Streem S B, Geisinger M A
Department of Urology, Cleveland Clinic Foundation, Ohio.
J Urol. 1993 Mar;149(3):449-52. doi: 10.1016/s0022-5347(17)36115-3.
A total of 10 patients with staghorn calculi in a solitary kidney was managed with endourological sandwich therapy consisting of primary percutaneous debulking followed by extracorporeal shock wave lithotripsy (ESWL*) of residual inaccessible stones. Secondary percutaneous procedures, ESWL and chemical dissolution were used as necessary in a vigorous attempt to render each patient stone-free. As such, these 10 renal units underwent 21 percutaneous procedures through 13 tracts, 17 ESWL treatments and 3 courses of hemiacidrin. No patient required open operative intervention or dialytic support. With 4 to 57 months (mean 31.6) of followup, renal function for the group as a whole improved as evidenced by a decrease in mean serum creatinine levels from 3.1 mg./dl. before treatment to 2.2 mg./dl. at latest followup. More importantly, renal function has remained stable or improved in 9 of the 10 patients individually. We conclude that an aggressive, combined endourological approach to the management of staghorn calculi provides long-term preservation of function in the affected kidney.
共有10例孤立肾鹿角形结石患者接受了腔内泌尿外科三明治疗法，即先进行经皮初次减容，然后对残留的难以触及的结石进行体外冲击波碎石术（ESWL*）。必要时采用二次经皮手术、ESWL和化学溶解，积极努力使每位患者无结石。因此，这10个肾单位通过13个通道进行了21次经皮手术、17次ESWL治疗和3个疗程的半胱氨酸。没有患者需要开放手术干预或透析支持。随访4至57个月（平均31.6个月），全组肾功能有所改善，平均血清肌酐水平从治疗前的3.1mg/dl降至最近随访时的2.2mg/dl即可证明。更重要的是，10例患者中有9例的肾功能保持稳定或有所改善。我们得出结论，积极的联合腔内泌尿外科方法治疗鹿角形结石可长期保留患肾的功能。
