儿童ESWL前放置双J型支架对并发症和结石清除率的影响。

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2025-03-08 DOI:10.1016/j.jpedsurg.2025.162274

Efe Bosnali , Nazim Mutlu , Kutlucan Cakmak , Enes Malik Akdas , Engin Telli , Abdullah Enes Baynal , Muhlis Unal , Hakkıcan Yuvak , Kerem Teke , Onder Kara

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引用次数: 0

摘要

背景：儿童尿石症在世界某些地区仍然是一个重要的健康问题。体外冲击波碎石术（ESWL）是治疗小于20mm的儿童上尿路结石的首选方法。然而，双J支架术（DJS）在儿童ESWL患者中的应用仍有争议。本研究旨在评估ESWL前放置dj对儿童并发症和无结石率（SFRs）的影响。目的：探讨eswl前双J型支架（DJS）应用对儿童年龄段结石释放及并发症的影响。研究设计：这项回顾性研究纳入了2006年至2024年间在Kocaeli大学接受ESWL治疗的268名儿科患者（≤18岁）的277个肾单位。患者分为两组：（DJS+）和（DJS-）预eswl支架置入组。采用单变量分析比较两组间的人口学和临床数据，包括结局和并发症。采用Clavien-Dindo分级系统评价ESWL术后并发症。采用多因素logistic回归分析确定影响SS形成风险的因素。结果：共有277个肾单位纳入研究：33个（13.1%）植入eswl前DJ支架，244个（86.9%）未植入支架。男性150例（54.1%），平均年龄（7.32±4.8）岁。平均结石大小为9.7±3.3 mm。DJS +组（33 RUs）和DJS-组（244 RUs）在SFR （60.6% vs. 68.4%, p = 0.36）和并发症发生率（15.2% vs. 14.3%, p = 0.79）方面无显著差异。ESWL术后出现并发症40例（14.4%）。在这些并发症中，24例（8.7%）为严重并发症（Clavien 3级），16例（5.8%）为轻微并发症（Clavien 1-2级）。此外，dj的放置并没有降低steinstrasse （SS）形成的风险（p = 0.97）。多元logistic回归发现结石大小是SS形成的唯一独立预测因子（OR: 1.13, 95% CI: 1.01-1.26, p = 0.02）。讨论：与成人研究不同，报道eswl前输尿管支架置入术对儿童影响的研究是有限的。据我们所知，本研究是文献中评估ESWL前输尿管支架使用对儿童人群ESWL治疗尿石症成功和并发症影响的患者最多的研究。此外，我们的研究结果可能有助于文献，因为研究输尿管支架在ESWL前对儿科年龄组的影响的研究数量有限，而且样本量小。结论：本研究显示，在儿童年龄组应用ESWL前DJS并没有增加ESWL成功率，对ESWL后并发症没有影响，也没有阻止steinstrasse的发展。

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Effects of Double J Stent (DJS) Placement Before Pediatric ESWL on Complications and Stone-free Rates

Background

Pediatric urolithiasis remains a significant health problem in certain regions worldwide. Extracorporeal shock wave lithotripsy (ESWL) is the preferred treatment for upper urinary tract stones smaller than 20 mm in children due to its ease of application and efficacy. However, the utility of double J stenting (DJS) before ESWL in pediatric patients is still debatable. This study aims to evaluate the impact of DJS placement prior to ESWL on children's complication and stone-free rates (SFRs).

Objectives

To determine the effect of pre-ESWL double J stent (DJS) application on stone-freeness and complications in the pediatric age group.

Study design

This retrospective study included 277 renal units from 268 pediatric patients (≤18 years) treated with ESWL at Kocaeli University between 2006 and 2024. Patients were divided into two groups: those with (DJS+) and without (DJS–) pre-ESWL stenting. Demographic and clinical data, including outcomes and complications, were compared between the groups using univariate analyses. The Clavien-Dindo grading system was used to evaluate complications after ESWL. Multiple logistic regression analysis was performed to determine the factors affecting the risk of steinstrasse (SS) formation.

Results

A total of 277 renal units were included in the study: 33 (13.1 %) with pre-ESWL DJ stents and 244 (86.9 %) without stents. 150 (54.1 %) of the patients were male, and the mean age was 7.32 ± 4.8. The mean stone size was 9.7 ± 3.3 mm. The DJS + group (33 RUs) and DJS– group (244 RUs) showed no significant difference in SFR (60.6 % vs. 68.4 %, p = 0.36) and complication rates (15.2 % vs. 14.3 %, p = 0.79). A total of 40 (14.4 %) cases had complications following ESWL. Of these complications, 24 (8.7 %) were major (Clavien Grade 3) and 16 (5.8 %) were minor (Clavien Grade 1–2). In addition, DJS placement did not reduce the risk of steinstrasse (SS) formation (p = 0.97). Multiple logistic regression identified stone size as the only independent predictor of SS formation (OR: 1.13, 95 % CI: 1.01–1.26, p = 0.02).

Discussion

Unlike adult studies, studies reporting the effects of pre-ESWL ureteral stent placement in children are limited. To our knowledge, the present study has the highest number of patients in the literature evaluating the effects of pre-ESWL ureteral stent use on success and complications in treating urolithiasis with ESWL in the pediatric population. In addition, the findings of our study may contribute to the literature due to the limited number of studies investigating the effect of ureteral stents before ESWL in the pediatric age group and their small sample size.

Conclusions

This study showed that pre-ESWL DJS application in the pediatric age group did not increase ESWL success, had no effect on post-ESWL complications and did not prevent the development of steinstrasse.

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.