先天性异常肾合并结石的临床治疗方法比较

Clinical comparison of therapeutic methods for calculi in congenital anomalous kidneys

目的探讨先天性异常肾合并结石的合理治疗方法。方法回顾性分析126例不同类型先天性异常肾合并结石的患者资料。男75例，女51例。年龄12～66岁，平均39岁。马蹄。肾40例（31．80）、重复肾51例（40．5％）、肾旋转不良35例（27．8％）。结石位于左肾70例（55．6％），右肾56例（44．4％）。单发结石96例（76．2％），多发结石30例（23．8％）。分别采用体外冲击波碎石（ESWL，37例）、微创经皮肾镜取石术（MPCNL，41例）及开放手术（48例）治疗。结石最大径ESWL组0．8～2．2cm，平均1．5cm；MPCNI．组1．0～4．0cm，平均2．5cm；开放手术组1．5～3．8cm，平均2．7cm。统计学比较3种方法的疗效。结果ESWL组结石一期清除率78．4％（29／37），MPCNL组85．4％（35／41），开放手术组87．5％（42／48），3组差异无统计学意义（Χ^2=1．39，P=0．50），3组并发症发生率分别为13．5％、9．8％、6．3％，差异无统计学意义（Χ^2=1．28，P=0．53）。1例肾旋转不良患者MPCNL术中发生较严重出血，经高选择性动脉栓塞后治愈，其余各组未发生严重并发症。结论掌握治疗指征，ESWL、MPCNL术治疗先天性异常肾合并结石的疗效同开放手术，可作为首选方式，但仍需强调个体原则，根据异常肾的类型、结石情况以及有无梗阻等因素进行操作才能做到安全、可靠。

Objective To evaluate the therapeutic methods for stones in congenital anomalous kidneys. Methods The clinical outcomes of 126 patients（75 males and 51 females; mean age 39 years, range 12-66 years）who underwent extracorporeal shock wave lithotripsy （ESWL, n= 37）, minimally invasive percutaneous nephrolithotomy （MPCNL, n 41） or open surgery （n=48） were retrospectively reviewed. There were 40 horseshoe kidneys（31.8%） , 51 duplex kidneys（40.5%）, 35 malrotated kidneys（27.8 % ）. Seventyl calculi were located in left kidneys （55.6% ）and 56 in right kidneys（44.4 % ）. There were 96 single stones（76.2 % ）and 30 complex stones（23.8 % ）. The greatest diameter of stone ranged from 0.8 cm to 2. 2 cm（mean 1. 5 cm） in ESWL group, 1.0 cm to 4.0 cm （mean 2.5 cm） in MPCNL group and 1.5 cm to 3.8 cm（mean 2.7 cm） in open surgery group. The therapeutic effects of 3 methods were compared. Results The stone-free rate at 1 session was 78.4%（29/31） in ESWL group, 85.4%（35/41） in MPCNL group and 87.5%（42/48） in open surgery group. No significant difference was found among the 3 groups（3（2= 1.39,P= 0.50）. The inci dence of complications was 13.5% in ESWL group, 9.7% in MPCNL group and 6.3% in open sur gery group（Χ^2 = 1.28,P= 0.53）. Only 1 case of malrotated kidney suffered massive hemorrhage and was cured by selective embolism of renal artery. No major complications occurred in the other patients. Conclusions With rigorous indication, ESWL or MPCNL is as safe and effective as open surgery in the management of stones in congenital anomalous kidneys. It should be considered as the primary therapy. But the treatment must be individualized in terms of the type anomalous kidney, stone characteristics and obstruction.