经皮肾镜取石术治疗多囊肾并肾结石12例报告

Percutaneous nephrolithotomy for management of renal calculi in autosomal dominant polycystic kidney disease(Report of 12 cases)

目的：探讨B超结合X线引导经皮肾镜取石术（PCNL）治疗多囊肾并肾结石的可行性及安全性。方法：2009年9月～2013年9月吗,广西医科大学第一附属医院及解放军303医院应用PCNL治疗多囊肾并肾结石患者合计12例。结果：12例患者肾脏均成功建立经皮肾通道,无中转开放手术者,无严重并发症发生。术后1～7天复查无石率91.7%（11/12）。1例残留结石行ESWL治疗。手术时间50～140min,平均（95.3±30.9）min;术中出血量10～200ml,平均（97.5±69.8）ml。术前术后血清肌酐均值分别为（165.71±46.32）μmol/L及（139.43±32.63）μmol/L,差异无统计学意义（P=0.223）。7例肾功能不全患者术后血清肌酐水平均有不同程度恢复,其中3例恢复至正常水平。术后住院时间4～7d,平均（5.67±1.15）d10随访5～24个月,无结石复发,肾功能稳定。结论：PCNL治疗多囊肾并肾结石是有效的、安全的。

Objective： To evaluate the feasibility and safety of percutaneous nephrolithotomy （PCNL） in management of the patients with autosomal dominant polycystic kidney disease （ADPKD） and associated nephrolithiasis. Method： We retrospectively reviewed the charts of 12 patients with ADPKD and associated renal calculi man- aged by PCNL from September 2009 to September 2013 at two centers. Result： Percutaneous access tracts were established successfully in all of the 12 kidneys without conversion to open surgery. No patient experience serious complication. The overall stone free rate was 91.7 % （11/12） one week after operation. One patient received ES WL because of residual calculi. The mean operation time was 50-140 （95.3±30.9） rain and the mean blood loss was 10-200 （97.5±69.8） ml. The mean preoperative serum creatinine was 68-239 （165.71±46.32） /1tool/L, and the mean postoperative serum creatinine was 65-203 （139.43±32.63） μmol/L. Statistical comparison showed that PCNL had no impact on perioperative renal function （ P 0. 223）. Serum creatinine of the seven patients with re nal insufficiency improved after operation, of which three cases returned to normal. The mean postoperative hospi- tal stay was 4-7 （5.67±1.15） days. No calculi recurrence or renal function deterioration was noted over the fol- low-up period of 5-24 months. Conelusiom PCNL was a safe and effective approach for management of renal calcu li in ADPKD.