微创经皮肾穿刺取石术治疗孤立肾多发性结石

目的探讨超声引导微创经皮肾穿刺取石术（MPCNL）治疗孤立肾多发性结石的有效性及安全性。方法回顾性分析采用超声引导MPCNL治疗21例孤立肾多发性结石的临床资料。先天性孤立肾1例,对侧肾切除术后9例,对侧肾无功能11例。17例采用单通道,4例采用多通道。于术前及术后检查血肌酐水平。结果本组手术时间40～150min,平均86min。术后2例发热,无需输血病例。11例血肌酐一过性轻微升高,术后1d,血肌酐由术前（129.3±57.5）μmol/L升高至（138.5±59.9）μmol/L,但差异无统计学意义（P〉0.05）。本组无中转开放手术,无严重并发症。手术取净率为81.0%（17/21）,术后3个月结石排净率为85.7%（18/21）,血肌酐降至（125.4±51.2）μmol/L（P〉0.05）。随访3～60个月,所有患者血肌酐水平均稳定或下降。结论 MPCNL治疗孤立肾多发性结石安全、有效,具有创伤小、并发症少、恢复快、结石清除率高等优点,长期随访显示MPCNL术后患者肾功能改善或稳定。

Treatment of multiple stones in solitary kidney with minimally invasive percutaneous nephrolithotomy

Objective To evaluate the efficacy and safety of minimally invasive percutaneous nephrolithotomy（MPCNL） for patients with solitary kidneys.Methods Data of 21 patients with solitary kidneys（congenital in 1 patient,contralateral nephrectomy in 9 patients,and nonfunctional kidney in 11 patients） suffering from multiple renal calculi were retrospectively investigated.The patients were treated with MPCNL under the guidance of ultrasound.Serum creatinine was measured preoperatively and postoperatively.Results The operation time ranged from 40 to 150 minutes（average 86）.2 cases had fever.No case needed blood transfusion after operation.11 cases had transient serum creatinine increasing from（129.3±57.5） μmol/L before operation to（138.5±59.9） μmol/L 1 day after operation（P0.05）.No open surgery was needed,and no severe complications were observed.The stone-free rate was 81.0%（17/21）.3 months after operation,the stone clearance rate was 85.7%（18/21） and serum creatinine decreased to（125.4±51.2） μmol/L（P0.05）.During the follow-up of 3 to 60 months,serum creatinine remained stable or decreased in all the cases.Conclusion MPCNL is safe and effective in the management of patients with solitary kidneys,which has advantages of minimal invasion,few complication,easy recovery and high stone-free rate.