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目的:探讨输尿管软镜碎石术(flexible ureteroscopic lithotripsy,FURL)治疗小儿上尿路结石的疗效和安全性。方法:回顾性分析2014年1月~2015年10月应用FURL术治疗的66例上尿路结石患儿的临床资料:年龄5个月~14岁,平均(4.22±3.84)岁。其中多发性结石52例,单发结石14例;结石位于肾上盏6例,中盏7例,下盏8例,肾盂33例,输尿管上段12例;结石最大径平均(13.6±7.3)(6~25)mm。17例因输尿管中下段结石先采用辅助硬镜碎石,随后使用FURL处理。结果:66例FURL均获得成功,手术时间(35.05±23.25)(6~90)min。术后1个月结石清除率(stone free rate,SFR)为78.78%(53/66),术后3个月SFR为86.36%(57/66);5例需要二期处理(1例SMP,4例输尿管镜下碎石),最终SFR为93.93%(62/66)。术后发热38.5℃以上者9例,经常规处理后恢复正常,无其他严重并发症发生。结论:FURL治疗小儿上尿路结石具有创伤小、安全、有效、恢复快、住院时间短等特点,甚至适用于肾下盏结石,值得在临床上进一步应用和推广。
Objective: To investigate the efficacy and safety of flexible ureteroscopic lithotripsy (FURL) in children with upper urinary tract calculi. Methods: The clinical data of 66 patients with upper urinary tract calculi treated with FURL from January 2014 to October 2015 were retrospectively analyzed. The patients were from 5 months to 14 years old (average 4.22 ± 3.84 years). There were 52 cases of multiple stones and 14 cases of solitary calculus. The stones were located in 6 cases of upper adrenal calculus, 7 cases of middle calyx, 8 cases of lower calyces, 33 cases of renal pelvis, 12 cases of upper ureter, 13.6 ± 7.3 (13.6 ± 7.3) 6 ~ 25) mm. 17 cases of stones in the lower ureter with the first use of auxiliary lithotripsy, followed by FURL treatment. Results: 66 cases of FURL were successful, the operation time (35.05 ± 23.25) (6 ~ 90) min. The stone free rate (SFR) at 1 month after operation was 78.78% (53/66), and the SFR at 3 months after operation was 86.36% (57/66). Five patients needed second phase treatment (SMP, 4 cases of ureteroscopic lithotripsy), the final SFR was 93.93% (62/66). Postoperative fever over 38.5 ℃ in 9 cases, routine treatment returned to normal, no other serious complications. Conclusion: FURL treatment of upper urinary tract stones in children with trauma, safe, effective, fast recovery, shorter hospital stay and other characteristics, and even suitable for lower calyceal stones, it is worth further clinical application and promotion.