PCNL在融合肾、异位肾、旋转不良、萎缩肾、肾盂肾盏畸形等异常肾结石中的应用  

Clinical application of percutaneous nephrolithotomy in fused kidney,ectopic kidney,malrotation,atrophic kidney,pyelonecalyces deformity and other abnormal kidneys

作　　者：张义[1] 喻华[1] 左婵娟 熊云鹤[3] 汪前亮 Zhang Yi;Yu Hua;Zuo Chanjuan;Xiong Yunhe;Wang Qianliang(Department of Urology,the People's Hospital of Hanchuan City,Hanchuan 431600,China;Department of Nephrology,the People's Hospital of Hanchuan City,Hanchuan 431600,China;Department of Urology,the People's Hospital of Wuhan University,Wuhan 430060,China;Department of Urology,Huangshi Central Hospital(Affiliated Hospital of Hubei Polytechnic University)of Edong Health Care Group,Huangshi 435000,China)

机构地区：[1]汉川市人民医院泌尿外科,汉川431600 [2]汉川市人民医院肾病内科血透室,汉川431600 [3]武汉大学人民医院泌尿外科,武汉430060 [4]鄂东医疗集团市中心医院(湖北理工学院附属医院)泌尿外科,黄石435000

出　　处：《国际泌尿系统杂志》2022年第1期18-22,共5页International Journal of Urology and Nephrology

基　　金：国家自然科学基金(31600785)。

摘　　要：目的探讨经皮肾镜取石术(PCNL)治疗融合肾、异位肾、旋转不良、萎缩肾和肾盂肾盏畸形等异常肾脏中的复杂结石的临床效果。方法回顾性分析2015年至2019年在汉川市人民医院行PCNL治疗的48例肾结石患者的临床资料。其中,14例存在肾脏旋转不良,12例有重复肾盂伴有完全或不完全性重复输尿管,10例为马蹄肾,8例单侧肾萎缩,3例交叉融合异位,1例盆腔肾。经过严格的术前准备,采用俯卧位或仰卧位,所有患者均一期完成手术操作。结果一期PCNL术后,39例患者(81%)达到完全的结石清除,另有7例术后残石患者经体外冲击波碎石治疗后也达到无石状态,最终结石清除率达96%(46/48)。术中25例手术采用仰卧位,其经皮肾脏通道建立到完成手术所需时间明显少于俯卧位(P<0.05);3例需要建立多通道;患者平均住院时间3(2~7)d。术后3例患者需要输血,2例出现肾周假性囊肿,未发生肠瘘或血管、内脏损伤患者。结石分析显示83%的结石为草酸钙结石。结论在治疗各种畸形肾脏的结石中,如融合肾、肾异位、旋转不良、肾萎缩、肾盂肾盏变异等,PCNL都能取得较好的效果,但需要外科医生有坚定的决心和熟练的手术技巧。Objective To investigate the clinical effect of percutaneous nephrolithotomy(PCNL)in the treatment of complex calculi in fused kidney,ectopic kidney,malrotation,atrophic kidney and pyelonecalyceal deformity.Methods The clinical data of 48 patients with kidney stones treated with PCNL in Hanchuan people's hospital from 2015 to 2019 were retrospectively analyzed.There were 14 cases of renal malrotation,12 cases of repeated renal pelvis with complete or incomplete repeated ureter,10 cases of horseshoe kidney,8 cases of unilateral renal atrophy,3 cases of cross fusion ectopic,and 1 case of pelvic kidney.After strict preoperative preparation,all patients were in prone or supine position,and the operation was performed in one stage.Results After stage I PCNL,39 patients(81%)achieved complete stone removal,and another 7 patients with residual stone also achieved stone-free state after extracorporeal shock wave lithotripsie,and the final stone removal rate reached 96%(46/48).During the operation,25 patients were operated in supine position,and the time required from the establishment of percutaneous renal channel to the completion of operation was significantly less than that in prone position(P<0.05).Three cases needed to establish multiple channels;the mean hospital stay was 3 days(2~7 days).After surgery,3 patients needed blood transfusion,and 2 patients developed perirenal pseudocysts,without intestinal fistula or vascular or visceral injury.Calculus analysis showed that 83%of the calculi were calcium oxalate calculi.Conclusions PCNL can achieve good results in the treatment of stones with various renal malformations,such as fusion kidney,renal ectopia,malrotation,renal atrophy,renal pelvis and calyceal variation,etc.,but it requires surgeons to have firm determination and skilled surgical skills.

关 键 词：肾造口术 经皮 融合肾 萎缩 肾 

分 类 号：R692.4[医药卫生—泌尿科学]