微创经皮肾镜钬激光治疗孤立肾鹿角性结石疗效分析

目的报道14例孤立肾鹿角性肾结石患者行微创经皮肾镜钬激光碎石术的疗效以及安全性。方法回顾性总结、分析我院2009年1月至2012年10月应用经皮肾镜钬激光碎石术治疗孤立肾鹿角性肾结石14例的临床资料，对患者的临床资料、结石清除率、术中出血量、术后并发症、术后。肾功能等进行分析。结果13例患者一期顺利完成手术，1例行二期手术治疗，术后随访时间为（20．8±3．0）个月（12～24个月），术后一周结石清除率为：85．7％（12／14），手术时间为：（60．8±15．4）min，平均住院时间（8．2±2．6）d，患者术前、术后3个月以及术后12个月肌酐值分别为：（152．8±61．3）umol／L、（104．9±38．5）umol／L、（100．5±43．9）umol／L，术后与术前比较差异具有统计学意义（P〈0．05），术中术后并发症为：1例术中出现肾穿透伤，1例术后继发出血，1例术后出现发热。结论微创经皮肾镜钬激光碎石术治疗孤立肾鹿角性肾结石并发症的发生率低，安全、有效、可行。

Minimally invasive percutaneous nephrolithotomy for staghorn calculi in patients with solitary kidney

Objective To report our experience with minimally invasive percutaneous nephrolithotomy （mPCNL） to manage patients with staghorn calculi in solitary kidney, and evaluate the safety, efficiency and feasibility of this approach. Methods The study included 14 patients with staghorn calculi in solitary kidney underwent mPCNL in our department from January 2009 to October 2012. Demographic characteristics, operative parameters, number of tracts, stone-free rates （SFRs）, stone analyses and complications were evaluated. Serum creatinine （Scr） was measured preoperatively, postoperatively at 3 month, and each follow-up visit. Results The initial stone-free status was achieved in 12 （85.7%） patients after mPCNL. The mean follow-up time was （20.8 ± 3.0）months （range： 12 - 24）, The mean operative time were 60.8±15.4min, The mean hospitalization time were 8.2 ± 2.6 days, respectively. During preoperative period, postoperative period （3 month） and postoperative period （12 month）, Scr were 152.8 ± 61.3 umol/L, 104.9 ± 38.5 umol/L, 100.5 ± 43.9 umol/L, Ser of preoperative compared with postoperative （P 〈 0.05）. 1 case complicated with penetrating injury of kidney, 1 case complicated with postoperative rebleeding, 1 case complicated with postoperative fever. Conclusions Our experience with mPCNL mPCNL demonstrates that it is safe, feasible and efficient for managing the staghorn calculi in solitary kidney with low complication rate. ,rate long-term follow- up,renal function stabilized or even improved in the majority of patients with solitary kidney.