孤立肾并复杂性结石的治疗选择  

The treatment choice of solitary kidney complicated with complex calculi: report of 42 cases

作　　者：刘刚 严共全[2] 

机构地区：[1]广东省荣军医院泌尿外科,广州510260 [2]广州海员医院泌尿外科

出　　处：《中华外科杂志》2005年第14期936-939,共4页Chinese Journal of Surgery

摘　　要：目的探讨孤立肾并复杂性结石的处理方式,提高其治疗的有效性和安全性。方法总结42例孤立肾并复杂性结石的治疗经验。其中先天性4例(10%)、后天原因38例(90%);左侧16例(38%)、右侧26例(62%)。均为铸形或鹿角状、多发性结石,8例合并输尿管结石,6例因急性梗阻性无尿入院;铸形或鹿角状结石首选体外震波碎石(ESWL)后经皮肾镜取石(PCNL)治疗,多发性结石先行PCNL后ESWL处理,部分病例配合腔内碎石。结果36例(86%)经ESWL及PCNL联合治疗获愈,11例PCNL术中辅以腔内碎石,6例梗阻性无尿者急诊ESWL或腔内碎石后12h内恢复排尿;6例(14%)因肾盂输尿管畸形、梗阻改行开放手术,2例继发反复感染需长期肾造瘘。37例获随访6～18个月,32例(86%)肾功能良好、5例(14%)存在肾功能不全,4例(11%)结石复发。结论联合应用ESWL及PCNL可安全有效地清除多数孤立肾的复杂性结石;肾性梗阻性无尿者行急诊ESWL是必要的,对输尿管下段梗阻性结石可首选腔内碎石;伴肾盂明显畸形或输尿管连接部严重狭窄者以选择开放手术为宜。Objective To investigate the therapeutics of complex calculi in solitary kidney,and to improve the effect and safety of treatment. Methods Experiences in the treatment of 42 patients were summarized.All patients were with mould or multiple calculi, 8 cases were complicated with ureter calculi ,and 6 cases were hospitalized because of obstructive anuria. The patients with mould calcuin received extracorporal shock wave lithotripsy (ESWL) prior to percutaneous nephrolithotomy(PCNL) .While the patients with multiple calculi received PCNL prior to ESWL . Some cases were treated by lithodialysis. Results Thirty-six cases (86%) were cured by ESWL combined with PCNL. Eleven cases receivecd lithodialysis during PCNL.The 6 cases with obstructive anuria recovered in 12 hours after emergent ESWL or lithodialysis;6 cases(14%) underwent open operation because of deformity or obstruction in renal pelvis and ureter; 2 cases have to keep nephrostomy because of repeated infection. Followed up 6—18 months, 38 cases(86%) keep good kidney function; 5 cases (14%) had renal insuffcifney; 4 cases(11%) reoccurred calculi. Conclusions The therapeutics of ESWL combined with PCNL may clear complex calcuin of solitary kidney effectively and safe. It is necessary to take emergent ESWL in renal obstructive calculi cases. And the patients with lower ureter obstructive caluli may take lithodialysis first.It is proper to choose open operation on the patients with deformity of renal pelvis or obstruction of ureter.

关 键 词：复杂性结石 孤立肾 急性梗阻性无尿 肾盂输尿管畸形 ESWL 多发性结石 PCNL 经皮肾镜取石 体外震波碎石 腔内碎石 输尿管连接部 开放手术 输尿管结石 鹿角状结石 肾功能不全 输尿管下段 治疗经验 联合治疗 反复感染 结石复发 

分 类 号：R699[医药卫生—泌尿科学] R692.4[医药卫生—外科学]