微创经皮肾镜取石术治疗肾脏鹿角型感染性结石的临床评价与风险防范  

Clinical Evaluation and Precaution of the Treatment of Renal Struvite Staghorn Calculi with Minimally Invasive Percutaneous Nephrolithotomy

作　　者：李逊[1,2] 李天[2] 何永忠[2] 徐桂彬[2] 冯钢[2] 谢清灵[2] 江先汉[2] 

机构地区：[1]华中科技大学同济医学院附属同济医院泌尿外科,武汉430030 [2]广州医学院港湾医院泌尿外科

出　　处：《临床泌尿外科杂志》2010年第1期11-13,共3页Journal of Clinical Urology

摘　　要：目的:评价微创经皮肾镜取石术治疗肾脏鹿角型感染性结石的安全性及可行性,探讨防范风险的应对措施。方法:回顾性分析2007年5月～2009年3月我院采用微创经皮肾镜取石术治疗49例(66例次)肾脏鹿角型感染性结石的患者资料,其中男16例,女33例;年龄32～67岁,平均46岁。并发高血压病4例,糖尿病3例,肾功能不全5例,贫血5,低蛋白血症8例。结石大小3.3 cm×2.6 cm～10.5 cm×4.6 cm,平均5.3 cm×3.5cm。结果:采用单通道13例次,双通道38例次,三通道15例次。一期平均手术时间为115 min,术中平均出血量为150 ml,平均住院天数为13天。结石的总取净率为83.6%(41/49),术后配合ESWL,3个月后,结石总排净率为89.8%(44/49)。术后并发高热6例,感染性休克1例,急性左心功能不全1例,肾动静脉瘘1例,均治愈,无死亡病例。结论:微创经皮肾镜取石术治疗肾脏鹿角型感染性结石具有创伤小、结石清除率高、恢复快等优点。加强并存病的围手术期处理,把握手术时机及提高手术技巧,术前有效抗感染,术中及时降低肾盂内压,术后保证引流通畅等措施是减少并发症的关键。而且多通道技术的运用或联合ESWL可提高结石清除率。Objective：To assess the feasibility and safety of the treatment of renal struvite staghorn calculi with minimally invasive percutaneous nephrolithotomy（MPCNL） ,and to explore the risk and precaution of MPCNL for renal struvite staghorn calculi. Methods：The clinical data of 49 patients（66 cases） with renal struvite staghorn calculi treated by MPCNL from May 2007 to March 2009 were analyzed retrospectively. There were 16 males and 33 females aging from 32 to 67 years with an average of 46 years. The coexisting diseases included hypertension（4 ca ses）, diabetes（3 cases）, abnormal renal function （ 5 cases）, anemia （ 5 cases）, and hypoproteinemia （ 8 cases ）. The mean stone burden was 5.3 cm×3.5 cm, ranged from 3.3 cm×2.6 cm to 10.5 cm×4.6 cm. Results： 13 cases were performed via single channel,38 cases via hi-channel, and 15 cases via tri channel. The mean operating time, blood loss and hospital stay were 115 minutes, 150 ml and 13 days, respectively. The total stone-free rate was 83.6% （41/49）, and 89.8%（44/49） after operation combined with ESWI. in 3 months. 9 complications after operation were cured： high fever in 6 cases, septic shock in 1 case, acute left heart failure in 1 case, renal arteriovenous fistula was cured with the hyperselective embolization of renal artery in 1 case o No postoperative deaths were revealed. Conclusions： MPCNL is a feasible and safe technique with less injury, higher stone-free rate ,quicker recovery to treat renal struvite staghorn stone. Only if pay more attention to perioperative managements of the coexisting diseases,grasp operative opportunities and deploy appropriate operation skills, take effective anti-infection, cut down renal intrapelvic pressure, guarantee postoperative urinary tract unobstruction,which are essential to decrease incidence of complication. The stone-free rate can be raised by multichannel nephrostomy or application for ESWL.

关 键 词：肾结石 鹿角型 微创经皮肾镜取石术 

分 类 号：R692.4[医药卫生—泌尿科学]