Srivastava A, Gupta P, Chaturvedi S, Singh P, Kapoor R, Dubey D, Kumar A
Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. anees772000 @ yahoo.com
Urol Int. 2010;85(1):37-41. doi: 10.1159/000315471. Epub 2010 May 27.
To assess the feasibility, safety and results of percutaneous nephrolithotomy (PNL) in ectopically located kidneys and in patients with musculoskeletal deformities.
Thirteen such patients underwent PNL between June 2005 and May 2008. Mean stone size was 27.4 mm (16-37 mm). Six patients had severe kyphoscoliosis, 2 patients each had achondroplasia, cross-fused ectopia and pelvic ectopic kidney, and 1 patient had thoracic kidney. All had a preoperative CT scan of the abdomen. Preoperative ultrasound- or CT-guided percutaneous nephrostomy (PCN) was done in 10 patients. Three patients underwent laparoscopic-assisted PNL. All underwent standard PNL. The stone-free rate, complication rate and need for secondary intervention were evaluated.
PNL was successfully completed in all. A second ultrasound-guided intraoperative puncture was required in 2 patients. Re-look PNL was required in 1 patient and the same patient later required shock wave lithotripsy for complete stone clearance. The remaining 12 patients (92.3%) were rendered stone-free in a single sitting.
PNL is a feasible and effective modality in anomalous kidneys. Preoperative planning with CT and image-guided PCN is helpful in these situations. Laparoscopic-assisted PNL can be safely performed in patients where access to a renal collecting system by fluoroscopy or image-guided assistance (ultrasound or CT scan) is not possible.
评估经皮肾镜取石术（PNL）在异位肾及合并肌肉骨骼畸形患者中的可行性、安全性及疗效。
2005年6月至2008年5月期间，13例此类患者接受了PNL治疗。结石平均大小为27.4mm（16 - 37mm）。6例患者患有严重脊柱侧凸，2例分别患有软骨发育不全、交叉融合异位肾和盆腔异位肾，1例患有胸内肾。所有患者术前行腹部CT扫描。10例患者术前行超声或CT引导下经皮肾造瘘术（PCN）。3例患者接受了腹腔镜辅助PNL。所有患者均接受标准PNL。评估结石清除率、并发症发生率及二次干预需求。
所有患者PNL均成功完成。2例患者术中需再次超声引导穿刺。1例患者需再次行PNL，该患者随后还需冲击波碎石术以完全清除结石。其余12例患者（92.3%）单次手术即实现结石清除。
PNL在异常肾脏中是一种可行且有效的治疗方式。在这些情况下，术前CT规划及影像引导下的PCN很有帮助。对于无法通过荧光透视或影像引导辅助（超声或CT扫描）进入肾集合系统的患者，可安全地进行腹腔镜辅助PNL。
