微创经皮肾镜取石术治疗异常肾肾结石

目的探讨微创经皮肾镜取石术（minimally invasive percutaneous nephrolithotomy，mPCNL）治疗异常肾肾结石的疗效与安全性。方法异常。肾肾结石患者共41例，其中马蹄。肾23例，解剖性孤立肾9例（其中合并脓肾、双J管遗留并巨大结石1例），功能性孤立肾7例，重复肾畸形并上肾结石2例。均采用实时B超引导mPCNL治疗。结果共进行49次mPCNL，均为单通道取石。除1例脓肾患者先穿刺引流后择期手术，其余均一期建立通道。手术时间70～105min，平均（81．9±10．6）min。27例一期取石成功，首次手术净石率65．9％（27／41），8例行二期mPCNL，mPCNL净石率85．4％（35／41），6例因结石残留行ESWL。2例患者较严重感染，积极治疗后恢复；1例患者并发大出血，行介入栓塞止血。所有患者术前外周血血红蛋白浓度（106．3±4．7）g／L，术后（98．5±5．7）g／L；所有孤立肾患者术前肾功能检查肌酐浓度（103．1±9．4）μmol／L，术后（134．1±11．5）μmol／L，手术前后比较，差异无统计学意义（P〉0．05）。本组患者未出现结肠、胸膜等周围脏器损伤等。结论mPCNL是治疗异常肾肾结石安全、有效的方法。

Minimally Invasive Percutaneous Nephrolithotomy (mPCNL) for Large Stones in Anomalous Kidneys

Objective To evaluate the effect and safety of minimally invasive percutaneous nephrolithotomy(mPCNL) for large calculi in anomalous kidneys.Methods A total of 41 kidney calculi patients with renal abnormalities were performed mPCNL.Of the 41 patients,23 had a horseshoe kidney,16 had a solitary kidney(9 patients were anatomical and 7 patients were functional),and 2 had a duplex kidney.Results 49 times mPCNL were performed with single channel.40 cases were reconstructed the channel on stage I except one pyon...