微创经皮肾取石术治疗孤立肾铸型结石的疗效观察

目的：探讨微创经皮肾取石术（MPCNL）治疗孤立肾铸型结石的安全性及有效性。方法：回顾性分析2007年4月-2008年12月应用MPCNL治疗34例孤立肾铸型结石患者的临床资料：34例患者结石平均表面积（2314±179）mm^2，肾积脓5例。4例先行穿刺造瘘术，5～7天后行二期经皮肾镜取石术，其余患者均行一期取石术。其中单通道取石18例，双通道取石15例，三通道取石1例。结果：3例一期取石时残余小结石，结合ESWL清除小残石，结石总清除率为91．2％（31／34）。1例出现感染性休克，1例术后大出血行介入栓塞治疗，无死亡患者。术后随访4～18个月，19例肾功能不全患者中，11例肾功能恢复正常，6例肾功能有不同程度改善，2例发展为尿毒症期行血液透析，其中1例为术后大出血行介入栓塞的患者。结论：微创多通道MPCNL治疗孤立肾铸型结石安全可行，效果确切，具有创伤小、恢复快、可反复操作等优点，可作为孤立肾铸型结石的首选治疗方法。

Treatment of Solitary Kidney Staghorn Calculi with Minimally Invasive Percutaneous Nephrolithotomy

Objective：To assess the safety and feasibility of minimally invasive percutaneous nephrolithotomy （MPCNL） in the treatment of solitary kidney staghorn calculi. Methods.. From Apt 2007 to Dec 2008, 34 cases minimally invasive percutaneous nephrolithotomy （MPCNL） in the treatment of solitary kidney staghorn calculi were retrospectively investigated, the average stone area of 34 cases was（2 314±179）mm^2, 5 cases with pyonephrosis. There was 4 cases with pyonephrosis were performed percutaneous nephrostomy first, then performed secondary pneumatic lithotripsy after 5-7 days, The other 30 cases with the treatment of one stage percutaneous nephrolithotomy. Single tract was used in 18 cases, two tracts were used in 15 cases and one patient was treat with 3 tracts. Results：3 cases remained some small stones after one stage nephrolithotomy, then cleaned the those stones combined with ESWL. A total of 91.2% （31/34） stone-free rate was achieved. One case with urinary tract infection suffered from postoperative infect shock and one case post-PCNL bleeding necessitated embolization. Totally 19 cases with renal failure were followed up for 4 to 18 months, renal function of 11 cases returned to normal, renal function of 6 cases improved in some degrees, and two cases developed as uremia need hemodialysis, then one case post-PCNL bleeding necessitated embolization. Conclusions, Minimally invasive pereutaneous nephrolithotomy is safe and effective in the treatment of solitary kidney calculi and could be used as the first choice.