Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University , Guangzhou, Guangdong, China .
J Endourol. 2014 Jan;28(1):17-22. doi: 10.1089/end.2013.0443. Epub 2013 Oct 4.
To review our experience of using minimally invasive percutaneous nephrolithotomy (MPCNL) in patients with autosomal dominant polycystic kidney disease (ADPKD).
We retrospectively reviewed 23 renal units in 23 patients with ADPKD who underwent MPCNL in our center between January 2007 and December 2012. The data on the stone burden, stone locations, patient characteristics, complications according to the modified Clavien system, and stone-free rates (SFR) were analyzed.
The mean stone area (±standard deviation) was 1382.87±1080.17 mm2. There were 10 (43.5%) staghorn stones. Flank pain was noted in 87% of the cases. SFR after initial MPCNL was 69.6% (16/23 renal units). Of the remaining seven renal units, six underwent second-look MPCNL and were rendered stone free, a 95.7% final SFR. Clavien grade I or II complications occurred in nine patients and were managed conservatively. One case needed selective arterial embolization for severe bleeding. There was no deterioration of renal function noted. The mean preoperative creatinine (Cr) and postoperative Cr concentrations were 148.17 μmol/L and 149.24 μmol/L (P=0.48).
The MPCNL was a safe and effective treatment for upper urinary tract stones in patients with ADPKD, even in patients with staghorn stone. It provided excellent SFR without compromising renal function. This procedure could be considered as a first-line treatment option for patients with ADPKD who have a large stone burden.
回顾我们使用微创经皮肾镜取石术（MPCNL）治疗常染色体显性多囊肾病（ADPKD）患者的经验。
我们回顾性分析了 2007 年 1 月至 2012 年 12 月期间在我院接受 MPCNL 的 23 例 ADPKD 患者的 23 个肾脏单位的数据。分析了结石负荷、结石位置、患者特征、根据改良 Clavien 系统的并发症以及无结石率（SFR）。
平均结石面积（±标准差）为 1382.87±1080.17mm2。有 10 例（43.5%）鹿角结石。87%的病例出现腰部疼痛。初始 MPCNL 后的 SFR 为 69.6%（23 个肾脏单位中的 16 个）。其余 7 个肾脏单位中，有 6 个接受了二次 MPCNL 并清除了结石，最终 SFR 为 95.7%。9 例患者出现 Clavien 1 或 2 级并发症，经保守治疗。1 例因严重出血需要选择性动脉栓塞。未发现肾功能恶化。术前肌酐（Cr）和术后 Cr 浓度的平均值分别为 148.17μmol/L 和 149.24μmol/L（P=0.48）。
MPCNL 是治疗 ADPKD 患者上尿路结石的一种安全有效的方法，即使是鹿角结石患者也是如此。它提供了极好的 SFR，而不会损害肾功能。对于有大结石负荷的 ADPKD 患者，该手术可作为一线治疗选择。
