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目的:评价经皮肾镜碎石术(PCNL)处理孤立肾铸型结石的安全性及有效性。方法:回顾性分析湘雅二医院泌尿外科从2009年4月至2011年12月行孤立肾铸型结石的PCNL患者的临床资料,收集通道数量、手术时间、清石情况、术后住院时间、术后并发症、肾功能改变等数据,并进行比较。结果:所有13台手术在92~164(117.2±21.5)min内完成;采用单通道9例,多通道4例;一期清石率76.9%,出院时清石率92.3%;术后血红蛋白下降11~32(16.4±4.6)g/L,1例需要输血处理,无患者需血管介入栓塞;术后住院5~10(6.9±1.5)d;术前血肌酐83~237(146.24±38.73)μmol/L,肾小球滤过率为42~114(71.32±20.82)mL/min,术后1个月血肌酐为81~242(134.56±21.52)μmol/L,肾小球滤过率为55~117(79.40±22.14)mL/min,术前术后血肌酐和肾小球滤过率差异均无统计学意义(P>0.05)。结论:PCNL处理孤立肾铸型结石手术时间短,结石清除率高,并发症少,恢复快,对肾功能影响小,是安全、有效的方法。
Objective: To evaluate the safety and efficacy of percutaneous nephrolithotomy (PCNL) in the treatment of solitary kidney stone. Methods: The clinical data of PCNL patients who underwent solitary renal calculus from April 2009 to December 2011 in Department of Urology, the Second Xiangya Hospital were retrospectively analyzed. The number of the patients, operative time, clear stone, postoperative hospital stay, Postoperative complications, changes in renal function and other data, and compared. Results: All of the 13 surgeries were completed within 92-164 (117.2 ± 21.5) min. Nine patients were single-channel and four-channel multi-channel. The rate of primary stone was 76.9% and the rate of clear stone at discharge was 92.3%. The postoperative hemoglobin decreased (16.4 ± 4.6) g / L, 1 patient needed blood transfusions, and no patient required vascular interventional embolization. The postoperative hospital stay was 5 to 10 (6.9 ± 1.5) days. Preoperative serum creatinine levels ranged from 83 to 237 (146.24 ± 38.73) glomerular filtration rate was 42 ~ 114 (71.32 ± 20.82) mL / min, serum creatinine was 81 ~ 242 (134.56 ± 21.52) μmol / L at 1 month after operation, glomerular filtration rate was 55 ~ 117 (79.40 ± 22.14) mL / min, there was no significant difference in serum creatinine and glomerular filtration rate before operation (P> 0.05). CONCLUSION: PCNL is a safe and effective method for the treatment of solitary kidney stone with short operation time, high stone removal rate, few complications, quick recovery and small influence on renal function.