微创经皮肾镜联合输尿管软镜碎石术治疗孤立肾鹿角形结石的临床研究

目的:探讨微创经皮肾镜取石术(MPCNL)联合输尿管软镜碎石术(FURSL)治疗孤立肾鹿角形结石的临床疗效,并对该方法的安全性、高效性及可行性进行评估。方法:研究纳入孤立肾鹿角形结石患者20例,对结石的位置和表面积进行统计。患者在知情同意后,先对其进行第一阶段的MPCNL治疗。术后5~7天,将第二阶段的MPCNL和FURSL相结合进行治疗。并对术中情况、结石清除率(SFR)和术后并发症进行评估,测量并记录患者术前、术后1个月以及每次复查时的血肌酐(Scr)、肾小球滤过率(GFR)和慢性肾脏疾病分级(CKD)。结果:所有患者均存在多个肾盏的鹿角形结石,结石平均大小为(1 099.9±843.95)mm2。所有患者均只有一处经皮入路,平均手术时间为(154.37±32.45)min,平均失血量为64(12~140)ml,最终SFR为90%。随访1个月,4例患者的CKD情况有所改善,2例CKD为5级的患者术后仍然需要透析,其余患者术前平均Scr为(187.16±94.12)μmol/L,术后1个月为(140.99±57.92)μmol/L,差异具有统计学意义(P=0.019)。GFR术前为(43.80±24.74)ml/min,术后随访1个月末为(49.55±21.18)ml/min,差异具有统计学意义(P≤0.05)。结论:MPCNL和FURSL联合治疗孤立肾鹿角形结石,可以有效地减少经皮入口的大小和数量,使得孤立肾结石患者的治疗更安全、可行且高效,进而得到满意的SFR,减少失血量及多入口相关的潜在并发症。在短期及长期愈后方面,该方法均不会对肾功能产生不利影响。

Clinical research of mini-percutaneous nephrolithotomy combined with flexible ureteroscopic lithotripsy for staghorn calculi in patients with solitary kidney

Objective：To investigate the clinical effects of mini-percutaneous nephrolithotomy（MPCNL）combined with flexible ureteroscopic lithotripsy（FURSL）to manage patients with staghorn calculi in solitary kidney,and to evaluate the safety,efficiency and feasibility of this approach.Method：The study included 20 patients with staghorn calculi in solitary kidney.Demographic characteristics,stone location and surface area were recorded.After informed consent,the patients underwent one stage MPCNL firstly.Combination of second stage MPCNL and FURSL simultaneously were performed at postoperative 5-7 days.Operative parameters,stone-free rate（SFR）,stone analyses and complications were evaluated.Serum creatinine（Scr）,glomerular filtration rate（GFR）and chronic kidney disease（CKD）were measured preoperatively,one month postoperatively,and at each follow-up visit.Result：All patients had staghorn stones involving multiple calyces.The mean stone burden was（1099.9±843.95）mm2.All patients had only one percutaneous access tract.The mean whole operative duration was（154.37±32.45）min.The mean blood loss was 64（range,12-140）ml.The final SFR was 90%.During the one-month follow-up study period,four patients improved in CKD stage.Two patients who had CKD（stage5）still needed dialysis postoperatively.Preoperative mean Scr of the rest patients was（187.16±94.12）,compared with（140.99±57.92）μmol/L by the end of one-month follow-up period there existed a significant difference（P=0.019）.The same findings were observed in GFR：preoperative result was（43.80±24.74）ml/min and by the end of the one-month follow-up was（49.55±21.18）ml/min（P≤0.05）.Conclusion：Combining MPCNL and FURSL effectively decrease the number and size of percutaneous access tracts,which is safe,feasible,and efficient for staghorn calculi in solitary kidney with satisfactory SFR and little blood loss,decreased potential morbidity associated with multiple tracts.