以肾中盏为目标肾盏行气压弹道联合超声碎石治疗鹿角形结石的效果及安全性

目的：探讨以肾中盏为目标肾盏，采用气压弹道联合超声碎石方式治疗鹿角形结石的效果及安全性。方法：取俯卧位，采用气压弹道联合超声碎石的方式，以肾中盏为目标肾盏行经皮肾镜碎石术（percutaneous nephrolithotomy，PCNL）治疗鹿角形结石患者145例184侧，其中不完全性鹿角形结石115例侧，完全性鹿角形结石69例侧。观察结石的排除率及并发症。结果：144例侧行一期单通道碎石（中盏），7例侧行一期双通道碎石（中盏及下盏5例，中盏及上盏2例）；2例侧残留肾盏结石未进一步处理，自动出院；31例侧行二期碎石，单通道者29例，其中4例先行ESWL再行PCNL碎石；双通道者2例（中盏及上盏1例，中盏及下盏1例）。151例侧排尽结石，其中完全性鹿角形结石54例侧，不完全性鹿角形结石97例侧，结石清除率82．1％。手术时间120～330min，平均（147±23）min。血红蛋白下降1～4g／L，平均下降（2．0±0．6）g／L，术中输血22例，术后输血5例；术后肾盂内感染3例，合并肾周感染、单侧分肾功能受损1例。平均住院时间（13．0±3．5）天。结论：以肾中盏为目标肾盏行PCNL治疗鹿角形结石是非常有效和安全的；气压弹道联合超声碎石对鹿角性结石的清除率较高，治疗时问短，并发症少。

Efficacy and Safety of Percutaneous Nephrolithotomy in Middle Renal Calices for Treatment of Staghorn Stones With the Combination of Pneumatic and Ultrasonic Lithotrite

Objective：To evaluate the efficacy and safety of percutaneous nephrolithotomy （PCNL） by middle renal calice used as the main access for the treatment of staghorn stones with the combination of pneumatic and ultrasonic lithotrite. Methods：Clinical data of 145 patients undergone PCNL by middle renal calices as main access with 115 incomplete staghorn stones and 69 complete staghorn stones located in 106 unilateral kidneys and 39 bilateral kidneys were reviewed. Take the prone position in all patients, pneumatic and ultrasonic lithotrite was used. The rate of stone removal and complications were the main points of the analysis. Results： 144 stone cases underwent one session PCNL by single access tract （middle calices）, 7 stone cases underwent one session PCNL by double access tracts （5 cases by middle and lower calices, 2 cases by upper and middle calices）. Of these pa tients, 2 cases had fragments of lateral renal calyceal stones with no further treatment and discharged by theirselves. 31 stone cases underwent second session PCNL. Of them, 29 stones were treated by single access tract （middle calices） and 4 stone cases had extracorporeal shock wave lithotripsy before the second PCNL. The other 2 stone cases underwent PCNL in double access tracts （1 case by middle and lower calices, 1 case by upper and middle calices）. 151 stone cases composed of 54 complete staghorn stones and 97 incomplete staghorn stones had no residual fragments with the stone removal rate 82.1 % （151/184）. The operative time was 120-330 min（mean 147 ±23 min）. Hemoglobin dropped 1-4 g/L（mean 2.0±0.6 g/L）, 22 cases and 5 cases needed blood transfusion in the operation procedure and post operation respectively. 3 cases developed pyelonephritis and 1 case had split renal dysfunction with peri-parenchyma infection. The average admission time was （13.0±3.5）days. Conclusions： By middle calices as a main access to perform PCNL for staghorn stones is effective and safe. Using pneumatic and ul- trasonic lith