临床与病理杂志2015，Vol.35Issue(4)：578-581,4.DOI:10.3978/j.issn.2095-6959.2015.04.012
超声引导经皮肾镜取石术治疗孤立肾肾结石的安全性分析
Safety and curative effects of ultrasound-guided percutaneous nephrolithotomy for renal calculi in solitary kidneys
王光春 1周婷婷 1刘敏 1黄建华 1胡洋洋 1严佳胜 1杨斌 1罗明 1张海民1
作者信息
- 1. 同济大学附属第十人民医院泌尿外科,上海 200072
- 折叠
摘要
Abstract
Objective: To evaluate the safety and curative effects of ultrasound-guided percutaneous nephrolithotomy (PCNL) for renal calculi in solitary kidneys.Methods: The clinical data of 138 renal calculi with functional or anatomic solitary kidney undergone PCNL in our department from July 2005 to December 2012 were retrospectively analyzed. hTey comprised of 16 anatomical solitary kidneys and 122 functional solitary kidneys (the GFR of contralateral kidney <10 mL/min). hTe total renal function was abnormal in 35 cases. hTere were staghorn calculi in 41 cases, multiple calculi in 85 cases, and single stone in 12 cases. 11 cases had a history of opennephrolithotomy. Percutaneous nephrostomy was performed to establish F18 minimally invasive channels or F24 standard channel with the guide of color Doppler ultrasound, and all calculi were broken and extracted by EMS lithotripsy and clearance system or holmium laser.Results: The percutaneous renal accesses were successfully established in 138 cases, including single access in 125 cases (90.6%) and double accesses in 13 cases (9.4%). hTe mean access setting time was (4.7±0.9) min, and the mean operation time was (49.5±12.6) min. Postoperative hemoglobin averagely declined for 5.8 g/L. Due to intra- or postoperative hemorrhoea, 6 patients received blood transfusion, and superselective renal angiographic embolization was performed to control bleeding in 3 of them. Of 35 cases of renal dysfunction, serum creatinine increased for (19.8±7.4) μmol/L in 32 cases (91.4%) on postoperative day 1, and declined to normal limits in 26 cases (74.3%) on postoperative day 7. Stones were cleared in 117 cases (84.8%) only by one time of PCNL. Total stone-free rate was 91.3% on postoperative month 1, and the remaining 12 cases with residual stones underwent ESWL and watchful follow-up. 15 cases (10.9%) had postoperative fever (temperature >38.5℃), but there were no cases with organ injury and septic shock in this group.Conclusion: Ultrasound-guided percutaneous nephrolithotomy is safe and effective to treat renal calculi in functional or anatomical solitary kidneys.关键词
经皮肾镜碎石术/肾结石/孤立肾/并发症Key words
renal calculi/percutaneous nephrolithotomy/solitary kidney/complications引用本文复制引用
王光春,周婷婷,刘敏,黄建华,胡洋洋,严佳胜,杨斌,罗明,张海民..超声引导经皮肾镜取石术治疗孤立肾肾结石的安全性分析[J].临床与病理杂志,2015,35(4):578-581,4.
