The incidence of urinary stones in children is increasing. If adult treatment technology is applied directly to children, it is necessary to consider the unique anatomy and physiological differences of patients with stones in children.Essence
Writing 丨 Huang Siyu
Responsible editor 丨 Wenhui
Like more and more children, 6 -year -old Xiaomin is being plagued by urinary system stones.
This year, he found that the kidneys and bladder were covered with stones. The local hospital had cut the bladder to take stones for him, but for the stones in the kidneys, the doctor said that due to technical restrictions,They are powerless.
If the kidney stones are not taken out as soon as possible, once the obstruction and infection are caused, Xiaomin may eventually develop into renal failure.After referring to the Childrens Hospital of Zhejiang University Medical College (hereinafter referred to as "Zhejiang University Childrens Hospital"), Yan Xiang, director of urology, did a "first case" surgery for him -the worlds thinner electronic ureteral soft mirror (FR6.3) For the first time, it is applied to childrens stone.
Yan Xiang told the "medical community" that the incidence of urinary stones in children is rising.Start with the doll. "
Behind surgical technology innovation, it also highlights the current treatment dilemma of childrens urinary stones: Although the method and intervention technology of childrens stones disease are similar to adults, they are similar to adults, but they are similar to adults, but they are similar to adults, but they are similar to adults, but they are similar to adults, but they are similar to adults, but they are similar to adults, but they are similar to adults, but they are similar to adults, but they are similar to adults, but they are similar to adults, but they are similar to adults, but they are similar to adults.Applying adult technology directly to children, sometimes it is necessary to consider the unique anatomy and physiological differences between patients with stones in children. The operation is more difficult than adults.
Director Yan Xiang (right) The pictures of this article are all provided by Zhejiang University Palace
High treatment for children with urinary stonesA few months ago, Xiaomin appeared hematuria. After examination, there were stones in the bladder and kidneys.The results of genetic testing show that Xiaomin suffers from primary alpine urine.In general, he lacks a special enzyme in his body, resulting in a large amount of oxalic acid accumulation to form stones.
Primary hyper -hydrogenuuria 3 is an extremely rare genetic disease, with only about 3 of each 1 million children.In front of Zhejiang University Hospital, Xiaomin cut the bladder to take stones at the local hospital.For stones in the kidneys, local doctors evaluated that all three commonly used stones and rock removal methods were not applicable.
For urinary stones, the three commonly used treatment commonly used in clinical clinical is in vitro shock wave gravel, leather renal mirrors, and ureteral soft mirrors.Among them, the in vitro shock wavestone is to break the stones with the help of ultrasonic waves. Patients discharge stones through urine after surgery, but this plan is first excluded.
"The stones caused by primary hyperexic urine are harder, and they are more and scattered in distribution. The patients are too young.The doctor completed the operation. "Yan Xiang said.
Check the image display, the stones in Xiaomins kidneys are widely distributed.If the kidneys are compared to a house, Xiaomins kidney stones are scattered in more than a dozen rooms.If you adopt a meridian renal mirror, you need to puncture more than ten times on your childs waist.
After excluding the first two treatment methods, only the ureteral soft mirror is left.Yan Xiang explained: "This is to extend the endoscopy from the urethral opening into the kidneys, and enter each room to take stones, which is suitable for scattered and more kidney stones."Essence
During the treatment of local hospitals, the doctor also considered this method, but the commonly used ureteral soft mirror is too thick. If you want to use it on children, you must first plant it in the urethra of the child.The expander is maintained for two weeks, and the surgery can be surgery after the urethra is fully expanded.
Considering that the ureter of the young children is more thinner, the ureter is difficult to place the ureter to transport the sheath during the operation. After the soft mirror enters the ureterExtraction and infection of irrigation fluid appear.Especially when the kidney conditions are not good, the ureteral soft mirrors can be forced to tear, perforation, and postoperative narrowing.
This requires ultra -fine ureteral soft mirrors to successfully enter the childs ureter.
A few months ago, Yan Xiang learned during the exchange with his peers that some domestic companies have developed the worlds finest FR6.3 (about 2.1mm in diameter) ultra -fine ureteral electronic e -electronicsA mirror has completed a stone retrieval surgery in adult patients abroad.He immediately contacted the other party and introduced the ureteral soft mirror to Zhejiang University.Xiaomins parents also went to Zhejiang University Hospital after being introduced by other doctors, hoping to try to use this ultra -fine ureteral soft mirror to take stone.
In the end, the surgery was successfully completed. Yan Xiang took out three "peas" stones from the childs kidneys, and dense tiny stones.
Director Yan Xiang (left) Visiting Xiaomin
Be alert to childrens urinary stonesTrends of the incidence
Although the operation is successful, Yan Xiang said that Xiaomin may have to undergo multiple gravel and stone take surgery in the future.Multi -subject rooms such as liver surgery, kidney, and nutritional department formulate more comprehensive treatment plans.
He told the "medical industry" that patients with primary hyper -oleology need to take long -term medication to reduce oxalic acid synthesis or remove oxalate through hemodialysis, but these methods cannot completely suppress grass completelyFor acid stones, the recurrence rate of the disease is close to 100%. Therefore, diagnosis and metabolic assessment are critical. Comprehensive metabolic assessment needs to be performed to determine the potential disease of childrens vulnerable stones.
In these years, the incidence of urine disease in children has become an upward trend globally.A crowd-based research estimated by the United States estimates that from 2005 to 2016, about 65 of each 100,000 children per year occurred with urinary system stones, which was significantly increased compared to 1999.
Compared with it, a Chinese population study involving 14,256 asymptomatic children shows that the prevalence of urine is 0.53%.
"The cause of childrens urinary stones is more complicated than adults." Yan Xiang introduced that adult urinary stones are usually caused by external reasons such as improper diet., Dehydration, environmental conditions, and other causes, you must also clarify whether there are internal causes such as genetic metabolic diseases, because genetic factors may cause metabolic abnormalities and increase the possibility of children with urinary stones.
For children with urinary system stones, about 15%to 25%of children have no symptoms, and stones are usually discovered accidentally during other image inspections.In children with symptoms, pain is the most common. Other symptoms include slow development, hematuria visible to the naked eye, and repeated urinary tract infections.
Yan Xiang reminded that early diagnosis of children with urinary system stones is very important.Taking Xiaomin as an example, although such patients are facing a higher risk of urinary stones for life, if they can be diagnosed as soon as possible, and adjustment of diet and lifestyle can effectively reduce the risk of stones recurrence, and reduce the acceptance of stones.Number of stone take surgery.
In order to allow children with urinary stones to get more standardized diagnosis and treatment, Yan Xiang, who had originally worked at the urology at the adult triple comprehensive hospital, was invited to join the Zhejiang University Hospital.
In 2020, he established the first domestic urinary stones center in Zhejiang Universitys childrens hospital to bring together multi -disciplinary forces in the hospital to participate in childrens urinary metropolitics diagnosis and treatment.In 2023, the East China Stone Alliance was approved to establish an East China Childrens Nourion Diagnosis and Treatment Base. As a national regional medical center, a child with complex suspicion stones from all over the country.
The minimum urinary stones that have been visited by the center are only more than a month.For children who are young, Yan Xiang does not recommend surgery immediately. Instead, it is recommended to perform physical stones through stones and light shooting. At the same time, actively investigate the incentives of stones and correct bad feeding methods.Fortunately, the children were smoothly discharged from the stones after physical treatment, and they were continuously observing and follow -up.
"As the lifestyle changes, the incidence of urinary stones in children is rising at a rate of about 6%per year." Yan Xiang called for "grabbing from dolls".It is important to pay attention to children and parents.When a child is a child, it is necessary to correct bad living habits, and it can also reduce the risk of urinary stones in adulthood.
Source: Medical Community
School Division: Zang Hengjia
Editor: Lili
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