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目的探讨微创经皮肾镜取石术(min-PCNL)治疗肾旋转不良并肾结石的可行性及有效性。方法对接受微创经皮肾镜取石术治疗的肾旋转不良并肾结石26例患者进行回顾性分析。结果 26例患者均为肾旋转不良并肾结石,其中2例马蹄肾。肾鹿角形结石、多发结石8例,单纯肾盂结石12例,下盏结石6例。其中合并肾盂输尿管连接部梗阻2例,并输尿管上段结石8例。该组患者行一期穿刺取石23例,一期结石清除率88.46%。二期取石3例,配合输尿管软镜取出。均为单通道穿刺取石。术中利用钬激光切开肾盂输尿管连接部梗阻2例。2例患者术后出现肾脏大出血,均为肾鹿角形结石,其中1例马蹄肾。在数字减影血管造影(DSA)下高选择性肾动脉栓塞治疗后痊愈,1例为假性动脉瘤,1例为假性动脉瘤合并动静脉瘘。结论微创经皮肾镜取石术治疗肾旋转不良并肾结石安全、可行、疗效确切,具有创伤小、恢复快、可反复操作等优点。
Objective To investigate the feasibility and effectiveness of minimally invasive percutaneous nephrolithotomy (min-PCNL) in the treatment of renal dysplasia and kidney stones. Methods A retrospective analysis of 26 patients with renal dysplasia and kidney stones undergoing minimally invasive percutaneous nephrolithotomy was performed. Results Twenty-six patients had renal dysplasia and kidney stones, of which 2 were horseshoe kidney. Kidney deer horns stones, multiple stones in 8 cases, simple renal pelvis in 12 cases, 6 cases of lower calyces. Including ureteropelvic junction obstruction in 2 cases, and upper ureteral calculi in 8 cases. The group of patients underwent a puncture in 23 cases, a stone clearance rate of 88.46%. Two cases of stone in 3 cases, with the ureteroscopy removed. All single-channel puncture stone. Intraoperative use of holmium laser incision ureteropelvic junction obstruction in 2 cases. Two patients had massive renal hemorrhage after surgery, all of which were kidney antlers, of which 1 was horseshoe kidney. One patient had pseudoaneurysm and one had pseudoaneurysm with arteriovenous fistula, healed after high-selectivity renal artery embolization under digital subtraction angiography (DSA). Conclusion Minimally invasive percutaneous nephrolithotomy for the treatment of renal dysplasia and kidney stones safe, feasible and effective, with less trauma, rapid recovery, can be repeated operation and so on.