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目的评价微通道及标准通道经皮肾镜碎石术治疗马蹄肾结石的安全性及有效性。方法回顾性分析我院2007年1月至2010年12月收治的马蹄肾结石患者共14例,男10例,女4例,平均年龄(38±10.2)岁(29～55岁)。均由B超、KUB、IVP及平扫CTU确诊。14例均为单侧,左侧9例,右侧5例,均多发结石,至少2个肾盏以上存在结石,其中鹿角形结石1例。结石长径平均(4.2±1.8)cm(2～6.5 cm)。所有病例均在B超引导下一次性穿刺建立通道,其中4例采用微通道(F18)经皮肾镜碎石术(MPNL),10例采用标准通道(F24)经皮肾镜碎石术(PCNL)治疗。结果患者分别成功建立F18/F24经皮肾通道一期碎石,一期结石清除率78.6%(11/14),其中MPNL组75%(3/4),PCNL组80%(8/10),3例有残石者术后辅以ESWL治疗,结石均排净,无二期手术。单通道9例,双通道5例;通道经上盏建立9例,中盏7例,下盏3例,平均手术时间(112.5±67.5)min。MPNL组平均手术时间为(135±45)min,长于PCNL组的(102.5±75)min。术后血红蛋白较术前平均下降(37±13)g/L,MPNL组下降程度低于PCNL组[(28±4)g/L vs(42±8)g/L]。PCNL组3例给予输血。手术相关感染2例,未出现胸膜及腹腔脏器损伤。结论微通道及标准通道经皮肾镜碎石术在治疗马蹄肾结石中各有优势,均具有较好的临床疗效。
Objective To evaluate the safety and efficacy of microchannel and standard channel percutaneous nephrolithotripsy in the treatment of horseshoe kidney stone. Methods A total of 14 patients with horseshoe kidney stones were included in our hospital from January 2007 to December 2010. There were 10 males and 4 females with a mean age of (38 ± 10.2) years (29-55 years). By B-ultrasound, KUB, IVP and plain CTU diagnosis. All the 14 cases were unilateral, 9 on the left and 5 on the right, with multiple calculi and at least 2 calculi above the calyceal calculus, including 1 antler calculus. The major diameter of stones was (4.2 ± 1.8) cm (2 ~ 6.5 cm). All the cases underwent B-ultrasound guided percutaneous puncture. Among them, 4 cases were treated with micro-channel (F18) percutaneous nephrolithotomy (MPNL) and 10 cases were treated with percutaneous nephrolithotomy (F24) PCNL) treatment. Results A total of 78.6% (11/14) of stones were removed from the first stage of F18 / F24 percutaneous renal access respectively. Among them, 75% (3/4) in MPNL group and 80% (8/10) in PCNL group , 3 cases of residual stone were treated with ESWL treatment, the stones were discharged net, no two operations. There were 9 cases of single passage and 5 cases of double passage. There were 9 cases of upper passage, 7 cases of middle lamp and 3 cases of lower lamp, the average operation time was (112.5 ± 67.5) min. The mean operative time in MPNL group was (135 ± 45) min longer than that in PCNL group (102.5 ± 75) min. Postoperative hemoglobin decreased by an average of 37 ± 13 g / L compared with that preoperatively, and decreased more significantly in the MPNL group than in the PCNL group [(28 ± 4) g / L vs (42 ± 8) g / L]. Three patients in PCNL group were given transfusion. Surgery-related infections in 2 cases, no pleural and abdominal organ injury. Conclusion Microchannel and standard channel percutaneous nephrolithotripsy have their own advantages in the treatment of horseshoe kidney stones and have good clinical efficacy.