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目的探讨孤立肾并复杂性结石的处理方式,提高其治疗的有效性和安全性。方法总结42例孤立肾并复杂性结石的治疗经验。其中先天性4例(10%)、后天原因38例(90%);左侧16例(38%)、右侧26例(62%)。均为铸形或鹿角状、多发性结石,8例合并输尿管结石,6例因急性梗阻性无尿入院;铸形或鹿角状结石首选体外震波碎石(ESWL)后经皮肾镜取石(PCNL)治疗,多发性结石先行PCNL后ESWL处理,部分病例配合腔内碎石。结果36例(86%)经ESWL及PCNL联合治疗获愈,11例PCNL术中辅以腔内碎石,6例梗阻性无尿者急诊ESWL或腔内碎石后12h内恢复排尿;6例(14%)因肾盂输尿管畸形、梗阻改行开放手术,2例继发反复感染需长期肾造瘘。37例获随访6～18个月,32例(86%)肾功能良好、5例(14%)存在肾功能不全,4例(11%)结石复发。结论联合应用ESWL及PCNL可安全有效地清除多数孤立肾的复杂性结石;肾性梗阻性无尿者行急诊ESWL是必要的,对输尿管下段梗阻性结石可首选腔内碎石;伴肾盂明显畸形或输尿管连接部严重狭窄者以选择开放手术为宜。
Objective To investigate the treatment of solitary kidney complicated with stones and to improve its effectiveness and safety. Methods To summarize the experience of 42 cases of solitary renal complicated calculus. There were 4 cases (10%) of congenital cases and 38 cases (90%) of acquired causes. There were 16 cases (38%) on the left side and 26 cases (62%) on the right side. All of them were cast or antlers, multiple stones, 8 cases with ureteral calculi, 6 cases with acute obstructive anuria admitted to the hospital, and cast or staghorn calculi preferred extracorporeal shock wave lithotripsy (ESWL) after percutaneous nephrolithotomy (PCNL ) Treatment, multiple stones ESLL after PCNL treatment, some cases with intraluminal gravel. Results 36 cases (86%) were cured by combined treatment of ESWL and PCNL, 11 cases of PCNL combined with intracavitary lithotripsy, 6 cases of obstructive anuria after emergency ESWL or intraluminal gravel resumed urination within 6 hours (14%) due to ureteropelvic deformity, obstruction diverted to open surgery, 2 cases of repeated infections require long-term renal fistulation. Thirty-seven patients were followed up for 6-18 months, 32 (86%) had good renal function, 5 (14%) had renal insufficiency and 4 (11%) had stone recurrence. Conclusions The combination of ESWL and PCNL can safely and effectively remove the most complicated solitary kidney stones. Emergency ESWL is necessary for patients with obstructive urogenital obstruction, and lithotripsy is the preferred choice for intra-ureteral obstruction. Or severe ureteral junction stenosis to choose the appropriate open surgery.