Takao M, Kimura F, Matsuzaki S, Murai M, Nakamura H
Department of Urology, National Defense Medical College, Saitama, Japan.
Nihon Jinzo Gakkai Shi. 1991 Mar;33(3):321-6.
Two patients with renal pelvic stone in a horseshoe kidney who underwent a percutaneous nephrolithotripsy (PNL) are presented. Case 1 was a 36-year-old man with a 20 x 12 mm right renal pelvic stone in a horseshoe kidney. Case 2 was a 47-year-old man who had been followed up at our clinic for a horseshoe kidney and was found to have a 15 x 10 mm left renal pelvic stone. We found that percutaneous removal of renal pelvic stones can be performed safely in a horseshoe kidney. It appears that to remove stones from the renal pelvis in a horseshoe kidney 4 items must be considered. 1) The anatomical relationships of the horseshoe kidney to other viscera and blood vessels should be confirmed before surgery utilizing computerized tomography or ultrasound sonography. 2) The occlusion ureteral catheter should be inserted up to the renal pelvis to prevent small fragments from falling into the ureter. 3) The rigid nephroscopy should be introduced through the most appropriate calyx, so that its manipulation could be limited. 4) The fragmentation of stones should be performed from the peripheral surface of a stone to prevent from migrating into another calyx. We believe this is only the sixth and seventh documented cases involving a horseshoe kidney.
本文介绍了两名马蹄肾合并肾盂结石患者接受经皮肾镜取石术（PNL）的情况。病例1为一名36岁男性，马蹄肾合并右肾盂结石，大小为20×12mm。病例2为一名47岁男性，因马蹄肾在我院随访，发现左肾盂结石，大小为15×10mm。我们发现经皮肾盂取石术在马蹄肾中可安全进行。似乎要在马蹄肾中取出肾盂结石，必须考虑4个因素。1）术前应利用计算机断层扫描或超声检查确认马蹄肾与其他内脏和血管的解剖关系。2）应将输尿管阻塞导管插入肾盂，以防止小结石碎片落入输尿管。3）应通过最合适的肾盏插入硬性肾镜，以便限制其操作。4）结石破碎应从结石外周表面开始，以防止结石移入另一肾盏。我们认为这仅是第六和第七例有文献记载的涉及马蹄肾的病例。
