超声引导下经皮肾镜取石术治疗多囊肾合并肾结石手术技术的改进  

Polycystic kidney disease with renal calculi treated by ultrasound-guided percutaneous nephrolithotomy

作　　者：王起[1] 王锐 唐旭[1] 徐涛[1] 杨波[1] WANG Qi;WANG Rui;TANG Xu;XU Tao;YANG Bo(Department of Urology,People＇s Hospital of Peking University,Beijing 100044,China)

机构地区：[1]北京大学人民医院泌尿外科,北京100044

出　　处：《现代泌尿外科杂志》2018年第7期530-532,共3页Journal of Modern Urology

摘　　要：目的探讨超声引导下经皮肾镜取石术在多囊肾合并肾结石治疗中的效果。方法回顾性分析2012年1月至2016年10月在北京大学人民医院泌尿外科治疗的多囊肾合并肾结石患者共37例:其中双侧肾结石4例,双侧结石均行分期手术;全部41例均采用经皮肾镜取石术治疗。对患者的临床参数进行分析,所有患者均定期随访,平均中位随访时间为24个月(2~36个月)。结果所有手术均I期成功建立皮肾通道,其中26例患者建立1个皮肾通道,10例患者建立2个、5例患者建立3个皮肾通道。平均结石最长直径为3.50(2.60~5.00)cm,总结石清除率为95.12%(39/41)。术后2例患者因结石残留II期行输尿管软镜碎石术。平均手术时间为40.95(18~69)min,平均出血量123(80~250)mL。术前平均血清肌酐水平为156.45(95~252)μmol/L,术后158.52(104~264)μmol/L。术后3例患者出现发热,围手术期无输血,无周围脏器损伤等并发症。术后平均住院天数为3.5d。30例患者术后行结石成分分析,尿酸结石22例,一水草酸钙结石7例,磷酸镁铵结石1例。术后6个月随访时平均血肌酐水平为155.32(90~247)μmol/L,与术前、术后肌酐水平比较,肾功能变化无统计学差异(P>0.05)。结论在多囊肾合并肾结石的治疗选择上,经皮肾镜取石术是一种安全有效的手术方式。Objective To evaluate the role of ultrasound-guided percutaneous nephrolithotomy（PCNL）in the treatment of congenital autosomal dominant compolycystic kidney disease（ADPKD）complicated with renal calculi.Methods The clinical data of 37 cases of ADPKD complicated with renal calculi were retrospectively analyzed,including 4 cases with bilateral renal stones.All cases were treated with PCNL.The clinical parameters were collected and analyzed.All patients were routinely followed up for an average of 24 months（2-36）postoperatively.Results All procedures were successful without conversion to open surgery.One channel was established in26 cases,2 channels were established in10 cases,and3 channels were established in 5 cases.The mean stone burden was 3.5 cm（2.6-5.0）.The overall stone clearance rate was 95.12%（39/41）.Two patients received flexible ureteroscopy lithotripsy postoperatively due to residual calculi.The mean operation time was 40.95 min（18-69）and the mean blood loss was 123 mL（80-250）.The mean preoperative serum creatinine level was 156.45μmol/L（95-252）and the mean postoperative serum creatinine level was 158.52μmol/L（104-264）.Fever occurred in3 cases.No patients had peripheral viscera injury or blood transfusion.The hospitalization was 3.5 days.Stone composition analysis reported uric acid calculi in 22 cases,calcium oxalate monohydrate calculi in 7 cases,and magnesium ammonium phosphate calculi in 1 case.During the follow-up of 6 months,the mean serum creatinine level was 155.32μmol/L（90-247）.Statistical comparison showed that PCNL had no impacts on perioperative renal function（P〈0.05）.Conclusion PCNL is an effective and safe procedure in managing ADPKD complicated with renal calculi.

关 键 词：多囊肾 肾结石 经皮肾镜取石术 肾功能 结石成分 

分 类 号：R692.4[医药卫生—泌尿科学]