复杂肾结石经皮肾镜取石术后结石残留的原因与处理

目的:探讨复杂肾结石PCNL术后结石残留的原因及处理方法.方法:回顾分析我院行二期PCNL取石的35例复杂肾结石患者的临床资料,既往有开放手术史17例,2例因术中出血影响视野改二期手术,合并肾盏憩室内结石2例.结果:除2例需辅助ESWL治疗外,其余33例在B超和输尿管镜辅助下,行二期PCNL全部成功取净残留结石.其中3例因残留结石所在肾盏位置远离经皮肾通道或在与皮肾通道平行的肾盏内,重新建立另一通道取石;1例行3通道取石.结论:术中出血、肾盏憩室内结石、既往开放手术史和肾内集合系统解剖异常,是PCNL术后结石残留的主要原因;术中B超及软镜的应用,可以清楚显示有无残留结石及其所在肾盏的位置;了解结石与经皮肾通道的位置关系,帮助引导最大限度地清除结石.

Cause and countermeasure of residual stones after PCNL for complex renal calculi

Objective:To investigate the cause and countermeasure of residual stone after percutaneous nephrolithotripsy(PCNL).Methods:A total of 35 complex renal calculi patients who had undergone second nephroscopy after treating with primary PCNL were retrospectively analyzed.Of the 35 cases,17(48.6 %)patients who had previously had open nephrolithotomy,2(5.7 %)multiple renal calculi with caliceal diverticular calculi,intraoperative hemorrhage during first PCNL in 2(5.7 %).Results:Pneumatic and ultrasoud lithotripsy was performed and the residual stone were removed under the assistance of B type ultrasonograph and ureterscopy in 33 patients(Single tract procedure was performed in 29 cases,two percutaneous access tracts were used in 3,three tracts in 1),only 2 patients required ESWL after managed by second nephroscopy.Conclusions:Intraoperative hemorrhage,previous open kidney surgery history and anatomy abnormally of intra-renal collection system maybe the important reasons of residual stone after PCNL.The application of B type ultrasonography in PCNL for staghorn calculi is safe and easy to do,and can reduce effectively the incidence of residual stones.