微创经皮肾镜取石术治疗孤立肾肾结石

目的探讨F14～F16MPCNL治疗孤立肾肾结石的疗效与技巧。方法总结2003年1月-2007年12月间利用MPCNL技术治疗孤立肾肾结石32例,其中9例先行经皮肾穿刺造瘘术,7d～10d后行Ⅱ期经皮肾镜气压弹道碎石、取石术,其余23例患者均行经皮肾镜气压弹道碎石、取石术。28例采用单通道取石,4例采用双通道取石。结果术后肾功能基本恢复正常或明显好转。结石清除26例（81.25%）;6例结石残留的患者中,有2例残留结石移行至输尿管上段给予ESWL治疗,结石顺利排出。另有1例残留结石下移至输尿管下段,用输尿管镜将结石取出。1例孤肾肾结石合并尿路感染,行Ⅰ期取石,术后出现中毒性休克;其余患者术后未出现严重的并发症。结论MPCNL疗效肯定,具有安全、实用、损伤小、并发症少、恢复快等优点。MPCNL在处理孤立肾肾结石并发梗阻性肾衰中,可作为首选治疗方法。

Treatment of solitary kidney calculus with minimally invasive percutaneous nephrolithotomy

Objective To assess the efficacy and technique of minimally invasive percutaneous nephrolithotomy (MPCNL) in treating solitary kidney calculus.Methods Thirty-two patients with solitary kidney calculus, treated with MPCNL from Jan 2003 to Dec 2007,were retrospectively investigated, nine of them were performed percutaneous nephrostomy first, then performed secondary pneumatic lithotripsy after 7-10 days. one-stage pneumatic lithotripsy was in all the other twenty-three cases.Single tract was in twenty-eight cases, double channel was in four cases. Results The renal function recovered to the normal level or got significantly better after operation. the stone-free rate was 81.25%, Of six cases residual stones patients, two cases with residual stones down to upper ureter, the calculi excretion smoothly after ESWL.one case with residual stones down to lower ureter, removal the calculi by ureteroscope. Only one case with urinary tract infection suffered from postoperative infect shock while one - stage MPCNL, the rest patients have no severe complications occurred after MPCNL.Conclusion MPCNL was effective,it had the advantage of safe and practical,less damage, rapid recovery and less complication. MPCNL could be used as the first choice for the treatment of solitary kidney calculus complicated with obstructive renal failure.