超声引导下经皮肾镜碎石取石术治疗马蹄肾合并肾结石的安全性和有效性

Efficacy and safety of standard percutaneous nephrolithotomy for calculi within horseshoe kidney

目的分析标准通道经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)治疗马蹄肾肾结石的疗效和安全性。方法回顾性分析北京大学人民医院泌尿外科2007年1月至2016年8月采用PCNL治疗的43例马蹄肾肾结石(50侧肾结石)和同期86例正常肾肾结石(92侧肾结石)患者的临床资料,对两组的手术时间、结石清除率和并发症进行比较分析。结果马蹄肾组建立单通道41侧,双通道9侧。正常肾组建立单通道66侧,双通道17侧,三通道9侧。马蹄肾组和正常肾组手术时间分别为(81.40±42.75)min和(77.74±34.46)min,差异无统计学意义(P>0.05);马蹄肾组一期清石率为82.00%(41/50),稍低于正常肾组84.78%(78/92),差异无统计学意义(P>0.05);马蹄肾组接受二次手术清除残余结石4侧,正常肾组二次手术6侧;马蹄肾组二期清石率为90.00%(45/50),稍低于正常肾组91.30%(84/92),差异无统计学意义(P>0.05);马蹄肾组和正常肾组术后血红蛋白较术前下降分别为(11.23±7.25)g/L和(12.17±10.18)g/L,差异无统计学意义(P>0.05);马蹄肾组手术相关感染发生率为6.0%(3/50),稍低于正常肾组6.52%(6/92),差异无统计学意义(P>0.05);马蹄肾组围手术期无输血,正常肾组输血率为1.1%(1/92),差异无统计学意义(P>0.05)。结论PCNL治疗马蹄肾肾结石是有效、安全的方法。

Objective To investigate the efficacy and safety of percutaneous nephrolithotomy(PCNL)in treatment of renal calculi in patients with horseshoe kidney.Methods The clinical data of 43 horseshoe kidney patients(50 sides)and 86 normal kidney patients(92 sides)with renal calculus treated by PCNL from January 2007 to August 2016 were retrospectively analyzed.Surgical time,stone-free rate,and complications were compared between the two groups.Results Among the horseshoe kidney group,single tract was established in 41 kidneys,double tracts were established in 9 kidneys.Among the normal kidney group,single tract was established in 66 kidneys,double tracts were established in 17 and triple tracts were established in 9.The mean operative time was(81.40±42.75)min and(77.74±34.46)min(P>0.05)in horseshoe kidney group and normal kidney group,respectively.The stone-free rate after one-session operation was 82.00%(41/50)and 84.78%(78/92)(P>0.05),respectively.In horseshoe kidney group,4 cases received a second-session PCNL to remove the residual calculi.In normal kidney group,6 cases received a second-session PCNL.The stone-free rate after two-session operation was 90.00%(45/50)and 91.30%(84/92)(P>0.05),respectively.After the operation,the hemoglobin decreased by(11.23±7.25)g/L and(12.17±10.18)g/L(P>0.05),respectively.The postoperative infection rate was 6.00%(3/50)and 6.52%(6/92)(P>0.05),respectively.None of the horseshoe kidney patients received blood transfusion while 1 normal kidney patient received blood transfusion(P>0.05).Conclusion PCNL is effective and safe in treatment of renal calculi in patients with horseshoe kidney.