中文摘要：

目的：分析B超定位引导穿刺的微通道经皮肾镜取石术（U-mPCNL）治疗幼儿双侧上尿路结石的临床安全及疗效。方法：回顾性分析2009年1月~2017年3月采用U-mPCNL治疗的17例双侧上尿路结石患儿（〈5岁）的临床资料,记录微通道碎石取石手术时间、净石率、术前术后血红蛋白变化、术后感染、术后平均住院时间。双侧单纯肾盂结石4例;双侧肾盂结石合并肾盏结石5例,双侧输尿管上段结石5例,一侧肾结石对侧输尿管上段结石3例。双侧结石平均大小（14.1±5.2）mm。结果：Ⅰ期双侧微通道取石6例;Ⅰ期双侧肾造瘘或放置双J管Ⅱ期微通道取石11例;微通道取石手术时间（65.8±7.4）min,血红蛋白平均下降值（7.72±1.53）g/L,红细胞压积平均下降（3.24±0.57）%。平均住院时间9.5d,术后23.5%（4/17例）发热（≥38.5℃）,无输血病例,无感染休克病例,无邻近脏器损伤病例。结石清除率88%（15/17）,术后1个月结石清除率100%。结论：U-mPCNL可以作为治疗〈5岁幼儿双侧上尿路结石的一种临床选择,特别是双侧上尿路结石伴有梗阻、无尿、发热的患儿,Ⅰ期肾造瘘或留置双J管引流便于控制感染,恢复肾功能,防治并发症发生,在确保患儿安全的情况下可以减少患儿手术次数。

英文摘要：

Objective：To assess the efficacy and safety of minimally invasive percutaneous nephrolithotomy guilded by doppler ultrasound（U-mPCNL）in treating the bilateral upper urinary stones.Method：From January2009 to March 2017,17 patients under five years old with bilateral upper urinary stones treated with U-mPCNL were retrospectively analysed.The surgery time,stone free rate,hemoglobin drops,postoperative infection and hospital stay were recorded.Four cases were bilateral renal pelvic stones,five cases were bilateral renal pelvic and calyx stones,five cases were bilateral upper ureteral stones,three cases have the kidney stone on one side and ureteral stones on another side.Among the 17 cases,the average stones size was（14.1±5.2）mm.Result：Of the 17 patients,a successful stone removal on one session was achieved in six patients.A second-look stone removal after first placement of nephrostomy tubes or double-J stents was achieved in 11 patients.The mean operating time was（65.8±7.4）min,the mean hemoglobin drops was（7.72±1.53）g/L,the mean hematocrit drop was（3.24±0.57）%,the mean hospital stay was 9.5days.Four of the patients（23.5%）had postoperative fever.There were no septic shock,no hydrothorax or blood transfusion.The average stone free rate was 88%（15/17）,and stone free rate in one month was 100%.Conclusion：U-mPCNL is an effective and safe option in treating children under five years old with the bilateral upper urinary stones,especially for those combined with obstruction,anuria or fever.In order to control infection,rescue the renal function and prevent the postoperative complication,a secondlook stone removal after first placement of the nephrostomy tubes or double-J stent is needed,which can make sure the safety of the children and reduce the number of operations.