Zeng Guohua, Zhao Zhijian, Wu Wenqi, Zhong Wen
Department of Urology, Minimally Invasive Surgery Center, First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology , Guangzhou , PR China.
Scand J Urol. 2014 Jun;48(3):295-300. doi: 10.3109/21681805.2013.852621. Epub 2013 Dec 18.
The aim of this study was to report a therapeutic approach comprising a combination of debulking single-tract percutaneous nephrolithotomy (PCNL) and subsequent retrograde intrarenal surgery (RIRS) for treatment of staghorn stones in patients with solitary kidney.
A retrospective review was undertaken of 56 patients with staghorn stones in a solitary kidney who underwent the above-mentioned combination therapy. PCNL was first performed for stone debulking and RIRS was then used to remove residual stones after an interval of 2-4 days. Data were collected on operative parameters, stone-free rate (SFR), complications and renal functions.
The staghorn stones had a mean stone burden of 2548 ± 1028 mm(2) (range 1438-3956 mm(2)). The SFR after 3 months was 89.3%. The overall blood transfusion rate was 7.1%. Complications were observed in nine patients (16.1%), including selective renal artery embolization, fever, gross haematuria and steinstrasse in one, two, three and three cases, respectively. At a mean follow-up of 31 months, available in 38 patients, kidney function was stable in 71%, improved in 26.3% and worsened in 2.7%, according to serum creatinine levels that remained within ±20%, or that increased or decreased outside this range. No patient required haemodialysis.
Combining single-tract PCNL with subsequent RIRS was an effective strategic option for treating staghorn stones in solitary kidneys. The method gave an excellent SFR, satisfactory preservation of renal function, reduced bleeding risk and potentially less morbidity than that associated with multiple-tract PCNL.
本研究旨在报告一种治疗方法，该方法包括减瘤单通道经皮肾镜取石术（PCNL）与后续逆行肾内手术（RIRS）相结合，用于治疗单肾鹿角形结石患者。
对56例接受上述联合治疗的单肾鹿角形结石患者进行回顾性分析。首先进行PCNL以减少结石体积，然后在2 - 4天的间隔后使用RIRS清除残余结石。收集手术参数、无石率（SFR）、并发症和肾功能的数据。
鹿角形结石的平均结石负荷为2548±1028 mm²（范围1438 - 3956 mm²）。3个月后的无石率为89.3%。总体输血率为7.1%。9例患者（16.1%）出现并发症，包括选择性肾动脉栓塞、发热、肉眼血尿和石街，分别为1例、2例、3例和3例。在平均随访31个月（38例患者可获得随访数据）时，根据血清肌酐水平保持在±20%以内、升高或降低超出此范围，71%的患者肾功能稳定，26.3%的患者肾功能改善，2.7%的患者肾功能恶化。无患者需要血液透析。
单通道PCNL与后续RIRS相结合是治疗单肾鹿角形结石的有效策略选择。该方法具有出色的无石率、令人满意的肾功能保留、降低出血风险以及与多通道PCNL相比潜在的更低发病率。
