微创经皮肾镜取石术治疗异常肾肾结石  

Minimally Invasive Percutaneous Nephrolithotomy(mPCNL) for Large Stones in Anomalous Kidneys

作　　者：王黎[1] 姚启盛[1] 王晓康[1] 陈从波[1] 龚小新[1] 杨勇[1] 

机构地区：[1]湖北医药学院附属太和医院泌尿外科,男科,泌尿系结石诊疗中心,十堰442000

出　　处：《中国现代手术学杂志》2011年第4期282-284,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨微创经皮肾镜取石术(minimally invasive percutaneous nephrolithotomy,mPC-NL)治疗异常肾肾结石的疗效与安全性。方法异常肾肾结石患者共41例,其中马蹄肾23例,解剖性孤立肾9例(其中合并脓肾、双J管遗留并巨大结石1例),功能性孤立肾7例,重复肾畸形并上肾结石2例。均采用实时B超引导mPCNL治疗。结果共进行49次mPCNL,均为单通道取石。除1例脓肾患者先穿刺引流后择期手术,其余均一期建立通道。手术时间70～105 min,平均(81.9±10.6)min。27例一期取石成功,首次手术净石率65.9%(27/41)8,例行二期mPCNL,mPCNL净石率85.4%(35/41),6例因结石残留行ESWL。2例患者较严重感染,积极治疗后恢复;1例患者并发大出血,行介入栓塞止血。所有患者术前外周血血红蛋白浓度(106.3±4.7)g/L,术后(98.5±5.7)g/L;所有孤立肾患者术前肾功能检查肌酐浓度(103.1±9.4)μmol/L,术后(134.1±11.5)μmol/L,手术前后比较,差异无统计学意义(P>0.05)。本组患者未出现结肠、胸膜等周围脏器损伤等。结论 mPCNL是治疗异常肾肾结石安全、有效的方法。Objective To evaluate the effect and safety of minimally invasive percutaneous nephrolithotomy （mPCNL） for large calculi in anomalous kidneys. Methods A total of 41 kidney calculi patients with renal abnormalities were performed mPCNL. Of the 41 patients, 23 had a horseshoe kidney, 16 had a solitary kidney （9 patients were anatomical and 7 patients were functional）, and 2 had a duplex kidney. Results 49 times mPCNL were performed with single channel. 40 cases were reconstructed the channel on stage I except one pyone- phrosis ease were performed selective operation after drainage. The mean operating time of mPCNL was （ 81.9 ＋ 10.6） rain （ranged 70 to 105 min）. 27 cases cleared stones by one-stage mPCNL, 8 received two-stage mPCNL, and 6 performe ESWL 1 month after discharge. The first and total stone-free rate of mPCNL was 65.9% （27/41） and 85.4% （35/41）respectively. 2 patients was found severe infection and recovered after active treatment and 1 patient had severe postoperative hemorrhage which was controlled by hyperselective angioembolization. All changes of the hemoglobin count and the plasma creatinine were not significant between pre- and post-operation. No adjacent organs injury or urosepsis was observed. Conclusion mPCNL is a safe and effective treatment for large stones in anomalous kidneys, although it demands skilled technique and careful performation.

关 键 词：肾造口术 经皮 肾结石 碎石术 

分 类 号：R692.4[医药卫生—泌尿科学]