肾镜联合输尿管软镜通过经皮肾单通道取石治疗肾鹿角形结石
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摘要
目的探讨肾镜联合输尿管软镜通过20 F经皮肾单通道碎石取石一期治疗肾鹿角形结石的效果。方法回顾性分析2014年1月至2016年8月我院37例采用肾镜联合输尿管软镜通过经皮肾单通道治疗的鹿角形肾结石患者的临床资料,男14例,女23例。年龄34～62岁,平均(46±13)岁,其中左侧25例、右侧12例。结石直径3.3 cm～6.0 cm,平均(4.9±0.1)cm。采用超声引导穿刺下经皮肾穿刺单通道取石,扩张通道至20 F,应用超声或钬激光碎石。结果 37例患者均一期建立20 F皮肾单通道,36例一期行肾镜联合输尿管软镜通过经皮肾单通道碎石取石,经下盏建立皮肾通道34例(91.9%),一期结石清除率86.5%(32/37),一期手术时间58～125 min,平均(92±23)min。术后当日测血红蛋白下降3.2～9.5 g/L,平均(5.7±1.8)g/L。术后住院时间5～9 d,平均(7±1)d。3例患者术后体温≥38.5℃。37例患者均无大出血及输血,无尿脓毒症,无肾脏穿孔及胸腹腔积液等并发症。结论肾镜联合输尿管软镜通过20 F经皮肾单通道碎石取石一期治疗肾鹿角形结石,结石清除率高、创伤小、并发症少。
Objective To evaluate the efficacy of percutaneous nephrolithotomy combined with flexible ureteroscope via single 20 F renal channel in the treatment of renal staghorn calculi. Methods Data of 37 cases of renal staghorn calculi treated by percutaneous nephrolithotomy combined with flexible ureteroscope via single 20 F renal channel from January 2014 to August 2016 were analyzed retrospectively.There were 14 males and 23 females. Age ranged from 34 to 62 years with a mean of 46 years. The stones in 25 cases were located on the left side, 12 cases on the right side. The diameter of stones was between 3.3 cm to 6.0 cm, average(4.9±0.1) cm. All patients underwent single channel percutaneous nephrolithotomy combined with flexible ureteroscope under the guidance of ultrasound, using EMS and holmium laser fragment stones, and the channel of puncture was expanded to 20 F. Results Thirty-seven cases were set single 20 F renal channel and 36 cases were treated by percutaneous nephrolithotomy combined with flexible ureteroscope in one-stage. Single renal channels were set at the subrenal calyx in 34 cases(91.9%). The stone clearance rate in the first stage was 86.5%(32/37)and operation time was between 58 to 125 min with an average of(92±23) min. Postoperative hemoglobin decreased 3.2～9.5 g/L with an average of(5.7±1.8) g/L. The postoperative hospitalization time was 5 to 9 days with an average of(7±1) days. Three patients suffered from fever on surgery day, the body temperature was over 38.5℃. No renal perforation, hydrothorax, seroperitoneum, hemorrhoea and blood transfusion occurred. Conclusion Percutaneous nephrolithotomy combined with flexible ureteroscope via single 20 F renal channel has high stone clearance rate, mini-invasion and less operative time in the treatment of renal staghorn calculi.
Objective To evaluate the efficacy of percutaneous nephrolithotomy combined with flexible ureteroscope via single 20 F renal channel in the treatment of renal staghorn calculi. Methods Data of 37 cases of renal staghorn calculi treated by percutaneous nephrolithotomy combined with flexible ureteroscope via single 20 F renal channel from January 2014 to August 2016 were analyzed retrospectively.There were 14 males and 23 females. Age ranged from 34 to 62 years with a mean of 46 years. The stones in 25 cases were located on the left side, 12 cases on the right side. The diameter of stones was between 3.3 cm to 6.0 cm, average(4.9±0.1) cm. All patients underwent single channel percutaneous nephrolithotomy combined with flexible ureteroscope under the guidance of ultrasound, using EMS and holmium laser fragment stones, and the channel of puncture was expanded to 20 F. Results Thirty-seven cases were set single 20 F renal channel and 36 cases were treated by percutaneous nephrolithotomy combined with flexible ureteroscope in one-stage. Single renal channels were set at the subrenal calyx in 34 cases(91.9%). The stone clearance rate in the first stage was 86.5%(32/37)and operation time was between 58 to 125 min with an average of(92±23) min. Postoperative hemoglobin decreased 3.2～9.5 g/L with an average of(5.7±1.8) g/L. The postoperative hospitalization time was 5 to 9 days with an average of(7±1) days. Three patients suffered from fever on surgery day, the body temperature was over 38.5℃. No renal perforation, hydrothorax, seroperitoneum, hemorrhoea and blood transfusion occurred. Conclusion Percutaneous nephrolithotomy combined with flexible ureteroscope via single 20 F renal channel has high stone clearance rate, mini-invasion and less operative time in the treatment of renal staghorn calculi.
引文
[1]那彦群,叶章群,孙颖浩,等.中国泌尿外科疾病诊断治疗指南(2014版)[M].北京:人民卫生出版社,2013:166.
[2]Hansel DE,Epstein JI,Berbescu E,et al.Renal carcinoid tumor:a clinicopathologic study of 21 cases[J].Am J Surg Pathol,2007,31(10):1539-1544.
[3]Snyder JA,Smith AD.Staghorn calculi:percutaneous extraction versusanatrophic nephrolithotomy[J].J Urol,1986.136(2):351-354.
[4]Basiri A,Ziaee SA,Nasseh H,et al.Totally ultrasonographyguided percutaneous nephrolithotomy in the flank position[J].J Endourol,2008,22(7):1453-1457.
[5]曾国华,钟文,李逊,等.一期多通道微创经皮肾穿刺取石术治疗鹿角状结石[J].中华泌尿外科杂志,2007,28(4):250-252.
[6]Akman T,Sari E,Binbay M,et al.Comparison of outcomes after perecutaneous nephrolithotomy of staghorn calculi in those with single and multiple accesser[J].J Endourol,2010,24(6):955-960.
[7]Goldberg H,Golomb D,Shtabholtz Y,et al.The“old”15 mm renal stone size limit for RIRS remains a clinically significant threshold size[J].World J Urol,2017,35(12):1947-1954.
[8]Dauw CA,Simen L,Alruwaily AF,et al.Contemporary practice patterns of flexible ureteroscopy for treating renal stones:results of a worldwide survey[J].J Endourol,2015,29(11):1221-1230.
[9]Aminsharifi A,Irani D,Eslahi A.Massive hemorrhage after percutaneousnephrolithotomy:saving the kidney when angioembolization has failed or is unavailable[J].Int J Surg,2014,12(8):872-876.
[10]程跃,严泽军,谢国海,等.“粉末化碎石”在输尿管软镜治疗肾结石中的应用[J].微创泌尿外科杂志,2013,2(3):210-212.
[11]陈宏宇,韩毅,孔垂泽,等.微通道和标准通道在经皮肾取石术中效果及安全性评价[J/CD].中华腔镜泌尿外科杂志(电子版),2011,5(1):44-47.
[12]Ray K.PCNL and staghorn kidney stones.Nat Rev Urol,2011,8(3):116.
[13]Martin X,Tajra LC,Gelet A,et al.Complete staghorn stones for the planning of percutaneous surgery in amorbidly obese patient[J].J Endourol,1999,139(5):367-368.
[14]Hegarty NJ,Desai MM.Percutaneous nephrolithotomy requiring multiple tracts:comparison of morbidity with single-tract procedures[J].J Endourol,2006,20(10):753-760.
[2]Hansel DE,Epstein JI,Berbescu E,et al.Renal carcinoid tumor:a clinicopathologic study of 21 cases[J].Am J Surg Pathol,2007,31(10):1539-1544.
[3]Snyder JA,Smith AD.Staghorn calculi:percutaneous extraction versusanatrophic nephrolithotomy[J].J Urol,1986.136(2):351-354.
[4]Basiri A,Ziaee SA,Nasseh H,et al.Totally ultrasonographyguided percutaneous nephrolithotomy in the flank position[J].J Endourol,2008,22(7):1453-1457.
[5]曾国华,钟文,李逊,等.一期多通道微创经皮肾穿刺取石术治疗鹿角状结石[J].中华泌尿外科杂志,2007,28(4):250-252.
[6]Akman T,Sari E,Binbay M,et al.Comparison of outcomes after perecutaneous nephrolithotomy of staghorn calculi in those with single and multiple accesser[J].J Endourol,2010,24(6):955-960.
[7]Goldberg H,Golomb D,Shtabholtz Y,et al.The“old”15 mm renal stone size limit for RIRS remains a clinically significant threshold size[J].World J Urol,2017,35(12):1947-1954.
[8]Dauw CA,Simen L,Alruwaily AF,et al.Contemporary practice patterns of flexible ureteroscopy for treating renal stones:results of a worldwide survey[J].J Endourol,2015,29(11):1221-1230.
[9]Aminsharifi A,Irani D,Eslahi A.Massive hemorrhage after percutaneousnephrolithotomy:saving the kidney when angioembolization has failed or is unavailable[J].Int J Surg,2014,12(8):872-876.
[10]程跃,严泽军,谢国海,等.“粉末化碎石”在输尿管软镜治疗肾结石中的应用[J].微创泌尿外科杂志,2013,2(3):210-212.
[11]陈宏宇,韩毅,孔垂泽,等.微通道和标准通道在经皮肾取石术中效果及安全性评价[J/CD].中华腔镜泌尿外科杂志(电子版),2011,5(1):44-47.
[12]Ray K.PCNL and staghorn kidney stones.Nat Rev Urol,2011,8(3):116.
[13]Martin X,Tajra LC,Gelet A,et al.Complete staghorn stones for the planning of percutaneous surgery in amorbidly obese patient[J].J Endourol,1999,139(5):367-368.
[14]Hegarty NJ,Desai MM.Percutaneous nephrolithotomy requiring multiple tracts:comparison of morbidity with single-tract procedures[J].J Endourol,2006,20(10):753-760.
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