标准通道辅助微通道经皮肾镜取石术联合EMS 治疗鹿角形肾结石合并脓肾的经验总结

Experience of standard access assisted MPCNL combined with EMS for the treatment of staghorn calculi accompanied with pyonephrosis

摘要:

目的 探讨标准通道辅助微通道经皮肾镜取石术（MPCNL）联合EMS 碎石清石系统治疗鹿角 形肾结石合并脓肾的疗效及安全性。方法 回顾性分析该院2015 年10 月-2017 年5 月在泌尿专用超声穿刺 探头引导下，采用穹窿穿刺法标准通道辅助MPCNL 联合EMS，治疗鹿角形肾结石合并脓肾53 例（55 侧，2 例双侧）患者的临床资料。总结其手术时间、结石清除率、术后住院天数、术后输血率和并发症。结果 53 例患者共55 侧肾脏均Ⅰ期建立F24 通道，并成功碎石取石。手术时间（82.3±22.5）min ；72.7% 的肾脏Ⅰ 期F24 辅助F16/18 双通道；18.2% 为Ⅰ期F24 辅助Ⅱ期F16/18 的双通道或多通道；9.1% 为Ⅲ期经原通道 PCNL 联合逆行输尿管软镜碎石术；4 例行体外冲击波碎石术辅助治疗。Ⅰ期结石清除率70.9%（39/55），总 结石清除率89.1%（49/55）。2 例患者术后输血，1 例行超选择性肾动脉栓塞术止血，3 例患者出现术后发热， 1 例出现感染性休克；2 例少量液胸保守治疗；1 例因尿外渗引起明显腰痛，给予止痛药物处理，未发生其他 严重并发症。结论 泌尿专用超声穿刺探头引导下，采用经穹窿穿刺法标准通道辅助微通道PCNL 联合EMS 碎石清石系统治疗鹿角形肾结石合并脓肾，具有结石清除效率高、肾盂内压低、安全性高和并发症发生率低 等优点，值得临床应用。

Abstract:

Objective To investigate the efficacy and safety of standard access assisted minimally access percutaneous nephrolithotomy (MPCNL) combined with EMS lithotripsy system in treatment of staghorn caculi accompanied with pyonephrosis. Methods From October 2015 to May 2017, we retrospectively analyzed the clinical data of 53 patients of staghorn calculi accompanied with pyonephrosis (55 sides, 2 patients with bilateral) were treated with using the special urology ultrasound, kidney dome puncture path method method to do standard channel assisted MPCNL combined with EMS. To summarize the operation time, stone clearance rate, postoperative hospital stay, postoperative blood transfusion rate and complications. Results 53 patients had a total of 55 kidneys had been established first-staged F24 channels,and successfully gravel stone. The operation time was (82.3 ± 22.5) min; 72.7% of the renal had been established first-staged F24 channels assisted F16/18 dual channel; 18.2% for the first phase F24 and secondary phase F16/18 of the dual or multi-channel; 9.1% PCNL combined with retrograde flexible ureteroscope; 4 cases of extracorporeal shock wave lithotripsy. The initial stone-free rate was 70.9% (39/55), total stone-free rate was 89.1% (49/55). 2 patients with postoperative blood transfusion, 1 case of super-selective renal artery embolization to stop bleeding, 3 patients had postoperative fever, 1 case of septic shock, 2 cases of conservative treatment of a small amount of liquid chest, 1 case of apparent low back pain due to urine extravasation, given pain medication.no other serious complications. Conclusions By special urology ultrasound probe guide, use the kidney dome puncture path method to do standard channel assisted MPCNL combined with EMS for the treatment of staghorn calculi accompanied with pyonephrosis, its benefits in high stone-free rate, low renal pelvis pressure, high security rate, low complication rate and so on. Therefore, it is worthy of clinical application.