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微创泌尿外科杂志  2015, Vol. 4 Issue (5): 274-276    
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微通道经皮肾镜取石术联合输尿管软镜治疗马蹄肾肾结石疗效分析
陈洪波1,江克华1,胡晓晖1,朱圣亮1,向小龙1
1武汉大学恩施临床学院泌尿外科 恩施土家族苗族自治州中心医院泌尿外科 445000 湖北恩施
Efficacy of mini-invasive percutaneous nephrolithotomy combined with retrograde intrarenal surgery for renal stones in horseshoe kidney
Chen Hongbo1, Jiang Kehua1, Hu Xiaohui1,Zhu Shenliang1, Xiang Xiaolong1
1Department of Urology, the Central Hospital of Enshi Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi 445000, China
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摘要 目的:探讨行微通道经皮肾镜取石术后结石残留行二期输尿管软镜治疗马蹄肾多发结石的临床疗效、安全性。方法:回顾性分析自2012年1月~2014年10月收治的马蹄肾多发结石或铸型结石患者共16例,连硬外麻醉下行斜侧卧位微通道经皮肾镜钬激光碎石取石术,术后1周复查KUB或CT评估结石清除率,对于残留结石者,于术后第7天行二期输尿管软镜手术,术后留置双 J管,术后1周复查KUB,对患者的结石清除率等进行分析。结果:本组16例患者在年龄、性别、结石的部位、结石面积等方面比较,差异无统计学意义,所有患者均一次性建立微通道成功,平均手术时间(70±31)min,术中平均出血(420±240)ml,术中并发症发生率为6.3%(1/16),为结肠损伤,术后复查KUB或CT提示结石残留者11例,其残留结石大小为0.8~2.0 cm,平均结石大小为1.6 cm,结石位于上盏以及中盏2例,中盏及下盏4例,下盏2例,三个肾盏均有残留结石2例,输尿管上段结石1例;于7 d后行逆行输尿管软镜手术,手术时间为(62±21)min,1周后复查,结石清除率为87.5%(14/16),1例术后输尿管石街形成,1例肾下盏结石残留,2例均行ESWL后结石排出,术后3个月复查肌酐为82~248 μmol/L,平均(98±56)μmol/L,较术前下降,所有患者均随访3~12个月,未见结石复发以及相关并发症发生。结论:斜侧卧位微通道经皮肾镜取石术联合逆行输尿管软镜手术治疗马蹄肾多发结石,安全有效,且并发症少,值得推广。
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陈洪波
江克华
胡晓晖
朱圣亮
向小龙
关键词 马蹄肾微通道经皮肾镜碎石术输尿管软镜铸型结石结石清除率    
AbstractObjective: To explore the efficacy of the technique by combining mini-invasive percutaneous nephrolithotomy (mPCNL) with retrograde intrarenal surgery (RIRS) in a second stage to treat the complex renal stones in horseshoe kidney. Methods: mPCNL with a single F16-F18 tract was performed first and RIRS was carried out at a second stage in solitary kidneys of 16 patients. The clinical data and curative effect indexes were evaluated. Results: No significant difference was found in age, sex, stone location, stone size of the 16 cases (P>0.05). Of the 16 mPCNL cases, mean operative of mPCNL was (70±31) min, the average blood loss was (420±240) mL, and the incidence of complications was 6.3% (1/16). At 7th day after mPCNL, 11 cases had residual stones with a mean size of 1.6 (0.8-2.0) cm. The mean operative time of RIRS was (62±21) min, and stone-free rate after RIRS was 87.5% (14/16). Two cases accepted ESWL. At the 3rd to 12th month during the follow-up period, renal function became stable or improved. Conclusions: mPCNL combined with RIRS could be an effective and safe option for complex stones in horseshoe kidney with less bleeding, minor complications and better renal function preservation.
Key wordshorseshoe kidney    mini-percutaneous nephrolithotomy    retrograde intrarenal surgery    complex renal stone
收稿日期: 2015-07-17     
ZTFLH:  R692.4  
通讯作者: 江克华     E-mail: tjjkh@sina.com
引用本文:   
陈洪波,江克华,胡晓晖,朱圣亮,向小龙. 微通道经皮肾镜取石术联合输尿管软镜治疗马蹄肾肾结石疗效分析[J]. 微创泌尿外科杂志, 2015, 4(5): 274-276.
Chen Hongbo, Jiang Kehua, Hu Xiaohui,Zhu Shenliang, Xiang Xiaolong. Efficacy of mini-invasive percutaneous nephrolithotomy combined with retrograde intrarenal surgery for renal stones in horseshoe kidney. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2015, 4(5): 274-276.
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