一期多通道微创经皮肾穿刺取石术治疗鹿角状结石

Multi-tract minimally invasive percutaneous nephrolithotomy in a single session for staghorn calculi

目的 探讨微创经皮肾穿刺取石术（minimally invasive-percutaneous nephrolithotomy，MPCNL）一期多通道治疗肾鹿角状结石的可行性与临床疗效。方法 2002年2月至2006年4月，采用MPCNL治疗鹿角状结石患者56例。其中全鹿角状结石21例，部分鹿角状结石35例。结石大小3．5cm×2．1cm～8．5cm×4．2cm，平均5．1cm×2．8cm。结果 一期手术平均手术时间112min，一期结石取净36例（64．3％）。18例接受二期MPCNL，12例结石清除，二期MPCNL后结石总清除率85．7％（48／56）。8例患者残留结石大小2～12mm，其中3例术后1个月接受体外冲击波碎石术。术后53例随访1～6个月，原残留结石8例中结石清除4例。结论 一期多通道MPCNL治疗鹿角状结石，创伤小、并发症少、恢复快、结石清除率高，可以选择性地作为鹿角状结石患者的治疗方案。

Objective To discuss the minimally invasive percutaneous nephrolithotomy （MPCNL） in treating staghorn calculi via multiple tracts in a single session, and evaluate the feasibility and efficiency of this technique. Methods From February 2002 to April 2006, 56 patients with renal staghorn calculi（21 cases with complete staghorn calculi and 35 cases with partial staghorn caiculi）were treated by multi-tract MPCNL. The stone had an average size of 5. 1 cm× 2.8 cm, ranged from 3.5 cm× 2.1 cm to 8.5 cm× 4.2 cm. Results The average operative time of first stage MPCNL was 112 min, 36 cases were rendered stone free and the clearance rate was 64.3%. Eighteen cases had a second-look MPCNL and the clearance rate reached 85.7% （48/56）. Eight cases had several residual calculi ranged from 2 mm to 12 mm, 3 cases had ESWL 1 month postoperatively. Fifty-three cases had a follow-up for 1-6 months,4 cases of those 8 cases with residual calculi were rendered stone free. Conclusions For the advantage of less bleeding, higher clearance rate, and shorter hospital stay time, multi-tract MPCNL in a single session approach could be an effective and feasible treatment option for staghorn calculi in selected cases.