B超介导微创经皮肾取石术治疗严重脊柱畸形合并上尿路结石

Ultrasound-guided mini-invasive percutaneous nephrolithotomy in treatment of severe spinal deformity with upper urinary tract calculi

目的评价应用B超介导微创经皮肾取石术（MPCNL）处理脊柱畸形合并上尿路结石的疗效。方法收集本院2001年8月至2010年2月严重脊柱畸形（Cobb角〉90°）合并上尿路结石患者10例，共11侧。肾，采用MPCNL术在B超介导下穿刺，观察术中术后大出血、周围器官损伤情况；记录平均手术时间、术后48h与术前相比的血红蛋白下降水平；应用腹部平片和B超复查术后上尿路结石取出情况；并进行术后随访，记录术后随访时间及结石复发情况。结果11侧肾脏共行14次MPCNL术，其中单通道MPCNL 10次，双通道MPCNL 4次。所有患者手术均成功，术中术后未见大出血、周围器官损伤等并发症发生。平均手术时间为（96±38）min，术后48h血红蛋白下降（16±7）g/L。术后复查腹部平片和B超显示11侧上尿路结石完全取净。术后随访（36±28）个月，1例患者复发下盏小结石，其余9例患者未见结石复发。结论B超介导下应用MPCNL处理严重脊柱畸形合并上尿路结石安全有效。

Objective To evaluate the efficacy of mini- invasive pereutaneous nephrolithotomy （MPCNL） in treatment of severe spinal deformity with upper urinary tract calculi. Methods Between August 2001 and February 2010, 10 patients with severe spinal deformity （Cobb〉90°）eombined and upper urinary tract calculi （a total of 11 side kidneys） underwent ultrasound-guided MPCNL in our hospital. The postoperation hemorrhage and the injury of neighboring organs were observed before and after operation. Furthermore, the mean operation time and the decrease level of hemoglobin at 48 h after operation were recorded. The abdomen film and ultrasound were used to reexamine the removal of upper urinary tract calculi after operation. Follow-up was carried out in these patients, the time and recurrence of calculi were recorded. Results A total of 14 MPCNLs were performed in 11 side kidneys, including 10 times of single channel MPCNL and 4 times of double channel MPCNL. All the operations were successful with no complications such as hemorrhage or neighboring organ injury during and after operations. The mean operation time was （96±38） min, and the decrease of hemoglobin was （16±7） g/L at 48 h after operations. In postoperative reexamination, the abdomen film and ultrasound showed that 11 side upper urinary tract calculus were totally removed. In the follow-up of （36±28） months, the recurrence of lower ealieeal stone was found in 1 ease and no recurrence in the remaining 9 eases. Conclusion Ultrasound-guided MPCNL is safe and effective in treatment of severe spinal deformity with upper urinary tract calculi.