经皮肾输尿管镜碎石取石术联合ESWL治疗肾功能不全的孤立肾鹿角形结石

A combination of minimally invasive percutaneous nephrolithotomy and extracorporeal shockwave lithotripsy for solitary renal staghorn calculi in patients with renal insufficiency

目的探讨经皮肾输尿管镜碎石取石术联合ESWL治疗肾功能不全的孤立肾鹿角形结石的疗效。方法经皮肾穿刺微造瘘延期输尿管镜下碎石取石术(minimallyinvasivepercutaneousnephrolithotomy,MPCNL)联合体外冲击波碎石(extracorporealshockwavelithotripsy,ESWL)治疗肾功能不全的孤立肾鹿角形结石8例。结果5例取尽结石,3例残余结石。术中未输血,未出现严重手术并发症。术后肾功能有不同程度的改善,血Cr由术前(289±166)μmol/L降至(155±33)μmol/L(t=4.69,P=0.004),血BUN由术前(15.1±7.9)mmol/L降至(8.3±1.9)mmol/L(t=4.00,P=0.005),ECT检查GFR由术前(48.8±12.4)ml/s升高至(63.0±8.4)ml/s(t=4.68,P=0.003)。术后肾后性梗阻消失。8例随访0.5～4.5年,平均2.8年,肾功能较术后无明显变化。结论MPCNL结合ESWL治疗肾功能不全的孤立肾鹿角形结石安全、疗效好。

Objective To explore the curative effect of combined use of minimally invasive percutaneous nephrolithotomy (MPCNL) and extracorporeal shockwave lithotripsy (ESWL) for the treatment of solitary renal staghorn calculi in patients with renal insufficiency. Methods Eight cases of solitary renal staghorn calculi associated with renal insufficiency were treated by a combination of MPCNL and ESWL. Results Stones were completely cleared away in 5 cases, while residual stones were found in 3 cases. No blood transfusion was required and no severe surgery-related complications were encountered. After surgery variable degrees of improvement in renal functions was observed. The serum creatinine (Cr) decreased from 289±166 μmol/L pre-operation to 155±33 μmol/L post-operation (t=4.69, P=0.004), and the blood urea nitrogen (BUN) decreased from 15.1±7.9 mmol/L to 8.3±1.9 mmol/L (t=4.00, P=0.005). The emission computed tomography (ECT) examinations showed the glomerular filtration rate (GFR) was elevated from 48.8±12.4 ml/s before operation to 63.0±8.4 ml/s after operation (t=4.68, P=0.003). Post-renal obstruction disappeared after operation. Follow-up for 0.5~4.5 years (mean, 2.8 years) in the 8 cases revealed no obvious changes in renal functions. Conclusions Combination of MPCNL and ESWL for solitary renal staghorn calculi associated with renal insufficiency is safe and effective.