Standard tract percutaneous nephrolithotomy in a single session for the treatment of renal staghorn calculi
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摘要: 目的：探讨经皮标准肾镜技术（SPCNL）治疗鹿角型肾结石的手术技巧和经验，并分析其并发症。方法：一期SPCNL治疗鹿角型肾结石66例，其中男42例，女24例，对所有患者的临床资料进行分析。结果：经皮肾通道均成功建立，第一主通道分别穿刺上盏29例、中盏20例、下盏17例。一期建立单通道碎石7例、双通道40例、三通道15例、四通道4例。平均手术时间75 min，无胸膜、肝脾、结肠损伤者，一期结石取净率69.7%（46/66）。术后发热（体温高于38.5℃）20例（30.3%），无感染性休克者。术中2例出血较多，术后4例迟发出血，其中1例行肾动脉栓塞（1.51%），2例需输血，无肾切除者。一期术后残石20例，6例需二期SPCNL碎石4例取净，5例输尿管镜取石均取净，7例配合ESWL治疗。随访3~12个月，总清石率为89.4%（59/66）。结论：一期多通道SPCNL治疗鹿角型肾结石清石率高，且不增加肾脏大出血的风险。结石清除的越彻底，则术后感染、发热的概率越低。Abstract: Objective: To investigate the experience and technique of standard tract percutaneous nephrolithotomy(SPCNL)for the treatment of renal staghorn calculi,and analyze the accidental complications.Methods: We analysed all the clinical data of 66 renal staghorn calculi patients(42 males and 24 females)whom underwent SPCNL in a single session.Results: All percutaneous tunnels were successfully established.The firstly renal tunnel went through supra-calyces of 29 cases and middle-calyces of 20 and infra-calyces of 17,of which single tunnels were used in 7 cases,dual tunnel in 40,three-way tunnels in 15 and four-way tunnels in 4 simultaneously.No severe complications such as the injury of membrana pleuralis or abdominal organs occurred.the average operative time of single stage SPCNL was 75 min and the stone clearance rate was 69.7%(46/75).20 cases had a post-op fever that more than 38.5℃(30.3%)with no one septic shock.2 cases had an immediate bleeding and 4 cases with tedious hemorrhage,of which 2 received blood transfusion and 1 required selective thrombosis of renal artery with no one nephrectomy had been applied.20 cases of the residual stone were treated that 6 cases had a second-look SPCNL and 4 were rendered stone free,5 cases had ureteroscopic lithotripsy and all the stone were cleared,and 7 cases had an ancillary ESWL respectively.All of the patients had a follow-up for 3 to12 months,the total stone clearance rate was 89.4%(59/66).Conclusions: Multi-tract SPCNL in a single session for the treatment of renal staghorn calculi brings about a high stone clear rate,and it doesn't increase the risks of hemorrhea of kidney. And the stones should be cleaned out in order to decrease the incidence rate of systematic infection and fever.
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Key words:
- multiple tracts /
- percutaneous nephrolithotomy /
- infection /
- staghorn calculi /
- stone clearance rate
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