微创经皮肾取石术治疗先天性异常肾合并结石

目的探讨微创经皮肾镜取石术（minimally invasive percutaneous nephrolithotomy,MPCNL）治疗先天性异常肾合并结石的疗效。方法2000年1月～2007年11月,采用MPCNL治疗异常肾合并结石41例,其中马蹄肾12例,重复肾19例,旋转肾10例。单发上盏结石4例,中盏6例,下盏7例,肾盂结石3例,重复肾上肾结石4例,多发结石12例,鹿角形结石5例。结石最大直径1.0～4.0 cm,平均2.5 cm。13例合并输尿管中上段结石同时取石。结果41例均一次穿刺成功。手术时间45～210 min,平均95 min。术中出血30～150 ml,平均80 ml。一期结石清除率85.4%（35/41）,2例马蹄肾和1例重复肾患者经二次取石取净,2例重复肾和1例旋转肾患者术后配合体外冲击波碎石治疗。1例旋转肾MPCNL术后发生较严重出血（800 ml）,经高选择性动脉栓塞后治愈,其余未见严重并发症发生。41例随访5～12个月,平均6个月,无结石复发。结论MPCNL治疗先天性异常肾合并结石安全、可靠。但仍需强调个体化的原则,根据不同异常肾的类型,结石大小、位置等情况进行操作。

Minimally Invasive Percutaneous Nephrolithotomy for Calculi in Patients with Congenital Anomalous Kidneys

Objective To assess the safety and effectiveness of minimally invasive percutaneous nephrolithotomy （MPCNL） in treating renal stones in patients with congenital anomalous kidneys. Methods From January 2000 to November 2007 a total of 41 patients with renal stones complicated with congenital anomalous kidneys, including 12 cases of horseshoe kidneys, 19 cases of duplex kidneys, and 10 cases of malrotated kidneys were treated by MPCNL in our hospital. Of the 41 patients, 4 had upper calyx calculi, 6 had middle calyx calculi, 7 had lower calyx calculi, 3 had pelvic calculi, 4 had the upper segment calculi in duplex kidney, 12 had multiple calculi, and 5 had staghorn calculi. The largest diameter of the stones ranged from 1.0 to 4.0 cm （ mean 2.5 cm）. Ureteral calculi that were found in 13 of the patients were treated at one time. Results The procedure were completed in all of the cases with the operation time ranged from 45 to 210 minutes （mean 95 minutes） , and blood loss ranged from 30 to 150 ml （mean 80 ml）. The overall stone-free rate at one session was 85.4% （35/41）. One of the duplex kidney cases and two of the horseshoe kidney cases were cured by a second operation. And two of the duplex kidney cases and one of the malrotated kidney cases were treated by ESWL after the MPCNL. One patient, who had malrotated kidney, suffered massive hemorrhage （800 ml） during the MPCNL, and was cured by selective embolization of the renal artery. No severe complications occurred in the other patients. The cases were followed up for 5 - 12 months,during the Period no patient had recurrence. Conclusions MPCNL is safe and reliable for the treatment of stones in patients with congenital anomalous kidneys. The treatment must be individualized in terms of the type of the renal abnormalities, and the size and location of the stones.