微创经皮肾镜碎石术治疗巨大肾鹿角形结石的疗效分析

Minimally invasive percutaneous nephrolithotomy for large complete staghorn calculi

目的:探讨微创经皮肾镜碎石术治疗巨大肾鹿角形结石的手术经验及其并发症的预防。方法:回顾性分析2001年8月～2007年6月采用微创经皮肾镜气压弹道碎石治疗巨大肾鹿角形结石36例(40例次)的临床资料:男25例,女11例,结石最大径42～126mm,平均68mm,结石表面积1246～6231mm2,平均2455mm2,均为全鹿角形肾结石,其中双肾鹿角形结石4例。结果:平均手术时间193min(140～340min),住院天数8～32天,平均17天。采用双通道取石11例侧,三通道取石25例侧,四通道取石4例侧。术前血红蛋白为(117±25)g/L,一期手术后1～3天复查血红蛋白为(105.5±21.5)g/L。术中损伤十二指肠、胸膜、腹膜各1例,术中或术后输血2例,术后高热4例,术后需要配合ESWL碎石23例。结石总排净率为87.3%。结论:微创经皮肾镜配合气压弹道碎石治疗巨大肾鹿角形结石具有创伤小、恢复快、患者容易接受等优点,但术中或术后要注意并发症的预防。

Objectives：To explore the surgical management of large complete staghorn calculi by minimally invasive percutaneous nephrolithotomy（MPCNL）. Methods：Between August 2001 and June 2007, 40 renal units （36 patients） with large complete staghorn renal calculi who underwent MPCNL were retrospectively reviewed. Of the 36 patients, 25 cases were men, 11 cases women. Age ranged from 25 to 72 years（average 46 years）. The diameter of calculi ranged from 42 to 126（mean=68） mm, The stone surface area was 1246-6231 （mean 2455） mm^2. Results：The average operation time was 193 minutes（range from 140 minutes to 340 minutes）. The average hospital stay was 17 days（range from 8 to 32 days）. The number of tracts required per procedure were 2 tracts in 11, three tracts in 25,4 tracts in 4. The average preoperative hemoglobin was 117 25 g/L and 1- 3 days after first-look procedure was 105.54-21.5 g/L. Complications were blood transfusion（n=2）, high fever（,=4） ,injury to duodenum（n= 1 ）, hydrothorax（n= 1）, hydroabdomen（n= 1）. Extrocorporeal shock wave lithotripsy was used to treat residual stones in 23 patients. The overall stone-free rate was 87.3%. Conclusions： MPCNL combined with pneumatic lithotripsy for treating large complete staghorn calculi in selected cases is safe ,feasible.