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目的探讨经皮肾镜碎石取石术(PCNL)治疗有功能萎缩肾肾结石的疗效。方法 22例有功能萎缩肾肾结石患者术前抗感染治疗后,在B超定位及引导下穿刺,用筋膜扩张器、金属扩张器扩张,置入肾镜鞘,采用EMS第三代超声气压弹道碎石清石系统,并在低压的状况行超声联合弹道碎石和清石,术后留置双J管和肾造瘘管。结果 22例均一期成功建立皮肾通道。一期手术结石全部取净15例(15/22,68.2%),二期手术17例(17/22,77.3%)。5例残留结石经排石、体外冲击波碎石治疗,3例排净结石。结石最终排净率为90.9%(20/22)。3例术后出现全身炎症反应综合征,1例出现肾周积液感染。术中、术后未出现大出血、邻近脏器损伤等并发症。术后1个月随访,3例肾功能不全者血肌酐较术前平均下降42.1μmol/L,术后6个月静脉肾盂造影提示患侧肾显影、积水均改善。结论采用PCNL术治疗有功能萎缩肾肾结石是一种安全、高效的方法,但对术者要求较高,应在熟练掌握经皮肾镜技术的基础上开展。
Objective To investigate the efficacy of percutaneous nephrolithotripsy (PCNL) in the treatment of patients with functional atrophic kidney and kidney stones. Methods Twenty-two patients with functional atrophy and renal nephrolithiasis were treated with anti-infective therapy before surgery. The patients were punctured with B-ultrasound and guided with a fascia dilator and a metal dilator. Ballistic lithotripsy clear stone system, and in the low-pressure ultrasound combined with lithotripsy and clear stones, postoperative double J tube and renal fistula. Results 22 cases of homogeneous phase successfully established the renal access. Fifteen cases (15/22, 68.2%) were treated with primary surgical stone and 17 cases (17/22, 77.3%) with secondary surgery. 5 cases of residual stones by row of stone, extracorporeal shock wave lithotripsy, 3 cases of clear stones. The final stone clearance rate was 90.9% (20/22). 3 cases of systemic inflammatory response syndrome, 1 case of perirephric fluid infection. No intraoperative and postoperative bleeding, adjacent organs and other complications. After one month follow-up, serum creatinine in 3 patients with renal insufficiency decreased by 42.1 μmol / L on average compared with that before operation. Intravenous pyelography at 6 months after operation showed ipsilateral renal development and hydrocephalus were all improved. Conclusion PCNL is a safe and effective method for the treatment of patients with functional atrophy of renal and renal calculus, but requires a high surgeon. It should be based on the master of percutaneous nephrolithotomy.