Cussenot O, Desgrandchamps F, Ollier P, Teillac P, Le Duc A
Service d'Urologie, Hôpital Saint Louis, Paris, France.
Surg Radiol Anat. 1992;14(3):209-13. doi: 10.1007/BF01794940.
Horseshoe kidney is a renal fusion which combines three anatomic abnormalities: ectopia, malrotation and vascular changes. These anomalies can be recognised separately to varying degrees in unfused kidneys. Necessary modifications of the standard technique for percutaneous nephrolithotomy (PNL) are directly deducible from analysis of the anatomic data of the imaging of horseshoe kidneys. We report our experience with 5 patients (7 kidneys) who underwent PNL for calculi in horseshoe kidneys. The percutaneous approach was performed under ultrasound and fluoroscopic monitoring. In situ disintegration by ultrasonic lithotripsy and nephrostomy drainage were necessary in all cases. Modifications of the standard PNL procedure are related to the anatomic changes. The lower abdominal position of a horseshoe kidney necessitates upper or middle calyceal puncture, while the malrotation necessitates a more posterior puncture. Monitoring of the puncture needle by fluoroscopy as it is advanced postero-anteriorly is more difficult and the risk of the surgeon's hand entering the radiation path is increased. The renal pelvis is deep and a long endoscope may be required. Aberrant segmental vessels may create potential hazards. The majority of problems in location can be avoided by use of an ultrasonically guided needle. Percutaneous nephrolithotomy is the treatment of choice for calculi in horseshoe kidneys for the following reasons: the high incidence of recurrent lithiasis in horseshoe kidney and the complexity of repeated surgical approaches diminish the acceptable results of open surgery; difficulties in focussing on the calculi and drainage problems militate against the success of extracorporeal shock wave lithotripsy (ESWL); PNL has a good success rate and the least morbidity.
马蹄肾是一种肾脏融合畸形，合并三种解剖学异常：异位、旋转不良和血管改变。这些异常在未融合的肾脏中可不同程度地分别识别。经皮肾镜取石术（PNL）标准技术的必要改进可直接从马蹄肾影像学解剖数据的分析中推导得出。我们报告了5例（7个肾脏）因马蹄肾结石接受PNL治疗患者的经验。经皮穿刺在超声和荧光透视监测下进行。所有病例均需要超声碎石原位碎石及肾造瘘引流。标准PNL操作的改进与解剖学改变有关。马蹄肾位于下腹部需要穿刺上盏或中盏，而旋转不良需要更靠后的穿刺。在荧光透视下监测穿刺针向后向前推进时更困难，且术者手部进入辐射路径的风险增加。肾盂较深，可能需要使用长内镜。异常的节段性血管可能带来潜在风险。通过使用超声引导针可避免大多数定位问题。经皮肾镜取石术是马蹄肾结石的首选治疗方法，原因如下：马蹄肾复发性结石的发生率高，重复手术入路的复杂性降低了开放手术的可接受效果；聚焦结石困难和引流问题不利于体外冲击波碎石术（ESWL）的成功；PNL成功率高且发病率最低。
