微创经皮肾镜取石术治疗先天性多囊肾结石

【目的】探讨微创经皮肾镜取石术（mPCNL）治疗先天性多囊肾结石的操作技巧及临床应用价值。【方法】多囊肾结石患者21例，均由肾输尿管与膀胱平片（KUB）加经静脉尿路造影（IVU）及CT确诊。单发肾盂结石13例，多发、复杂结石8例（其中鹿角形结石6例）。采用蛛网膜下腔、硬膜外联合阻滞麻醉应用m-PCNI．术治疗，输尿管硬镜下钬激光碎石。【结果】21例均经一次穿刺成功建立通道，平均手术时间80（40～150）min。术中平均出血20（5～40）mL，均未输血。结石一期取净17例（80．1％），3例经二期取净，1例有0．3cm×0．4cm残石。随访6～24个月，20例结石取净者未见结石复发，1例残石患者结石体积无明显变化。【结论】m—PCNL治疗多囊肾结石效果明显、操作安全、创伤较小，术后并发症少。

Minimally Percutaneous Nephrolithotomy for the Treatment of Congenital Polycystic Kidney Calculi

Objective] To explore the procedure technique and value of minimally percutaneous nephro lithotomy （m PCNL） for the treatment of congenital polycystic kidney calculi. Methods] Twenty one patients with polycystic kidney calculi were diagnosed by KUB, IVU and CT. Among all cases, 13 cases were single pelvis calculi and 8 were complex calculi which included 6 cases of staghom stone. No stricture was found in pelvis and ureter. Lumbar anesthesia combining epidural block anesthesia was applied for m PCNL. With the guidance of B ultrasound, renal calices were punctured and safety guide wire was inserted. Fascial dilator was expanded to 18F by turns and pushed into Peel away sheath. Holmium laser lithotripsy was performed under ureteroscope. Results]All the 21 cases were punctured and the passage was established successfully. The operative time ranged from 40 to 150min（mean 80min）. Bleeding volume ranged from 5 to 40ml（mean 20ml） and no case needed for blood transfusion. The stone free rate was 80.1% （17/21） at one stage and the stones of 3 cases were free at second stage. Only one case had residual stone with 3cm 〉（0.4 cm. All the cases were lot lowed up for 6 to 24 months. Twenty cases had no recurrence. One case with residual stone had no obvious change of stone. Conclusion] The m-PCNL for the treatment of polycystic kidney calculi is effective and safe, and has less trauma and postoperative complication.