Trapeznikova M F, Urenkov S B, Dutov V V, Podoĭnitsin A A, Ivanov A E
Urologiia. 2009 Nov-Dec(6):3-7.
We studied efficacy of transcutaneous nephrolithotripsy (TNLT) in patients with urolithiasis and anomalous upper urinary tract. For two years we performed TNLT in 148 patients with complicated forms of urolithiasis and anomalous kidneys (age 18-86, 76 females and 72 males). The examination for urolithiasis has found different anomalies of the urinary tract in these patients: double pelvis and ureter (9 cases--6.1%), lumbar dystopy of the kideney (59 cases--39.9%), horseshoe kidney (12 cases--8.1%), solitary cyst of the kidney (43 cases--29.0%), parapelvic cysts (25 cases--16.9%). Extracorporeal shock-wave lithotripsy (ESWL) was conducted as first-line treatment in the other 139 patients with nephroliths under 1.5-2 cm in size who had the following anomalies of the urinary system: a solitary kidney (n=14), double pelvis and ureter (n=26), anomalous position of the kidney (n=46), anomalous shape of the kidney (n=20), simple and parapelvic cysts (n=33). A total of 154 TNLT were performed in 148 patients. Transcutaneous interventions were most frequent in the treatment of coral (31.3%) and pelvoureteral (14.6%) concrements, one-stage operation was made in 143 patients. Transcutaneous puncture nephrostomy as the first stage was made in 5 patients. The concrements were removed by one operative intervention in 132 (89.2%) out of 148 patients. Exacerbation of pyelonephritis as a postoperative complication was treated conservatively in 12.5% patients. Residual fragments were diagnosed in 16 patients. Of them, 11 patients had multiple and 5 patients had coral concrements. Residual fragments were removed in 14 patients either by renephroscopy or by ESWL. Treatment of 139 patients with concrements less than 1.5-3 cm in size consisted in 197 ESWL sessions. In combination of anomaly and urolithiasis the number of lithotripsy sessions per one patient was 1.8 +/- 0.2. The least number of ESWL sessions per one patient was conducted in patients with lumbar dystopy of the kidney (1.3 +/- 0.45), the greatest number in horseshoe kidney (3.8 +/- 0.8). Evacuation of the concrements after ESWL depended on the type of anomaly and concrement location. It was 61-69% in patients with anomaly of the shape and position of the kidney, in cystic anomalies is was 89-91%. Open surgery was indicated in 7 patients who needed plastic surgery of hydronephrosis (4) and obstructive megaureter (3). Thus, low-invasive operations provide high efficacy of urolith removal in patients with anomalies of the urinary tract and can replace traumatic open operations.
我们研究了经皮肾镜碎石术（TNLT）治疗尿路结石合并上尿路异常患者的疗效。两年来，我们对148例患有复杂型尿路结石和肾脏异常的患者（年龄18 - 86岁，女性76例，男性72例）实施了经皮肾镜碎石术。尿路结石检查发现这些患者存在不同的尿路异常：重复肾盂和输尿管（9例，占6.1%）、肾脏低位（59例，占39.9%）、马蹄肾（12例，占8.1%）、肾孤立性囊肿（43例，占29.0%）、肾盂旁囊肿（25例，占16.9%）。另外139例肾结石直径在1.5 - 2 cm以下且存在以下泌尿系统异常的患者接受了体外冲击波碎石术（ESWL）作为一线治疗：孤立肾（14例）、重复肾盂和输尿管（26例）、肾脏位置异常（46例）、肾脏形态异常（20例）、单纯性和肾盂旁囊肿（33例）。148例患者共进行了154次经皮肾镜碎石术。经皮干预在治疗珊瑚状结石（31.3%）和肾盂输尿管结石（14.6%）时最为常见，143例患者接受了一期手术。5例患者以经皮穿刺肾造瘘作为第一阶段。148例患者中有132例（89.2%）通过一次手术干预清除了结石。12.5%的患者术后肾盂肾炎加重采用保守治疗。16例患者被诊断有残留碎片。其中，11例患者有多发碎片，5例患者有珊瑚状结石。14例患者通过肾镜检查或体外冲击波碎石术清除了残留碎片。139例结石直径小于1.5 - 3 cm的患者接受了197次体外冲击波碎石术。尿路异常合并尿路结石时，每位患者的碎石次数为1.8±0.2次。每位患者接受体外冲击波碎石术次数最少的是肾脏低位患者（1.3±0.45次），最多的是马蹄肾患者（3.8±0.8次）。体外冲击波碎石术后结石清除情况取决于异常类型和结石位置。肾脏形态和位置异常的患者结石清除率为61 - 69%，囊性异常患者的结石清除率为89 - 91%。7例需要肾盂积水整形手术（4例）和梗阻性巨输尿管整形手术（3例）的患者接受了开放手术。因此，低侵入性手术在尿路异常患者中具有较高的尿路结石清除疗效，可替代创伤性开放手术。
