二期微创经皮肾镜联合输尿管软镜处理孤立肾鹿角状结石

Second-staged minimally endoscopic combined intrarenal surgery for staghorn calculi in patients with solitary kidney

目的观察二期微创经皮肾镜取石术联合输尿管软镜治疗孤立肾鹿角状结石的安全性和有效性。方法回顾性分析2013年12月至2014年6月二期微创经皮肾镜取石术联合输尿管软镜治疗60例孤立肾鹿角型结石患者的临床资料。平均结石负荷(1 023.9±743.95)mm2。结果 I期均成功建立单通道碎石取石,二期联合手术顺利完成。1月结石清除率86.7%。总并发症率25%,4例输血,无介入。8例慢性肾功能不全(CKD)Ⅳ期患者恢复为Ⅲ期。术后1月的平均血肌酐为(130.99±47.32)μmol/L,明显低于术前的(177.16±84.12)μmol/L(P=0.024)。中位随访期12个月,患者的肾功能都保持稳定(P>0.05)。结论二期微创经皮肾镜取石术联合输尿管软镜治疗孤立肾鹿角状结石安全有效,结石清除率高,出血并发症少,对近远期肾功能影响小。

Objective To explore the safety and efficacy of second-staged minimally endoscopic combined intrarenal surgery（MECIS）in the treatment of staghorn calculi in solitary kidney.Methods The clinical data of 60 cases of staghorn calculi in solitary kidney treated during Oct.2013 and June 2014 were retrospectively analyzed.The mean diameter of stones was（1 023.9±743.95）mm2.Results In the first stage,one percutaneous access tract was established.In the second stage,MECIS was successfully performed.Blood transfusion was needed in 4 cases,and no intervention was needed.The overall rate of complications was 25%.One month after surgery,the stone free rate（SFR）was 86.7%.The stage Ⅳ chronic kidney disease（CKD）in 8 patients improved to stageⅢ.The mean Scr reduced from（177.16±84.12）to（130.99±47.32）μmol/L,（P=0.024）.During the median follow-up of 12 months,the renal function remained stable.Conclusions Second-staged MECIS is safe,feasible,and effective in the treatment of staghorn calculi in solitary kidney,with satisfactory SFR and fewer complications.The approach does not adversely affect renal function in short and long term.