Raj Ganesh V, Auge Brian K, Weizer Alon Z, Denstedt John D, Watterson James D, Beiko Darren T, Assimos Dean G, Preminger Glenn M
Department of Urology, Duke University Medical Center, Durham, NC 27710, USA.
J Urol. 2003 Jul;170(1):48-51. doi: 10.1097/01.ju.0000067620.60404.2d.
Percutaneous treatment of patients with calculi in a horseshoe kidney can be challenging due to the altered anatomical relationship in the retroperitoneum. Therefore, we performed a multi-institutional review to assess the safety and efficacy of this minimally invasive technique.
Of 37 patients identified with calculi in a horseshoe kidney at 3 institutions 24 (65%) underwent percutaneous nephrolithotripsy as primary treatment. Average patient age was 48.4 years and 75% of the patients were male. In 3 patients with staghorn calculi mean stone size as measured by computed digitized stone surface area was 448 mm2. Mean followup was 5.8 months. The stone-free rate, complication rate, need for secondary intervention and stone composition were evaluated.
Renal access was obtained through an upper pole calix in 63% of the cases, a lower calix in 25% and a middle calix in 4%. Access location was not documented in 1 patient (4%). Of the 24 patients 21 (87.5%) were rendered stone-free after primary or second look procedures. Flexible nephroscopy was used in 84% of cases. Minor complications occurred in 4 patients (16.7%), whereas 3 (12.5%) experienced major complications, including significant bleeding necessitating early cessation, nephropleural fistula and pneumothorax. No deaths occurred as a result of this treatment choice. Stone analysis was available for 21 cases (87.5%). Calcium stones predominated (87.5%), followed by uric acid (9.5%) and struvite (4.8%).
Percutaneous treatment of patients with renal calculi in a horseshoe kidney is technically challenging, usually requiring upper pole access and flexible nephroscopy due to the altered anatomical relationships of the fused renal units. The success rate based on stone-free results and a relatively low incidence of major complications suggest that this minimally invasive management option is an effective means of stone management in this complex patient population.
由于马蹄肾患者后腹膜解剖关系改变，经皮治疗马蹄肾结石患者具有挑战性。因此，我们进行了一项多机构回顾性研究，以评估这种微创技术的安全性和有效性。
在3家机构中，共识别出37例马蹄肾结石患者，其中24例（65%）接受经皮肾镜取石术作为主要治疗方法。患者平均年龄为48.4岁，75%为男性。3例鹿角形结石患者，通过计算机数字化结石表面积测量的平均结石大小为448平方毫米。平均随访时间为5.8个月。评估了结石清除率、并发症发生率、二次干预需求及结石成分。
63%的病例通过上极肾盏建立肾通路，25%通过下极肾盏，4%通过中极肾盏。1例患者（4%）未记录通路位置。24例患者中，21例（87.5%）在初次或二次手术后结石清除。84%的病例使用了软性肾镜。4例患者（16.7%）发生轻微并发症，3例（12.5%）发生严重并发症，包括因大出血需提前终止手术、肾胸膜瘘和气胸。未因该治疗选择导致死亡。21例（87.5%）可进行结石分析。以钙结石为主（87.5%），其次为尿酸结石（9.5%）和鸟粪石结石（4.8%）。
经皮治疗马蹄肾肾结石在技术上具有挑战性，由于融合肾单位的解剖关系改变，通常需要通过上极通路和软性肾镜。基于结石清除结果的成功率和相对较低的严重并发症发生率表明，这种微创治疗方法是处理这类复杂患者肾结石的有效手段。
