孤立肾肾结石经皮肾镜取石术安全性分析

目的 探讨孤立肾肾结石经皮肾镜取石术(PCNL)的安全性及临床疗效.方法 孤立肾合并肾结石患者156例,其中解剖性孤立肾35例,功能性孤立肾121例(对侧肾GFR＜10ml/min).肾功能异常71例(SCr＞115,μmol/L).鹿角状结石57例,多发结石83例,单发结石16例,其中有同侧开放手术史者11例.采用实时彩色多普勒超声引导穿刺,2步法扩张建立24 F标准通道,使用弹道联合超声碎石清石系统清除结石.结果 156例均一期建立通道.采用单通道143例(91.7%),双通道9例,三通道1例;多期多通道3例.平均手术时间(46.7±11.2)min,通道建立时间(4.5±0.8)min.术后实验室检查Hb平均下降5.3 g/L.输血5例,其中4例行超选择性肾动脉介入栓塞控制出血.71例肾功能异常者中34例(47.9%)术后SCr恢复到正常范围;SCr升高13例(18.3%),平均增高3%(7.5±0.6)μmol/L].一期PCNL结石清除116例(74.4%),多期结石清除21例(13.5%).总体结石清除137例(87.8%).19例有残石者门诊行ESWL治疗或保守观察.未发生脏器损伤和感染性休克病例.结论 对于操作技术熟练的医生,功能性或解剖性孤立肾合并肾结石PCNL治疗安全、有效.

Percutaneons nephrolithotomy for calculi in solitary kidney: challenge and risk

Objective To evaluate the efficacy and safety of standard percutaneous nephrolithot- omy(PCNL)in the treatment of calculi in solitary kidney. Methods One hundred and fifty-six pa- tients of renal calculi with functional or anatomic solitary kidney had undergone PCNL accessed by two steps dilation to 24 F tract with ultrasound guidance from Aug 2003 to Oct 2008.Fifty-seven cases were with staghorn calculi，83 were with multiple calculi，16 were with single stone.There were 71 cases with abnormal renal function and 11with open nephrolithotomy history.All calculi were frag- mented and extracted by pneumatic and ultrasound lithotripter. Results The percutaneous renal ac- cess was successfully established in 1 56 patients under ultrasound guidance and immediate lithotripsy was performed.The calculi of 143(91.7％)patients were cleared by single access，9(5.8％)by double accesses，1 by triple accesses in one session and 3 by multiple accesses in multiple-session pro- cedures.The mean operating time was(46.7±11.2)min，the mean first accessing time was(4.5± 0.8)min.The stone-free rate after the first operation was 74.4％.There were 2 1 kidnevs accepted another PCNL to remove the residual calculi.The stone-free rate of this group was 87.8％.Five cases (3.2％)needed transfusion，4(2.6％)underwent hyperseleetive angioembolization for bleeding con- trol.No injury of adjacent organs or urosepsis happened.The plasma creatinine decreased after opera- tion in 81.7％of patients with pre-operative abnormal renal function.and no patient needed replace- ment therapy for deteriorated renal function. Conclusion Standard PCNL for calCUIus in solitary kidnev accessed by two steps dilation to 24 F tract with uhrasound-guided punCture is safe and effective.