摘要
目的：探讨经皮肾镜钬激光碎石术治疗海绵肾肾结石的临床疗效.方法：收集2005年9月~2013年11月间采用经皮肾镜钬激光治疗的海绵肾肾结石19例(36侧)患者的临床资料及治疗方法和结果进行回顾性分析.采用彩超引导定位穿刺的标准通道(F24)及微通道(F16)经皮肾镜碎石术,配合钬激光、气压弹道及超声碎石清石系统清除结石.结果：19例患者中,合并慢性肾功能不全8例.本组患者结石最大长径(21??4±5??2) mm.17例均分期对双侧肾行经皮肾镜碎石,其中单通道9侧肾,双通道22侧肾,三通道3侧肾；2例单侧海绵肾肾结石患者采用双通道碎石.19例36侧肾结石经上盏建立通道20个,经中盏36个,经下组肾盏10个.手术时间(68??4±15??1)mi n .所有病例的游离结石全部被粉碎及清除.术后血红蛋白含量较术前下降(12??3±5??7)g/L .围手术期无输血,术后发热发生率为10??5％(2/19),无失肾,无气胸或腹腔脏器损伤.19例平均随访11??2个月,7例有经尿道残余结石再次排出史,术后1、12个月8例合并肾功能不全者肾功能均有不同程度改善,1年后肾功能不全者无进一步进展；所有病例腰部症状、血尿及尿路刺激症状明显缓解.结论：经皮肾镜钬激光碎石术治疗髓质海绵肾结石有效、安全,能缓解临床症状,改善肾功能.
Objective:To evaluate the indication,safety and efficacy of percutaneous nephrolithotomy(PCNL)in treating medullary sponge kidney(MSK).Methods:By using the hospital information system(HIS)databases of Renmin Hospital of Wuhan University and Xinjiang People's Hospital,we identified and retrospectively reviewed 19patients(36kidneys)who underwent PCNL for MSK between September 2005 and November 2013.Patients treated with other methods were excluded.Results:Chronic renal failure(CRF)was recorded in 8cases from 19 patients.The stone burden was(21.4±5.2)mm as describled by the maxium length of the stones.The staged surgery was preformed on 17 bilateral cases with one session for each kindey,including 9kindeys with single access tract,22 kidneys with two access tracts and 10 with three tracts.The 2unilateral cases were treated with two access tracts.The percutaneous renal access was established through different calices,including 20 tracts through upper calices,36 tracts through middle calices and 10 through lower calices.The operative time of our cohort was(68.4±15.1)min with all free stones of all patients being shattered and cleared.The postoperative hemoglobin was reduced by(12.3±5.7)g/L as compared with their preoperative counterpart.No transfusion was needed in this series.The rate of urinary infection related to the operation was 10.5%(2/19).No kidney lost.No pneumothorax or surrounding organ injury was found.All 19 cases were followed up for 11.2months(range from 6to 20months).Seven cases reported the history of spontaneous discharge of the residuary stones.The kidey function in 8cases of CRF was amel-iorated to varing degrees,1and 12 months post-operation.The symptoms such as lumbodynia,gross hematuria and urinary tract infection were significantly ameliorated,and only 21.1%(4/19)cases complained these symptoms,but the frequency was reduced dramatically after PCNL.Conclusions:PCNL was a safe and effective treatment for MSK based on its effect on amelioration of symptom,and maintainence of the renal function.
出处
《微创泌尿外科杂志》
2014年第3期-,共6页
Journal of Minimally Invasive Urology
关键词
髓质海绵肾
肾结石
经皮肾镜碎石术
medullary sponge kidney
renal caculi
percutaneous nephrolithotomy
