微创经皮肾镜术治疗孤立肾结石22例的临床分析

目的探讨微创经皮肾通道输尿管硬镜下取石术（MPCNL）治疗孤立肾肾结石的临床疗效与手术技巧。方法利用MPCNL技术治疗孤立肾肾结石22例,其中9例先行经皮肾穿刺造瘘术,7～10d后行二期经皮肾镜气压弹道碎石、取石术,其余13例患者均行一期经皮肾镜气压弹道碎石、取石术。18例采用单通道取石,4例采用2通道取石。结果结石清除17例（77.27%）。在结石残留的5例患者中,2例残留结石移行至输尿管上段给予ESWL治疗,结石顺利排出;1例残留结石下移至输尿管下段,用输尿管镜将结石取出;余2例结石残留肾内,未作进一步处理,定期观察。本组患者术后肾功能基本恢复正常或明显好转,手术效果良好,除1例孤立肾结石合并尿路感染,一期取石术后出现中毒性休克,其余患者术后未出现严重的并发症。结论MPCNL疗效肯定,具有安全、实用、损伤小、并发症少,恢复快等优点。MPCNL在处理孤立肾结石并发梗阻性肾衰中,可作为首选治疗方法。

Clinical analysis of 22 cases of solitary kidney calculi with minimally invasive percutaneous nephrolithotomy

Objective To study the efficacy and technique of minimally invasive percutaneous nephrolithotomy（MPCNL） in treating solitary kidney calculi. Methods Twenty-two patients with solitary kidney calculi, treated with MPCNL, nine of them were performed percutaneous nephrostomy first, then performed secondary pneumatic lithotripsy under percutaneous nephroscope after 7 ~ 10 days. one-stage pneumatic lithotripsy was in all the other thirteen cases. Single tract was in eighteen cases, double channel was in four cases. Results The stone clearance patients were 17 cases （77.27%）. Of five cases residual stones patients, two cases with residual stones down to upper ureter, the calculi excretion smoothly after ESWL, one case with residual stones down to lower ureter, removal the calculi by ureteroscope. The reste two cases residual stones in renal, untreated more and treated with conservatived. The renal function in the group recovered to the normal level or got significantly better after operation. Only one case with urinary tract infection suffered from postoperative infect shock while onestage MPCNL, the rest patients have no severe complications occurred after MPCNL. Conclusion MPCNL is effective, it has the advantage of safe and practical, less damage, rapid recovery and less complication. MPCNL can be used as the first choice for the treatment of solitary kidney calculi complicated with obstructive renal failure.