超微经皮肾镜碎石取石术治疗26例肾结石的疗效分析

Effects of super-mini percutaneous nephrolithotomy in treatment of kidney stones:report of 26 cases

目的探讨超微经皮肾镜碎石取石术(SMP)治疗肾结石的适应证、安全性及疗效。方法回顾性分析2016年1月至2017年2月深圳市龙华区人民医院泌尿外科运用SMP治疗26例肾结石患者的临床资料。男18例,女8例,年龄28~60岁,平均年龄(44.0±2.8)岁。结石直径1.5~2.7 cm,平均(2.1±0.6)cm。其中结石位于肾下盏10例、肾中盏4例、肾盂10例、肾盂合并下盏2例。结果 25例一次完成SMP手术。1例需要体外冲击波碎石术(ESWL)辅助治疗,手术时间45~130 min。术后血红蛋白下降(13.5±8.4)g/L,均无需输血。其中,2例患者(7.7%)术后留置肾造瘘管(初期开展),5例患者(19.2%)因结石较大术后留置双J管(均初期开展),其余19例(73.1%)均未留置肾造瘘管及双J管。术后住院时间为2~5 d,均未出现发热及其他严重并发症。术后第1天和术后3个月的完全结石清除率分别为76%(20/26)和100%。结论 SMP治疗2 cm左右的肾结石安全、有效。

Objective To evaluate the clinical efficacy, indications and safety of super-mini percutaneous nephrolithotomy（SMP） in the treatment of kidney stones. Methods Clinical data of 26 patients with renal stones and treated by SMP in the People＇s Hospital of Longhua District Shenzhen from January 2016 to February 2017 were reviewed respectively. The study group was consisted of 18 males and 8 females, aged from 28 to 60 years and the mean age was（44.0 ±2.8） years. The diameters of stones ranged from 1.5 cm to 2.7 cm and the mean stone diameter was（2.1 ± 0.6） cm. The cases of stones in the subrenal calyx, midrenal calyx, renal pelvic and renal pelvic combined subrenal calyx were 10, 4, 10, 2, respectively. Results Twenty five patients were successfully managed by SMP at one time, and one patient needed the adjuvant therapy of the extracorporeal shock wave lithotripsy（ESWL）. The operative time ranged from 45 to 130 min. The mean hemoglobin drop was（13.5 ± 8.4） g/L and no transfusion was needed. There were 2 cases（7.7%） treated with nephrostomy tube after the operation and 5 cases（19.2%） treated with double J stent because of the larger renal stones（initial period） and the other 19 cases（73.1%） were not treated with nephrostomy tube or double J stent. The postoperative hospital stay ranged from 2 to 5 days and no serious complications occured. The stone-free rate（SFR） after 24 hours and 3 months were 76%（20/26） and 100%, respectively. Conclusion SMP is safe and effective for the management of renal stones about 2 cm.