微通道经皮肾镜取石术治疗马蹄肾肾结石

Minimally invasive percutaneous nephrolithotomy in treatment of renal calculi in patients with horseshoe kidney

目的探讨微通道经皮肾镜取石术(MPCNL)治疗马蹄肾肾结石的安全性和有效性。方法回顾性分析2008年4月—2012年4月期间我院接受微通道经皮肾镜取石术治疗的16例马蹄肾结石患者,其中男性患者12例,女性4例。年龄17~58岁,平均41岁。结石大小1.0 cm×2.0 cm^2.5 cm×3.9 cm。所有病例术前均行静脉尿路造影以及行CT尿路成像(CTU)明确诊断。B超引导穿刺目标肾盏建立微通道(F16),输尿管镜下钬激光碎石取石,术后留置肾造瘘管和双J管。结果所有患者均成功建立经皮肾穿刺通道并一期碎石,一期结石清除率为68.75%(11/16),3例二期取石。2例患者术后辅助体外震波碎石(ESWL)。单通道患者14例,双通道患者2例,其中经上盏通道10例,中盏通道6例,下盏通道2例。平均手术时间90 min(40~120 min),术中平均出血量100 ml(40~300 ml)。围手术期无输血,围手术感染患者2例,无气胸、腹腔脏器损伤等并发症。所有患者术后随访6~24个月,术后6个月结石复发1例。结论微通道经皮肾镜取石术是治疗马蹄肾结石安全有效的方法 。

Objective To evaluate the safety and efficacy of minimally invasive percutaneous nephrolithotomy （MPCNL） in treatment of renal calculi in patients with horseshoe kidney. Methods Clinical data of 16 patients with horseshoe kidneys, who underwent MPCNL for renal calculi from April 2008 to April 2012 were retrospectively reviewed. Among 16 patients, there were 8 cases with single calculus,7 cases with multiple calculi and 1 case with staghorn calculi. Results All operations were completed in one session. Single tract was established in 14 kidneys, while double tracts were used in 2 cases. Nine tracts were made through the upper calyx,5 through the middle calyx and 2 through the lower calyx. The mean operation time was 90 min （40 - 120 rain）. The stone-free rate after one-session operation was 68.75% （11/16）,3 cases received a second-session PCNL to remove the residual calculi. After the operation, none of them received blood transfusion. The rate of postoperative surgery-related infection was 12.5% （2/16）. No pleural or abdominal injury occurred. Fourteen patients were followed up for 6 - 24 months. The rate of recurrence at 6 months was 6.25 % （1/16）. Conclusion Minimally invasive percutaneous nephrolithotomy is safe and effective in treatment of renal calculi in patients with horseshoe kidney.