彩超引导下经皮肾镜碎石取石术治疗鹿角形肾结石

Colour Doppler guide the percutaneous nephrolithotomy for Staghorn calculi

目的评估彩超引导下经皮肾镜碎石取石术（PCNL）治疗鹿角形肾结石的疗效及安全性。方法对46例接受彩超引导下PCNL的鹿角形肾结石患者的临床资料进行回顾性分析。患者平均年龄43岁，结石直径3．0～7．5cm，其中完全鹿角形结石29例，孤立肾结石1例，既往开放手术史6例。彩超引导下穿刺并建立皮肾通道，行气压弹道碎石或EMS混合动力碎石清石术。结果46例患者共55侧均成功建立F22皮。肾通道，一期碎石55侧，二期碎石14侧；单通道碎石38侧，双通道16侧，三通道1侧术后3—4d复查X线腹部平片，18侧结石残留，残石直径0．4～2．0cm，14侧行二期碎石术，一期、二期术后4侧残石直径0．6～1．0cm，行体外冲击波碎石；3侧一期碎石术后残石直径≤0．5em予药物排石治疗，总结石清除率为87．0％（48／55）。手术时间为65～160min，平均95min。1例因迟发性出血，行超选择性肾动脉栓塞治愈。无中转开放手术、肾切除及死亡病例，无胸膜及肠道损伤。术后随访3-18个月，9例肾功能不全患者中6例恢复正常，3例血肌酐波动于185～220μmol／L。结论彩超引导下经皮肾镜碎石取石术治疗鹿角形肾结石安全、有效。

Objective To evaluate the safety and efficacy of colour doppler in guiding the percutaneous nephrolithotomy（PCNL） for Staghorn calculi. Methods The clinical records of 46 patients with renal calculi who underwent PCNL were retrospectively analyzed. Patients＇ mean age was 43 years old, and the range of diameter of stone was 3.0 - 7. 5 cm. Among these cases,29 cases had complete staghorn calculus. One case had isolated kidney stone. And the other 6 patients had open surgery history. Using Colour Doppler guidance, the percutaneous nephrolithotomy for renal calculi was conducted. Results F22 percutaneous channel was successfully established in 55 sides of 46 patients, with the first and the second phase surgeries of 41 and 14 sides respectively. Single-, double- and three-channel PCNL were performed in 38, 16, and 1 sides respectively. Abdominal x-ray conducted at 3 -4 days post operation revealed residual stones on 18 sides, with the range of 0. 4 - 2.0 cm in diameter. Second-phase lithotripsy was conducted on 14 sides of patients. After the first and the second phases of surgery, 4 sides having residual stones ranging 0. 6 - 1.0 cm, underwent extracorporeal shock wave lithotripsy. After the third-phase surgery, the diameters of residual stones were much less than 0. 5 cm and patients were treated with medication. The total rate of clearance was 87. 0% （48/55）. The duration of surgery was 65 - 160 minutes and 95 minutes on average. One patient having delayed bleeding was cured with selective renal artery embolization. There were no complications such as nephrectomy, deaths, pleural or intestinal damage during the period of study. Patients were followed up for 3 to 18 months. Six of 9 patients with renal insufficiency recovered after surgery. The serum creatinine in the remaining 3 patients ranged 185 - 220μmol/L. Conclusion Colour Doppler-guided percutaneous nephrolithotomy for renal calculi is safe and effective.