/j.urology.2004.08.032本文系王司军医生授权好大夫在线(www.haodf.com)发布,未经授权请勿转载。
治疗前 老年男性,79岁,因“尿潴留”入院。前列腺三径约8.25*5.33*3.71cm 治疗后 治疗后7天 选择1470nm激光前列腺剜除术,剜除时间不到1小时,手术后无不适,恢复顺利。术后7天拔出尿管,排尿通畅,最大尿流率达34ml/s
治疗前 老年男性,术前尿潴留,残余尿700ml左右,长期导尿,核磁共振示前列腺增生,中叶凸出明显,超声示前列腺大小为69*51*51mm 治疗中 手术中发现前列腺三叶增生,中叶凸出明显,3个视野,双输尿管口因中叶阻挡不可见,行1470激光前列腺整叶剜除术,术毕见双输尿管口清晰,无损伤,尿管引流通畅,尿液清,白色 治疗后 治疗后7天 拔尿管,病人即刻排尿通畅,尿线粗,色清,无尿不净,最大尿流率达22.6ml/s
治疗前男性儿童,外院X线、CT示左输尿管下段结石,直径约1厘米左右,并左肾积水。治疗后治疗后1天经完善术前准备,择期行输尿管镜激光碎石,手术时间30分钟,术后患儿无不适。复查X线,结石完全消失,患儿出院。