多镜联合手术治疗马蹄肾结石的临床疗效观察

Efficacy and safety of simultaneous multiplex endoscopy for treatment of renal stones in horseshoe kidneys

目的:探讨多镜联合手术治疗马蹄肾结石的疗效和安全性。方法:回顾性分析北京清华长庚医院泌尿外科2016年1月—2020年7月采用多镜联合手术治疗16例马蹄肾结石患者资料:包括病例的人群特征、结石特征、多镜联合手术方式和手术结局。术后根据腹部CT评价结石清除率。结果:16例患者手术均顺利完成。6例双肾结石,10例单侧肾结石,共22例结石肾脏。右侧10例,左侧12例。单发结石4例,多发结石17例,鹿角状结石1例。结石平均最大径(36.0±15.3)mm。所有经皮肾镜手术为单通道。多镜联合术式:经皮肾镜联合顺行软镜18例,经皮肾镜联合逆行输尿管软镜3例,腹腔镜联合软镜和肾镜1例。平均手术时间(101.2±26.9)min。围手术期并发症4例:发热、泌尿系感染、输血各1例,1例术后假性动脉瘤形成局麻行超选择性肾动脉栓塞术。一期术后1个月结石清除率为77.3%(17/22)。随访有残石的5例患者,3例保守观察,另2例分别行逆行输尿管软镜术和体外冲击波碎石术,本组最终结石清除率为81.8%(18/22)。结论:多镜联合手术可以获得满意的结石清除率,并发症少,是马蹄肾结石安全且有效的治疗方法。

Objective:To assess the efficacy and safety of endoscopy combined with intrarenal surgery in the treatment of renal stones in horseshoe kidneys.Methods:From January 2016 to July 2020,in the department of urology,Beijing Tsinghua Changgung Hospital,the clinical results of 16 patients with horseshoe kidney were studied retrospectively.The patients’characteristics,stone characteristics,operation modes and outcomes of surgery were all well evaluated.The stone free rate was evaluated by abdominal CT after operation.Results:The operation of 16 patients were successfully completed.Six patients had stones in both kidneys,thus there were 22 pathological kidneys.Ten kidneys had stones in the right side,and twelve kidneys had left-sided stones.There were 4 cases of single stone,17 cases of multiple stones,and 1 case of staghorn stone.The maximum diameter of stones was(36.0±15.3)mm.All percutaneous nephrolithotomies were performed in a single tract and successfully completed in one procedure.Endoscopic combined intrarenal surgery included percutaneous nephroscope combined with antegrade flexible endoscope in 18 cases,percutaneous nephroscope combined with retrograde flexible ureteroscopy in 3 cases,and laparoscopy combined with flexible endoscope in 1 case.Perioperative complications occurred in 4 cases:fever in 1 case,urinary infection in 1 case,blood transfusion in 1 case,and superselective renal artery embolization in 1 case with pseudoaneurysm after operation.The stone free rate was 77.3%(17/22)one month after primary operation.Five cases with residual stones were followed up,and three cases were under conservative observation.One case underwent retrograde intrarenal surgery and achieved complete stone removal,and the other case underwent extracorporeal shock wave lithotripsy.The final stone free rate in the group was 81.8%(18/22).Conclusion:Simultaneous multiplex endoscopic surgery could increase the stone free rate,which could be safe and effective alternatives for renal stone removal in patients with horseshoe kidneys.