Extracorporeal Shock Wave Lithotripsy in Children: Experience with the Multifunctional Lithotripter MFL 5000

使用MFL 5000體外震波碎石機治療小兒尿路結石之經驗

林志明(Chih-Ming Lin)

《Acta Paediatrica Sinica》 33卷5期 (1992/10) Pp. 357-362

摘要

體外震波碎石術已經證明是治療成人上尿路系統結石非常有效之方法。但是對於小兒尿路結石，尤其是下輸尿管或膀胱結石，則甚少文獻報告。
國泰綜合醫院自1989年7月至1991年6月，總共治療了1257位結石病患，其中有9位年齡小或等於18歲，因腎臟、輸尿管或膀胱結石接受共11次MFL 5000體外震波碎石機之碎石治療，其平均年齡為12歲。
在小兒腎臟結石的治療中，有特殊於成人之處。由於小孩體型小，肺部與腎臟常會同在於震波範圍內，會因肺泡內氣體與人體組織介質不同，造成肺部嚴重之傷害，導致術後咳血現象。依我們經驗：用約1公分厚度之保麗龍來局限震波範圍，可防止肺部之傷害。
在治療下輸尿管與膀胱結石時，患者採用俯臥姿勢。能避免震波由後面進入體內被骨盤腔之骨骼阻擋，而達不到治療結石之目標。
由治療小兒尿路結石之經驗得知：(1)小孩與大人一樣適用於體外震波治療。(2)幼兒需要全身麻醉，但較大小孩則可與大人相同之方法麻醉。(3)體形較小之小孩，肺部需要特別保護。(4)小兒結石擊碎後，並不因輸尿管較細，延遲排出，甚至於5毫米以下的碎片皆能自動排出。

並列摘要

Extracorporeal shock wave lithotripsy (ESWL) has been proved to be an effective method of treating upper urinary tract calculi. However, there is little experience with the use of this approach in pediatric urolithiasis, especially for lower urinary tract calculi. Nine children, aged 1-18 years, were treated here with urolithiasis in the renal pelvis, lower ureter and bladder, using Dornier MFL 5000. A polystyrene plate was used to protect small children from chest damage. Prone position was routinely used to treat lower ureteral and vesical calculi, thus avoiding bony pelvis blockage of shock wave energy. Excellent pulverization was achieved in eight cases; fragmentation in only one case, then required cystolithotripsy for bladder stone fragments three months after ESWL. No patient had melena. Neither hemoptysis nor gastrointestinal complications were seen. Extracorporeal shock wave lithotripsy is a safe and effective method of treating urinary tract calculi in children.

並列關鍵字

lithotripsy ； urolithiasis ； pediatric