CAJ | 학술논문

目的探讨鹿角形肾结石气压弹道联合超声碎石治疗中以肾中盏为目标肾盏的临床效果及安全性.方法采用气压弹道联合超声碎石的方式,以肾中盏为目标肾盏行经皮肾镜碎石术(PCNL)治疗鹿角形肾结石患者73例92侧,其中不完全性鹿角形肾结石57侧,完全性鹿角形肾结石35侧.观察结石的排除率及并发症.结果 72例行一期单通道碎石(中盏),其中3例行一期双通道碎石(中盏及下盏2例,中盏及上盏1例);1例(1侧)残留肾盏结石未进一步处理,自动出院.16侧行二期碎石,均为单通道,其中2侧先行体外冲击波碎石术(ESWL)再行PCNL碎石;76侧排尽结石,其中完全性鹿角形肾结石27侧,不完全性鹿角形肾结石49侧,结石清除率82.6％ (76/92).血红蛋白下降1 ～4g/L,术中输血11例,术后输血3例;术后肾盂内感染1例,合并肾周感染、单侧分肾功能受损1例.结论以肾中盏为目标肾盏行PCNL治疗鹿角形肾结石是非常有效和安全的,气压弹道联合超声碎石对鹿角形结石的清除率较高,治疗时间短,并发症少.
목적 탐토록각형신결석기압탄도연합초성쇄석치료중이신중잔위목표신잔적림상효과급안전성.방법 채용기압탄도연합초성쇄석적방식,이신중잔위목표신잔행경피신경쇄석술(PCNL)치료록각형신결석환자73례92측,기중불완전성록각형신결석57측,완전성록각형신결석35측.관찰결석적배제솔급병발증.결과 72례행일기단통도쇄석(중잔),기중3례행일기쌍통도쇄석(중잔급하잔2례,중잔급상잔1례);1례(1측)잔류신잔결석미진일보처리,자동출원.16측행이기쇄석,균위단통도,기중2측선행체외충격파쇄석술(ESWL)재행PCNL쇄석;76측배진결석,기중완전성록각형신결석27측,불완전성록각형신결석49측,결석청제솔82.6％ (76/92).혈홍단백하강1 ～4g/L,술중수혈11례,술후수혈3례;술후신우내감염1례,합병신주감염、단측분신공능수손1례.결론 이신중잔위목표신잔행PCNL치료록각형신결석시비상유효화안전적,기압탄도연합초성쇄석대록각형결석적청제솔교고,치료시간단,병발증소.
Objective To evaluate the efficacy and safety of percutaneous nephrolithotomy(PCNL) by middle renal calice used as main access for the treatment of staghorn stones with the combination of pneumatic and ultrasonic lithotrite.Methods Clinical data of 73 patients underwent PCNL by middle renal calices as main access with 57 incomplete staghorn stones and 35 complete staghorn stones.The rate of stone removal and complications were the main points of the analysis.Results Seventy-two cases underwent first session PCNL by single access tract(middle calices),3 cases underwent first session PCNL by double access tracts (2 cases by middle and lower calices,1 case by upper and middle calices).Of these patients,1 case had fragments with no further treatment,16 cases underwent second session PCNL.All were treated by single access tract (middle calices) and 2 cases had extracorporeal shock wave lithotripsy before the second PCNL.Seventy-six cases composed of 27 complete staghorn stones and 49 incomplete staghorn stones had no residual fragments with the stones removal rate 82.6％ (76/92).Hemoglobin dropped 1-4 g/L,11 cases and 3 cases were given blood transfusion in the operation procedure and post operation respectively.One case developed pyelonephritis and 1 case had split renal dysfunction with peri-parenchyma infection.Conclusions By middle calices as a main access to perform PCNL for staghorn stones is effective and safe.Using pneumatic and ultrasonic lithotrite will be very useful with high stones free rate and short procedure time and less complication.