Rodrigues Netto N, Claro J de A, Ferreira U
Division of Urology, Hospital Israelita Albert Einstein, San Paulo, Brazil.
J Endourol. 1994 Jun;8(3):195-7. doi: 10.1089/end.1994.8.195.
Staghorn stones can be treated by percutaneous nephrolithotomy (PCNL) or by extracorporeal shockwave lithotripsy (SWL); however, the combination of the two techniques appears as the most frequent treatment. In a previous study, the investigators noted that staghorn calculi treated with PCNL monotherapy have a good clearance rate. Herein, we have reviewed 102 staghorn stones that underwent PCNL before (1984-1986) (Group 1; n = 51) and after (1987-1990) (Group 2; n = 45) the introduction of SWL. The stone burden has increased in both size and complexity: there were 27 complete staghorn calculi (60%) in Group 2 compared with 19 (37%) in Group 1. Despite the higher number of kidney punctures, blood urea nitrogen and serum creatinine measurements demonstrated improvement of renal function postoperatively. The stone-free rates were 78% and 89% and the retreatment rates 31% and 18% in Groups 1 and 2, respectively. Complications (29% and 38%) were a function of the technical factors that become more apparent in the more difficult cases. Our data support the concept that the surgeon should have no previous intention to use the lithotripter and, therefore, should try to remove the entire stone percutaneously safely and economically.
鹿角形结石可通过经皮肾镜取石术（PCNL）或体外冲击波碎石术（SWL）进行治疗；然而，两种技术联合使用似乎是最常用的治疗方法。在之前的一项研究中，研究人员指出，采用PCNL单一疗法治疗的鹿角形结石清除率良好。在此，我们回顾了102例接受PCNL治疗的鹿角形结石患者，其中1984 - 1986年（第1组；n = 51）和1987 - 1990年（第2组；n = 45）分别是在SWL引入之前和之后接受治疗的。结石负荷在大小和复杂性方面均有所增加：第2组有27例完全鹿角形结石（60%），而第1组为19例（37%）。尽管肾穿刺次数更多，但血尿素氮和血清肌酐测量结果显示术后肾功能有所改善。第1组和第2组的结石清除率分别为78%和89%，再次治疗率分别为31%和18%。并发症发生率（29%和38%）是技术因素作用的结果，在更困难的病例中表现得更为明显。我们的数据支持这样一种观念，即外科医生事先不应打算使用碎石机，因此，应尝试以安全且经济的方式经皮完全清除结石。
