经皮肾镜取石术治疗孤立肾肾结石合并肾功能不全患者的临床疗效分析

Clinical efficacy of percutaneous nephrolithotomy for the treatment of solitary kidney stones associated with renal insufficiency

目的:分析经皮肾镜取石术(PCNL)治疗孤立肾肾结石合并肾功能不全患者的临床疗效。方法:回顾性分析我院泌尿外科2015年1月~2017年2月行PCNL治疗的26例孤立肾肾结石合并肾功能不全患者的临床资料,包括患者基本信息、结石大小、通道大小及数量、手术时间、术后并发症、住院时间、结石清除率、肾功能等临床数据,并对其进行统计学分析。结果:26例手术均严格遵循经"目标盏穹隆-盏颈轴线"两步穿刺法建立经皮肾通道,手术在55~128(78.3±16.6)min内完成;单通道19例,双通道6例,三通道1例;术后住院天数8~12(9.6±1.3)d;一期结石清除率88.4%,需二期手术2例,总结石清除率96.2%;输血1例,无介入栓塞患者;术前血清肌酐96~312(152.46±27.15)μmol/L,术后1个月血清肌酐56~287(87.18±21.84)μmol/L,术前血红蛋白92~156(131.45±15.64)g/L,术后血红蛋白84~145(128.37±13.82)g/L,术前、术后1个月血清肌酐水平比较差异有统计学意义(P<0.05),术前、术后血红蛋白水平比较差异无统计学意义(P>0.05)。结论:严格遵循经"目标盏穹隆-盏颈轴线"两步穿刺法建立经皮肾通道是PCNL安全有效治疗孤立肾肾结石合并肾功能不全患者的保障之一。

Objective：To analyze and discuss the clinical efficacy of percutaneous nephrolithotomy for the treatment of solitary kidney calculi associated with renal insufficiency.Method：Between January 2015 and February 2017,26 patients with renal calculi and renal insufficiency in the solitary kidney were treated by PCNL in our hospital.The patients＇ information,the stone size,postoperative complications,renal function changes and so on were analyzed.Result：All 26 patients underwent PCNL following the two step puncture with the axis of renal fornix and the neck to set up the percutaneous renal channel.Surgery time was 55-128（78.3±16.6）min.Nineteen cases underwent PCNL through a single access tract,6 cases through two access tracts,1 case through three access tracts.Hospital stay was 8-12（9.6±1.3）days postoperatively.The stone removal rate in one session of PCNL was 88.4%,and 2 cases need second surgery.The total stone clearance rate was 96.2%.One case required blood transfusion and no interventional embolization was applied in any patient.Preoperative serum creatinine was 96-312（152.46±27.15）μmol/L and the end of one-month follow-up the serum creatinine was 56-287（87.18±21.84）μmol/L（P0.05）.Preoperative hemoglobin was 92-156（131.45±15.64）g/L,postoperative hemoglobin was 84-145（128.37±13.82）g/L（P0.05）.Conclusion：Following the two step puncture with the axis of renal fornix and the neck to set up the percutaneous renal channel is a safe and effective guarantee for the treatment of solitary kidney stones associated with renal insufficiency in PCNL.