微创经皮肾镜治疗多囊肾合并肾结石的疗效分析

Minimally invasive percutaneous nephrolithotomy in patients with autosomal dominant polycystic kidney disease and renal stone

目的探讨超声引导下微创经皮肾镜碎石取石术(MPCNL)治疗多囊肾合并肾结石的安全性及疗效。方法回顾性分析梅州市人民医院自2006年1月至2015年12月采用超声引导下MPCNL治疗多囊肾合并肾结石的临床资料。结果共计有26例患者纳入研究,1例双侧结石,25例单侧结石,均成功建立了经皮肾通道。25例患者行一期MPCNL,1例患者行二期MPCNL,术后2~5 d复查无石率88.9%(24/27),3例残留结石患者行体外冲击波碎石术(ESWL)治疗。手术时间20~140 min,平均(68±34)min,术中失血量10~250 ml,平均(57±49)ml。术前、术后平均血肌酐为(292±51)μmol/L、(220±34)μmol/L(t=2.388,P=0.025)。术后2例患者出现发热,4例患者接受输血治疗,无其他明显并发症。术后平均住院时间(6.8±2.4)d。随访10~24个月,结石均无复发,2例患者最终需血液透析维持治疗,其余患者肾功能稳定。结论 MPCNL治疗多囊肾合并肾结石是安全、有效的,但多囊肾可增加手术难度及并发症。

Objective To evaluate the safety and efficacy of minimally invasive percutaneous nephrolithotomy（MPCNL） in patients with autosomal dominant polycystic kidney disease（ADPKD） and renal stone. Methods The clinical data of patients with ADPKD and renal stone who underwent MPCNL in our hospital between January 2006 and December 2015 were analyzed retrospectively. Results twentyseven renal units in 26 patients were included in our study. Twenty-five patients were performed in one stage MPCNL and one patient underwent second-stage MPCNL. The overall stone clearance rate was 88.9%（24/27）. Three patients received ESWL because of residual calculi. The mean operation time was（68±34） min（range 20～140 min） and the mean blood loss was（57±49） ml（range 10～250 ml）. The mean preoperative creatinine（Cr） and postoperative Cr level were（292±51） μmol/L and（219.8±33.6） μmol/L,（t=2.388, P=0.025）. Two cases had fever postoperatively and four cases received blood transfusion because of hemorrhage. Conclusion MPCNL is a safe and effective approach for management of renal calculi in patients wih ADPKD.