马蹄肾合并结石的微创治疗

Minimally invasive treatment of horseshoe kidney with stones

目的:分析输尿管软镜手术治疗马蹄肾合并结石的疗效和安全性。方法:回顾性分析2009年5月至2018年1月宜宾市第三人民医院收治的21例马蹄肾合并肾结石患者的临床资料。7例行体外冲震波碎石术(ESWL),14例行输尿管软镜碎石取石术(FURL)。结果:7例ESWL术后1月排石率71.4%(5/7);FURL术后1月结石清除率78.6%(11/14)。FURL术后5年复发率35.7%(5/14),术后2 d发现输尿管石街1例,行输尿管硬镜取石术(URL),2例术后2年结石复发再次行FURL术。14例FURL术中、术后无大出血、无输尿管损伤,无气胸。结论:FURL具有微创、可重复取石的特点,特别适用于马蹄肾合并肾结石患者,手术安全、有效,并发症低,对复发病例,也可再次行MPCNL。

Objective:To determine the efficacy and safety of flexible ureteroscopy in the treatment of horseshoe kidney with stones.Methods:The clinical data of 21 patients with horseshoe kidney and kidney stones treated between May 2009 and January 2018 were included in the study,including 16(76.2%) males,and 5(23.8%) females,with an average of 47.23±11.50 years old.The average stone surface area was 109±45 mm2.Seven patients underwent extracorporeal shock wave lithotripsy(ESWL) and 14 patients underwent flexible ureteroscopic lithotripsy(FURL).The average postoperative follow-up time was 3 years and the longest was 6 years.Results:The stone discharge rate was 71.4%(5/7) at 1 month after ESWL.The stone clearance rate was78.6%(11/14) at1 month after FURL.The recurrence rate was 35.7%(5/14) at 5 years after FURL.One case of ureteral stone was found at 2 days after the operation,and the ureteroscopic lithotripsy(URL) was performed.Two patients with recurrence of stones at 2 years after the operation underwent FURL again.There were no major bleeding,ureteral injury,and pneumothorax in 14 FURL cases during and after the operation.Conclusion:FURL is advantageous in minimal invasiveness and repeatable stone removal,and therefore especially suitable for patients with horseshoe kidney and kidney stones,with reliable safety,good efficacy and few complications.MPCNL can be performed again for recurrent cases.