ESWL术后即刻PCNL在无积水鹿角形肾结石中的临床应用

Clinical application of percutaneous nephrolithotomy for non-hydronephrotic staghorn renal calculi immediately after extracorporeal shock wave lithotripsy

目的探讨体外冲击波碎石(ESWL)术后即刻经皮肾镜取石(PCNL)治疗无积水鹿角形肾结石的可行性。方法回顾性分析徐州医科大学附属第三医院2008年1月至2016年7月采用ESWL术后即刻PCNL治疗的119例无积水鹿角形肾结石患者的临床资料,其中部分鹿角形肾结石86例,完全鹿角形肾结石33例,结石直径2.1~6.7 cm。采用对目标肾盏、与目标肾盏平行肾盏、分支细长肾盏内结石先行ESWL而后即刻PCNL治疗,对手术时间、出血量、清石率等结果进行分析。结果 119例131侧肾鹿角形结石中有126侧肾结石接受该治疗方案,均一期成功建立经皮肾脏通道并取石,118侧肾完成一期手术,8侧肾因故改二期手术。一期单通道取石108侧(85.7%),双通道取石18侧(14.3%);一期手术中有6例行二期手术,共14侧接受二期手术,取净8侧,一期结石取净率为78.6%(99/126),两期结石清除率为84.9%(107/126);手术时间60~210 min,平均103 min;术后输血5例,发热(>38.5℃)3例,尿外渗1例,均对症处理治愈,无内脏损伤。结论 ESWL术后即刻PCNL治疗无积水鹿角形肾结石具有疗效好、安全。

Objective To explore the feasibility of percutaneous nephrolithotomy（PCNL） in the treatment of nonhydronephrotic staghorn renal calculi immediately after extracorporeal shock wave lithotripsy（ESWL）. Methods The clinical data of 119 patients with non-hydronephrotic staghorn renal calculi who underwent PCNL immediately after ESWL from January 2008 to July 2016 in our hospital were reviewed retrospectively, including 86 cases of partial staghorn renal calculi and 33 cases of complete staghorn renal calculi. Stone diameter was 2.1-6.7 cm. Calculi in target renal calyces, parallel with the target renal calyces, and the slender branching renal calyces were treated with PCNL immediately after ESWL. The results of operation time, bleeding volume and stone clearance rate were analyzed. Results Of the 119 patients with131 cases of lateral staghorn renal calculi, 126 cases were treated with this treatment, all of which successfully established percutaneous renal channel in the first-stage operation and removed stones. 118 cases of unilateral kidney completed the first-stage operation, and the other 8 cases of one-side kidney changed to the second-stage surgery for some reason or other. 108 cases of renal stones（85.7%, 108/126） were removed in the first-stage operation by a single tract,compared to 18 cases（14.3%, 18/126） by a double tract. In the first-stage operation, 6 patients underwent a second-stage surgery, and a total of 14 cases of unilateral kidney underwent the second-stage surgery, with 8 sides removed stone. The stone clearance rate in the first-stage operation was 78.6%（99/126）, compared to overall 84.9%（107/126） in two stages of surgery. The operation time was 60~210 min with an average of 103 min. 5 cases of postoperative blood transfusion, 3 cases of fever（〉38.5℃） and 1 case of extravasation of urine were all cured by symptomatic treatment and no visceral injury. Conclusion The PCNL immediatly after ESWL for the treatment of non-hydronephrotic staghorn renal calculi has the advantage of good efficacy, safety and minimally invasive.