Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota, USA.
J Urol. 2010 Jan;183(1):183-7. doi: 10.1016/j.juro.2009.08.141.
Percutaneous nephrolithotomy is standard therapy for upper tract calculi larger than 2 cm. However, the role of percutaneous nephrolithotomy in patients with autosomal dominant polycystic kidney disease has not been well evaluated. We report our experience with percutaneous nephrolithotomy in patients with autosomal dominant polycystic kidney disease.
We retrospectively reviewed the charts of all patients with autosomal dominant polycystic kidney disease and subsequent renal calculi managed by percutaneous nephrolithotomy from October 1981 to the present.
We identified 9 patients. Percutaneous nephrolithotomy was performed in 11 kidneys. Flank pain was the presenting symptom in 6 patients. Average stone burden was 2.5 cm (range 1.6 to 3.6). Two access tracts were necessary in 5 kidneys. No intraoperative complications occurred. In 2 kidneys a second stage endoscopic procedure with ultrasonic lithotripsy was required to achieve stone-free status. Nephrostogram 24 hours after the final procedure showed no residual stone fragments in 9 of 11 kidneys (82%). The remaining 2 patients underwent percutaneous basket extraction to render them stone-free. There were no postoperative complications or recurrent stones. No patient required blood transfusion. Mean followup was 2.7 years (range 0.3 to 4). Mean calculated creatinine clearance was stable at 85.6 (range 45.9 to 126.6) and 89.5 mg/dl per minute (range 39.6 to 126.6) preoperatively and at last followup, respectively (p = 0.783).
Autosomal dominant polycystic kidney disease increased operative complexity, the need for multiple percutaneous access tracts and the likelihood of repeat endoscopy. Despite the altered anatomy percutaneous nephrolithotomy was a safe, efficacious approach for autosomal dominant polycystic kidney disease. At last followup there was no stone recurrence and renal function was stable.
经皮肾镜取石术是治疗大于 2cm 的上尿路结石的标准治疗方法。然而，经皮肾镜取石术在常染色体显性多囊肾病患者中的作用尚未得到很好的评估。我们报告了我们在常染色体显性多囊肾病患者中经皮肾镜取石术的经验。
我们回顾性分析了 1981 年 10 月至目前所有接受经皮肾镜取石术治疗的常染色体显性多囊肾病和随后发生肾结石的患者的病历。
我们共确定了 9 例患者。11 个肾脏进行了经皮肾镜取石术。6 例患者的首发症状为腰痛。平均结石负荷为 2.5cm（范围 1.6 至 3.6）。5 个肾脏需要 2 个通道。无术中并发症发生。2 个肾脏需要进行第 2 阶段的内镜下超声碎石术以达到无结石状态。最后一次手术后 24 小时的尿路造影显示 11 个肾脏中的 9 个（82%）无残余结石碎片。另外 2 例患者接受了经皮篮筐提取以达到无结石状态。无术后并发症或结石复发。无患者需要输血。平均随访时间为 2.7 年（范围 0.3 至 4 年）。术前和最后一次随访时的平均估算肾小球滤过率分别为 85.6（范围 45.9 至 126.6）和 89.5mg/dl/min（范围 39.6 至 126.6）（p=0.783）。
常染色体显性多囊肾病增加了手术复杂性、需要多次经皮肾通道和重复内镜检查的可能性。尽管解剖结构改变，经皮肾镜取石术仍是一种安全、有效的常染色体显性多囊肾病治疗方法。最后一次随访时无结石复发，肾功能稳定。
