超声引导经皮肾镜治疗肾脏鹿角状结石

目的探讨超声引导、超声气压弹道碎石经皮肾镜治疗肾脏鹿角状结石的可行性、临床疗效及临床经验。 方法2006年1月至2015年1月北京大学人民医院泌尿外科采用超声引导经皮肾镜、超声气压弹道碎石共治疗完全鹿角状结石患者128例，共142个肾脏鹿角状结石，结石体积：3~179 ml。其中双侧鹿角状结石14例，孤立肾或功能性孤立肾伴鹿角状结石13例，合并肾功能不全22例，合并肾积脓25例，合并脊柱畸形4例。 结果128例患者142个肾脏鹿角状结石手术均获成功，手术时间30~150 min，平均（64.5±39.1）min；一次手术净石率76.8%（109/142），63.4%（90/142）的肾脏为Ⅰ期单通道，17.6%（25/142）的肾脏为Ⅰ期双通道；16.9%（24/142）的肾脏为Ⅱ期3通道，2.1%（3/142）的肾脏为Ⅲ期4~5通道，9例患者术后行体外冲击波碎石辅助治疗，1个月后净石率为85.2%（121/142）。6例患者（4.2%）术后输血，3例患者（2.1%）行选择性肾动脉栓塞。3例患者（2.1%）出现感染中毒性休克，经抗休克、加强抗炎治疗后好转。3例患者（2.1%）出现一过性肾功能减退，均为孤立肾Ⅰ期双通道取石术后；无一例发生其他严重并发症。 结论超声引导、超声气压弹道碎石经皮肾镜治疗肾脏鹿角状结石安全、有效。

Ultrasound-guided percutaneous nephrolithotomy for management of renal complete staghorn stones

ObjectiveTo assess the safety and efficacy of ultrasound-guided percutaneous nephrolithotomy (PCNL) with ultrasonic and pneumatic lithotripters for complete renal staghorn stones. MethodsFrom January 2006 to January 2015, 128 patients (142 kidneys) with complete staghorn stones underwent PCNL, included 14 patients with bilateral renal complete stones, 13 patients with solitary or founctional solitary kidney, 22 patients with renal insufficiency, 25 patients with renal empyema, 4 patients with spine malformation, ultrasound-guided PCNL were performed. Stones were fragmented and cleared using a combination of ultrasonic and pneumatic lithotripters. ResultsAll PCNL procedures were successful. Successful access to the collecting system was 100%. Mean operation time was (64.5±39.1) minutes (range 30-150 minutes). The primary stone-free rate of PCNL was 76.8% (109/142). Most of the renal stones (63.4%, 90/142) were managed satisfactorily by a single tract, a second tract was used in 25 renal stones (17.6%, 25/142). There were 36 auxiliary procedures (24 second PCNL and 3 third PCNL and 9 extracorporeal shock wave lithotripsy). One month after treatment, the overall stone-free rate was 85.2% (121/142). Six patients (4.2%) received blood transfusion, three patients (2.1%) received angiography and embolization. Three patients (2.1%) with septic shock were cured by intravenous antibiotics and antishock treatments. Three patients with temporary renal function receded were observed in solitary kidney for two tracts PCNL. No other severe complications occurred. The mean postoperative stay was 5.2 days (range 2-12 days). ConclusionUltrasound-guided PCNL with ultrasonic and pneumatic lithotripters for management of renal complete staghorn stones is safe and effective.