Castillo Rodríguez M, Larrea Masvidal E, García Serrano C, Hernández Siverio D, Valdés Gómez C, Báez Hernández D, Ramírez Hernández L
Centro de tratamiento de Litiásis Urinaria, Hospital Clínico Quirúrgico Hnos. Ameijeiras, La Habana, Cuba.
Arch Esp Urol. 1993 Oct;46(8):699-706.
We present our experience in 61 patients with partial or complete staghorn stone who underwent combined treatment with PCN and ESWL. We excluded the cases with an additional factor complicating staghorn stone, such as horseshoe kidney, severe ectopic, mal-rotated or high, with pyeloureteral junction stricture, etc. The patients were submitted to 72 PCN and 113 ESWL sessions, 5 percutaneous nephrostomies prior to PCN and 5 ureteroscopy procedures to remove post-ESWL obstruction. Complications were observed in 24.5%; acute urinary infection post-PCN (13 patients, 21.3%), massive absorption of liquid (1 case) and arteriovenous fistula (1 case). One year following treatment 83.6% of the patients are stone free and 14.9% have residual stone fragments. No patients developed arterial hypertension and one patient was submitted to nephrectomy due to pyelonephritic atrophy. Our criteria concerning the indications for the different therapeutic methods are discussed. In our view, the role of each method must be reviewed in the light of current clinical experience and investigative data.
我们介绍了61例部分或完全鹿角形结石患者接受经皮肾镜取石术（PCN）和体外冲击波碎石术（ESWL）联合治疗的经验。我们排除了伴有使鹿角形结石复杂化的其他因素的病例，如马蹄肾、严重异位、旋转不良或高位肾，伴有肾盂输尿管连接处狭窄等。患者接受了72次PCN和113次ESWL治疗，PCN术前进行了5次经皮肾造瘘术，以及5次输尿管镜检查以解除ESWL后的梗阻。观察到并发症发生率为24.5%；PCN术后急性尿路感染（13例，21.3%）、大量液体吸收（1例）和动静脉瘘（1例）。治疗后一年，83.6%的患者结石清除，14.9%有残余结石碎片。无患者发生动脉高血压，1例患者因肾盂肾炎萎缩接受了肾切除术。我们讨论了关于不同治疗方法适应证的标准。我们认为，每种方法的作用必须根据当前的临床经验和研究数据进行重新审视。
