B超引导微创经皮肾镜取石术治疗孤立肾肾结石

Treatment of solitary kidney calculi with minimally invasive percutaneous nephrolithotomy

目的探讨B超引导下微创经皮肾镜取石术（MPCNL）治疗孤立肾肾结石的安全性和疗效。方法回顾性分析2005年12月~2010年1月在B超引导下行MPCNL治疗孤立肾肾结石27例患者的临床资料。其中21例Ⅰ期穿刺碎石取石,并发肾积脓的4例和肾功能衰竭的2例患者先行经皮肾穿刺造瘘引流,在感染控制和肾功能好转后行Ⅱ期MPCNL。结果 27例患者中,经单通道取石22例,双通道取石5例。一次取尽结石21例,需2次取尽结石3例,总结石清除率88.89%（余3例联合体外冲击波碎石治疗结石排尽）。随访3~12月,肾功能不全的9例患者中,5例恢复正常,3例明显改善,1例因尿毒症需血液透析治疗,无其他重大并发症发生。结论 B超引导MPCNL治疗孤立肾肾结石安全、有效,创伤小、恢复快、并发症少。

Objective To evaluate the safety and efficacy of minimally invasive percutaneous nephrolithotomy（MPCNL） under ultrasound guidance for the treatment of stones in solitary kidney.Methods From December 2005 to January 2010,27 patients with stones in solitary kidney were treated with MPCNL under ultrasound guidance.4 cases with pyonephrosis and 2 cases with renal failure first received percutaneous nephrostomy,and then MPCNL after 5~14 days.The other 21 cases were treated with one-stage MPCNL.Results Of the 27 cases,single tract was used in 22 cases,and double tracts were used in 5 cases.The total stone free rate was 88.89%.During the follow-up of 3 to 12 months,5 of the 9 cases with renal dysfunction recovered to normal after 1~6 months,2 improved significantly,and 1 needed hemodialysis because of renal failure.No other major complications occurred.Conclusion MPCNL under ultrasound guidance appears to be effective and safe for patients with a solitary kidney calculi.