CAJ | 학술논문

目的：探讨经皮肾镜钬激光碎石术治疗海绵肾肾结石的临床疗效.方法：收集2005年9月~2013年11月间采用经皮肾镜钬激光治疗的海绵肾肾结石19例(36侧)患者的临床资料及治疗方法和结果进行回顾性分析.采用彩超引导定位穿刺的标准通道(F24)及微通道(F16)经皮肾镜碎石术,配合钬激光、气压弹道及超声碎石清石系统清除结石.结果：19例患者中,合并慢性肾功能不全8例.本组患者结石最大长径(21??4±5??2) mm.17例均分期对双侧肾行经皮肾镜碎石,其中单通道9侧肾,双通道22侧肾,三通道3侧肾；2例单侧海绵肾肾结石患者采用双通道碎石.19例36侧肾结石经上盏建立通道20个,经中盏36个,经下组肾盏10个.手术时间(68??4±15??1)mi n .所有病例的游离结石全部被粉碎及清除.术后血红蛋白含量较术前下降(12??3±5??7)g/L .围手术期无输血,术后发热发生率为10??5％(2/19),无失肾,无气胸或腹腔脏器损伤.19例平均随访11??2个月,7例有经尿道残余结石再次排出史,术后1、12个月8例合并肾功能不全者肾功能均有不同程度改善,1年后肾功能不全者无进一步进展；所有病例腰部症状、血尿及尿路刺激症状明显缓解.结论：经皮肾镜钬激光碎石术治疗髓质海绵肾结石有效、安全,能缓解临床症状,改善肾功能.
목적：탐토경피신경화격광쇄석술치료해면신신결석적림상료효.방법：수집2005년9월~2013년11월간채용경피신경화격광치료적해면신신결석19례(36측)환자적림상자료급치료방법화결과진행회고성분석.채용채초인도정위천자적표준통도(F24)급미통도(F16)경피신경쇄석술,배합화격광、기압탄도급초성쇄석청석계통청제결석.결과：19례환자중,합병만성신공능불전8례.본조환자결석최대장경(21??4±5??2) mm.17례균분기대쌍측신행경피신경쇄석,기중단통도9측신,쌍통도22측신,삼통도3측신；2례단측해면신신결석환자채용쌍통도쇄석.19례36측신결석경상잔건립통도20개,경중잔36개,경하조신잔10개.수술시간(68??4±15??1)mi n .소유병례적유리결석전부피분쇄급청제.술후혈홍단백함량교술전하강(12??3±5??7)g/L .위수술기무수혈,술후발열발생솔위10??5％(2/19),무실신,무기흉혹복강장기손상.19례평균수방11??2개월,7례유경뇨도잔여결석재차배출사,술후1、12개월8례합병신공능불전자신공능균유불동정도개선,1년후신공능불전자무진일보진전；소유병례요부증상、혈뇨급뇨로자격증상명현완해.결론：경피신경화격광쇄석술치료수질해면신결석유효、안전,능완해림상증상,개선신공능.
To-evaluate-the-indication-,safety-and-efficacy-of-percutaneous-nephrolithotomy-(PCNL-)i-n-treati-ng-medullary-sponge-kidney-(MSK-).Methods-:By-usi-ng-the-hospital-information-system-(HIS-)databases-of-Renmin-Hospital-of-Wuhan-Uni-versity-and-Xi-njiang-People's-Hospital-,we-identified-and-retrospecti-vely-revie-wed-19-patients-(36-kidneys-)who-under-went-PCNL-for-MSK-bet-ween-Septe-mber-2005-and-Nove-mber-2013-.Patients-treated-with-other-methods-were-excl-uded-.Results-:Chronic-renal-fail-ure-(CRF-)was-recorded-i-n-8-cases-fro-m-19-patients-.-The-stone-burden-was-(21??4-±5??2-)mm-as-descri-bled-by-the-maxi-u-m-length-of-the-stones-.The-staged-surgery-was-prefor-med-on-17-bilateral-cases-with-one-sessi-on-for-each-ki-ndey-,including-9-kindeys-with-single-access-tract-,22-ki-d-neys-with-t-wo-access-tracts-and-10-with-three-tracts-.The-2-unilateral-cases-were-treated-with-t-wo-access-tracts-.The-percutaneous-renal-access-was-established-through-different-calices-,including-20-tracts-through-upper-calices-,36-tracts-through-mi-ddle-calices-and-10-through-lower-calices-.The-operative-time-of-our-cohort-was-(68??4-±15??1)mi-n-with-all-free-stones-of-all-patients-bei-ng-shattered-and-cleared??-The-postoperative-he-mogl-obi-n-was-reduced-by-(12??3-±5??7-)g/L-as-co-mpared-with-their-preoperative-counterpart-.No-transfusi-on-was-needed-i-n-this-series-.The-rate-of-u-ri-nary-infection-related-to-the-operati-on-was-10??5-%-(2/19-).No-kidney-l-ost-.No-pneu-mothorax-or-surroundi-ng-organ-injury-was-found-.All-19-cases-were-foll-o-wed-up-for-11??2-months-(range-fro-m-6-to-20-months-).Seven-cases-reported-the-history-of-spontaneous-discharge-of-the-resi-duary-stones-.The-ki-dey-function-i-n-8-cases-of-CRF-was-a-meli-orated-to-vari-ng-degrees-,1and-12-months-post-operati-on-.The-symptomssuch-as-l-u-mbodynia-,gross-he-maturia-and-uri-nary-tract-infection-were-si-gnificantly-a-meli-orated-,and-onl-y-21??1%-(4/19-)cases-co-mplai-ned-these-symptoms,but-the-frequency-was-reduced-dra-matically-after-PCNL-.Conclusions-:PCNL-was-a-safe-and-effective-treatment-for-MSK-based-on-its-effect-on-a-meli-orati-on-of-symptom,and-mai-ntai-nence-of-the-renal-function-.