微创经皮肾取石术联合体外震波碎石治疗肾鹿角状结石

目的探讨微创经皮肾取石术(minimally invasive percutaneous nephrolithotomy,MPCNL)联合体外震波碎石(extracoporeal shock wave lithotripsy,ESWL)治疗肾鹿角状结石的临床疗效。方法 2005年1月~2009年1月,采用MPCNL联合ESWL治疗30例肾鹿角状结石,术中采用钬激光碎石,平均功率45 W,术后ESWL单次冲击次数200~1200次。结果 30例采用单通道取石。手术时间42~180 min,平均72 min。未出现出血、气胸、肠道损伤等手术并发症。ESWL后复查KUB平片,27例结石清除;3例结石残留(结石长径0.7~1.0 cm,平均0.8 cm)口服药物及观察治疗,其中2例结石排除干净,1例结石长径约0.6 cm残留在肾脏,未引起肾脏积水。27例术后随诊3个月复查KUB和IVU无异常。结论 MPCNL联合ESWL治疗较大肾鹿角状结石具有高效、安全的特点,值得临床推广应用。

Second Treatment of Renal Staghorn Calculus by Minimally Invasive Percutaneous Nephrolithotomy Combined with ESWL

Objective To evaluate the efficacy of second treatment for renal staghorn calculus by minimally invasive percutaneous nephrolithotomy（MPCNL） combined with ESWL. Methods From January 2005 to January 2009,30 patients with renal staghorn calculus underwent a second treatment by MPCNL combined with ESWL.Holmium laser at 45 W was used during the MPCNL. Results Single canal was employed in the 30 patients.The mean operation time of this series was 72 minutes（42-180 minutes）.No hemorrhage,pneumothorax,or injury to the intestine occurred.Postoperative KUB showed that the calculi were completely removed in 27 patients,and the other 3 showed residual stones（0.7-1.0 cm in length,mean,0.8 cm） and thus received conservative therapy,which cured two patients,the other one still had residual stone（0.6 cm） after the operation without leading to hydronephrosis.The 27 cases were followed up for 3 months with KUB and IVU,both of which showed normal results. ConclusionPCNL combined with ESWL is effective and safe for large renal staghorn calculus.