| 摘要: |
| 目的：评价微通道及标准通道经皮肾镜碎石术治疗马蹄肾结石的安全性及有效性。方法：回顾性分析我院自2007年1月至2010年12月收治的马蹄肾结石患者共14例，男10例，女4例，平均年龄38岁（29~55岁）。均由B超、KUB、IVU及平扫CTU确诊。14例均为单侧，左侧9例，右侧5例，均多发结石，至少2个肾盏以上存在结石，其中鹿角形结石1例。结石长径平均4.2cm（2-6.5cm）。10例曾行体外冲击波碎石（ESWL）治疗，曾接受肾盂输尿管成形术者6例。所有病例均在B超引导下一次性穿刺建立通道，其中4例采用微通道（F18）经皮肾镜碎石术（MPNL），10例采用标准通道（F24）经皮肾镜碎石术（PCNL）治疗。结果：两组患者分别成功建立F18及F24经皮肾通道一期碎石，一期结石清除率78.6%(11/14），其中MPNL组75%（3/4），PCNL组80%（8/10），3例有残石者术后辅以ESWL治疗，结石均排净，无二期手术。单通道9例，双通道5例，通道经上盏建立9例，中盏7例，下盏3例，平均手术时间112.5±67.5min，MPNL组平均手术时间长于标准PNL组（135±45min对比102.5±75min）。而PCNL组中有3例术中出血较多(﹥500ml)给予输血。术后血红蛋白较术前平均下降3.7±1.3g/dl，MPNL组明显低于PCNL组（2.8±0.4g/dl对比4.2±0.8g/dl）。手术相关感染2例，未出现胸膜及腹腔脏器损伤。结论：微通道及标准通道经皮肾镜碎石术在治疗马蹄肾结石中各有优势，两种术式均具有较高的结石清除率，创伤小，并发症少，临床效果较好。 |
| 关键词: 经皮肾镜取石术 微通道经皮肾镜取石术 肾结石 马蹄肾 效果 |
| DOI：10.3724/SP.J.1008.2011.0683 |
| 投稿时间：2011-03-01修订日期：2011-05-13 |
| 基金项目: |
|
| Clinical analysis of mini-PNL and standard PNL for calculi within horseshoe kidney |
| Cui Xiao Lu,Liu Xian Kui |
| (The first hospital of China Medical Universuty) |
| Abstract: |
| Objectives: To evaluate the outcome of mini-PNL and standard PNL in horseshoe kidney. Methods: A total of 14 patients with horseshoe kidney were offered PCNL from January 2007 to December 2010 in our department. The male/female ratio was 2.5(10/4). The mean age was 38 years (range 29-55). All underwent color Doppler sonography, plain x-ray of kidney, ureter, and bladder, intravenous urography and CT. The left-to-right ratio was 1.8(9/5). All 14 patients had multiple stones or complex renal calculi, including 1 with staghorn stones. Mean stone size was 4.2cm(2-6.5cm). 10 patients had a history of failed extracorporeal shock wave lithotripsy. All percutaneous renal surgery was performed in one session under ultrasonography guidance. Among the treatments, 4 were mini-PNL, 10 were standard PNLs. Results: All surgery was successfully performed in one session under ultrasonography guidance by F18 tract or F24 tract. The stone-free rate after one-session operation was 78.6 %( 11/14). mini-PNL group was 75%(3/4), while PNL group was 80%(8/10). 3 cases received ESWL to remove the residual calculi, no second-session operation. 9 were performed in one tract and 5 in two tracts. 9 in upper calix, 7 in middle and 3 in lower. Mean operative time was 112.5±67.5min, mini-PNL operative time was longer than that of standard PNL (135±45min vs102.5±75min, respectively). Conversely, there was an advantage for miniperc over standard PNL in terms of a significantly reduced hematocrit drop (2.8±0.4g/dl VS 4.2±0.8g/dl, respectively). No mini-PNL patients required blood transfusions, whereas 3 did in the standard PNL group. Postoperative rate of surgery-related infection was 14.4 %( 2/14). No pleural or abdominal injury occurred. Conclusion: Both treatments have their own advantage. Mini-PNL and standard PNL are both effective and safe for calculi within horseshoe kidneys. |
| Key words: Percutaneous nephrolithotomy Mini-PNL Renal calculi Horseshoe kidney Outcomes Horseshoe kidney |
