微创经皮肾镜取石术治疗无肾积水的铸型肾结石

[Mini-percutaneous nephrolithotomy in the treatment of un-hydronephrotic cata-staghorn renal calculi].

作者信息

Gao Ning, Chen He-Qun, Qi Lin, Yang Zhong-Qing, Qi Fan, Zhang Xiang-Yang

机构信息

Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China.

出版信息

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2007 Aug;32(4):718-22.

PMID:17767074

Abstract

OBJECTIVE

To evaluate the surgical techniques and clinical effects of mini-percutaneous nephrolithotomy (mini-PCNL) in the treatment of un-hydronephrotic cata-staghorn renal calculi.

METHODS

The clinical data of 46 cases (31 males and 15 females) treated by mini-PCNL were retrospectively analyzed. There were mono-renal calculi in 38 patients (3 patients were the isolated renal calculi) while the other 8 combined opposite side upper urinary tract calculi. The diameter of calculi ranged from 4.2 to 6.4 (mean=5.2) cm. Puncturation was guided by B-type ultrasound. Lithotripsy by air pressure path lithotripter and/or holmium laser was done when the pervium was established.

RESULTS

The pervium in the 46 patients was successfully established by one-session puncturation with B-type ultrasonography guidance. The operative time ranged from 140 to 280 (mean=190) min. The amount of blood ranged from 50 to 200 (mean=100) mL and no one needed blood transfusion. Calculus was completely removed in 18 patients (39.1%). Calculi in 10 patients (21.7%) were completely removed among the 20 patients who underwent second-look mini-PCNL. Calculi in 1 of the 3 cases were completely removed by third-look mini-PCNL. Left-over calculi in 17 patients (8 patients after the first time mini-PCNL, 7 patients after second-look, and 2 patients after third-look) were treated by extracorporeal shock-wave lithotripsy (ESWL) and 8 were removed completely. All the 46 patients were followed up for 4 to 48 months. None of them had nephro-hydrops or stenosis. Renal function re-investigation showed that 8 patients recovered and 2 improved in the 10 patients who had azotemia before. Two (5.4%, 2/37) had calculus recurrence in 37 cases which calculi were completely removed before. The size and amount of left-over calculi in 3 patients (33.3%, 3/9) were increasing.

CONCLUSION

Mini-PCNL is effective and causes less trauma for un-hydronephrotic cata-staghorn renal calculi. Mini-PCNL combined ESWL may substitute the open operation and is the preferred method for un-hydronephrotic renal cata-staghorn calculi.

摘要

目的

评估微创经皮肾镜取石术（mini-PCNL）治疗非积水性鹿角形肾结石的手术技巧及临床效果。

方法

回顾性分析46例（男31例，女15例）接受mini-PCNL治疗的临床资料。38例为单肾结石（3例为孤立肾结石），另8例合并对侧上尿路结石。结石直径4.2～6.4（平均5.2）cm。在B型超声引导下进行穿刺。建立经皮肾通道后，采用气压弹道碎石机和/或钬激光碎石。

结果

46例患者均在B型超声引导下一次穿刺成功建立经皮肾通道。手术时间140～280（平均190）分钟。出血量50～200（平均100）ml，无1例需要输血。18例（39.1%）结石完全清除。20例行二期mini-PCNL的患者中，10例（21.7%）结石完全清除。3例中的1例行三期mini-PCNL结石完全清除。17例残留结石患者（首次mini-PCNL后8例，二期后7例，三期后2例）采用体外冲击波碎石术（ESWL）治疗，8例结石完全清除。46例患者均随访4～48个月。无一例发生肾积水或狭窄。肾功能复查显示，术前有氮质血症的10例患者中，8例恢复，2例改善。37例结石完全清除的患者中，2例（5.4%，2/37）结石复发。3例（33.3%，3/9）残留结石的大小和数量增加。