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目的评价输尿管镜取石术治疗学龄前儿童输尿管中下段结石的疗效与安全性。方法2001年2月～2006年4月,13例学龄前儿童输尿管中下段结石患儿接受不同方式输尿管镜术治疗,回顾性分析其临床资料。结果13例患儿中,1例输尿管末端结石患儿逆行人镜及置入导丝失败改开放手术,2例行Ⅰ期6.5/8.5 Fr输尿管半硬镜下钬激光碎石,2例行Ⅰ期硬性扩张后8/9.8 Fr输尿管硬镜取石,1例行Ⅰ期气囊扩张后8/9.8 Fr输尿管硬镜下取石,7例Ⅰ期输尿管置管被动扩张1～3周后,Ⅱ期8/9.8 Fr输尿管硬镜下取石。12例患儿共接受19次输尿管镜术,结石全部取出,无输尿管穿孔等严重并发症。随访3～12个月,4例(1例Ⅰ期硬性扩张,3例置管被动扩张)患儿接受排尿性膀胱造影未见膀胱输尿管反流,5例(2例Ⅰ期6.5/8.5 Fr输尿管半硬镜下钬激光碎石术,3例Ⅰ期置管被动扩张)行静脉肾盂造影未见输尿管开口狭窄及肾积水。结论输尿管镜术治疗学龄前儿童输尿管中下段结石直接明了,安全有效,作为ESWL的有益补充。
Objective To evaluate the efficacy and safety of ureteroscopic lithotripsy in the treatment of lower ureteral calculi in preschool children. Methods From February 2001 to April 2006, 13 cases of presurgical ureteral calculi in children with lower ureteral calculi underwent ureteroscopy, and the clinical data were retrospectively analyzed. Results Of the 13 children, one case of ureteral calculi underwent retrograde microsurgery and guidewire insertion failure. Two cases underwent 6.5 / 8.5 Fr ureteroscopic holmium laser lithotripsy and two cases received Ⅰ 8 / 9.8 Fr ureteroscopic rigid lithotomy, 1 case of balloon dilatation 8 / 9.8 Fr ureteroscopic lithotomy, 7 cases of stage I ureteral catheter passive expansion of 1 to 3 weeks after the second phase of 8 / 9.8 Fr ureteroscopic lithotomy. 12 cases of children received a total of 19 ureteroscopy, stone removed, no serious complications such as ureteral perforation. All cases were followed up for 3 to 12 months. No urinary vesicoureteral reflux was found in 4 cases (1 case of stage I rigid expansion and 3 cases of passive dilatation of catheter) in urinary bladder. Five cases (2 cases of stage I 6.5 / 8.5 Fr ureter Semi-rigid endoscopic holmium laser lithotripsy, 3 cases of passive placement of Ⅰ catheter) intravenous pyelography no ureteral stenosis and hydronephrosis. Conclusions Ureteroscopy is a direct, safe and effective method for the treatment of middle and lower ureteral calculi in preschool children as a beneficial supplement of ESWL.