超声引导下经肋上入路肾上盏单通道经皮肾镜治疗鹿角形肾结石

Ultrasound-guided one supracostal upper-calyx percutaneous access nephrolithotomy for staghorn stone

目的评价超声引导下经肋上入路肾上盏单通道经皮肾镜治疗鹿角形肾结石的疗效和安全性。方法回顾性分析我院2004年10月至2011年10月超声引导下经肋上入路肾上盏单通道经皮肾镜治疗鹿角形肾结石患者581例。泌尿系X线平片测量结石最大长径3.6～6.5cm,平均(5.10±0.82)cm。B超引导下经肋上选取肾上盏穿刺,穿刺点在第11肋间隙或第10肋间隙,建立F22-24的经皮肾通道,以70W大功率钬激光碎石。统计手术时间、围手术期并发症及结石清除率。结果所有患者均成功建立经皮肾镜通道并碎石。手术时间54～140min,平均(82.07±16.25)min,一期结石清除率85.4%(496/581)。术后高热14例(2.4%),其中感染性休克3例(0.5%);术后需输血治疗4例(0.7%),其中2例(0.3%)行数字减影血管造影栓塞止血;术后行胸腔穿刺引流患者4例(0.7%),无肺损伤、肾盂穿孔、腹腔脏器损伤等并发症,总体并发症率3.8%(22/581)。术后住院时间4～15d,平均(5.55±1.35)d。结论经肋上穿刺肾上盏入路单通道经皮肾镜治疗鹿角形肾结石的结石清除率高,但存在较高并发症发生的风险;在超声引导的配合下,可明显减少其并发症的发生,使该术式更加安全。

Objective To evaluate the safety and efficacy of ultrasound-guided one supracostal upper-calyx percutaneous access nephrolithotomy for staghorn stone. Methods A total of 581 patients with staghorn stone were treated with one supracostal upper calyx access percutaneous nephrolithotomy from October 2004 to October 2011. The maximal diameters of stone measured by plain abdominal radiography were 3.6 6.5 cm, with a mean of （5.10±0.82） cm. Target calyx was posterior upper-calyx,puncture point was selected in tenth or eleventh intercostal space as guided by ultrasound, and the F22-24 upper- calyx percutaneous access was established. 17F nephroscope and 70 W holmium laser were employed to crush the stones. The operation time, perioperative complications, and stone-free rate were recorded. Results The upper-calyx percutaneous access was established successfully in all patients. The mean operation time was （82.07±16.25） min （range 54 to 140 rain）. The stone- free rate was 85.4% （496/581） after firsvstage procedure. Fourteen patients （2.4%） had postoperative high fever, and 3 of them （0.5%） had infectious shock. Four patients received blood transfusion, and 2 of them underwent digital subtraction angiography to control bleeding. Four patients （0.7%） underwent thoracic drainage. There were no injuries to the lung, spleen, colon, or liver. The overall postoperative complication rate was 3.8 %. The mean postoperative hospital stay was （5.55 ± 1.35） days （ranging 4-15 days）. Conclusion One supracostal upper-calyx percutaneous access can achieve high stone-free rate in treating staghorn stone, but with relatively high risk of complications. Ultrasound-guided technique can greatly reduce complication, making the procedure safer.