经皮肾镜手术治疗上尿路结石合并脊柱畸形的临床分析

Percutaneous nephrolithotomy for patients with upper urinary tract calculi and spinal deformity

目的:探讨经皮肾镜手术治疗上尿路结石合并脊柱畸形的可行性、安全性及疗效。方法:15例患者,男8例,女7例,年龄41~69岁。所有病例均经CT平扫+增强或CTU检查明确诊断为上尿路结石,结石大小为(35±19)mm。合并脊柱侧凸10例,胸椎后凸2例,腰椎后凸3例。经皮肾镜手术时体位选择为俯卧位或侧卧位。定位方法采用B超实时引导下经皮肾穿刺,必要时建立2个以上通道。术中采用钬激光碎石术或气压弹道联合超声碎石取石术。结果:15例患者共实施19侧肾脏经皮肾镜手术。一期术中建立单通道15例,双通道4例。一期手术结石清除率为73.7%(14/19)。5侧肾脏残留结石中,2侧行二期经皮肾镜(PCNL)联合输尿管软镜(RIRS)钬激光碎石术,1侧行二期PCNL手术,术后复查KUB示3侧结石取净;2侧未进一步治疗。19侧肾脏经皮肾镜手术总的结石清除率为89.5%(17/19)。术后并发出血2例,发热3例,经保守治疗后好转。无感染性休克、腹腔脏器和大血管以及胸膜损伤等并发症发生。结论:上尿路结石合并脊柱畸形采用经皮肾镜手术治疗,创伤小、疗效确切、安全性高;B超实时引导穿刺安全有效,可以有效地避免腹腔内脏器官的损伤。

Objective: To explore the feasibility and safety of percutaneous nephrolithotomy(PCNL) for patients with upper urinary tract calculi and spinal deformity. Methods: A total of 15 patients(8 males, 7 females,age range: 41-69 years) with upper urinary tract calculi diagnosed by enhanced CT scanning or CTU were enrolled in the study. The average size of calculi was(35±19) mm. There were 10 cases of scoliosis,2 cases of thoracic kyphosis and 3 cases of lumbar kyphosis. Operative positions(prone or lateral supine position) were determined based on the different conditions of spinal deformity. Patients underwent ultrasonography-guided PCNL. Two or more percutaneous accesses were established when necessary. Holmium laser lithotripsy or pneumatic lithotripsy was used in the operation. Results: Among the 15 patients, PCNL was performed on 19 sides. Single percutaneous access was established in 15 cases, and 2 accesses in 4 cases. One-stage stone clearance rate was 73. 7%(14/19).Among the 5 cases with residual stones, 1 case underwent second-stage PCNL and 2 cases were given PCNL combined with flexible ureteroscopy(RIRS), and KUB showed the complete removal of calculi one month later; two patients were not treated thereafter. The total stone clearance rate was 89. 5%(17/19). Two patients developed hemorrhage after the operation and recovered after conservative treatment. Fever occurred in 3 cases. No other complications were found, such as septic shock, injuries of organs and great vessels in the abdominal cavity. Conclusions :Minimal invasive PCNL is effective and safe for the treatment of patients with upper urinary tract calculi and spine deformity. Ultrasonography-guided puncture is found to be effective and safe, and can effectively avoid the injuries of abdominal organs.