Research Of Minimally Invasive Percutaneous Nephrolithotomy In The Treatment Of Patients With Horseshoe Kidney Combined Stones

ObjectiveHorseshoe kidney, resulting in pelvic anterior position and high ureteral entrancebecause of its special anatomic structure. And it also causes the ureter across thefusion isthmus of horseshoe kidney and shifts forward, causing various degrees ofureter obstruction which prone to hydronephrosis, kidney stones. About20%of themare urinary stones. It is a difficult problem always concerned by people to cure thehorseshoe kidney combined stones. We have improved the operation method ofhorseshoe kidney combined stones to assess the safety and feasibility of minimallyinvasive percutaneous nephrolithotomy lithotomy (MPCNL) in treating patients withcalculi within horseshoe kidney.Subjects and methodsThe research data retrospectively investigated9patients and11medical data,that took the method of minimally invasive percutaneous nephrolithotomy in treatingcalculi within horseshoe kidney at The First Affiliated Hospital of ZhengzhouUniversity from November2008to June2013.. The patients’ ages are between32to71years, and the average age of those surveyed is43.4±8.2years old.. Location of stone:2cases are bilateral (the stone in one case was small,4mm. There was no pain,percussion tenderness and other clinical symptoms in the ipsilateral renal region. As aresult, we just observe giving no treatment. And it was not included in the bilateralcase. Tell patients to drink more water, and take tamsulosin for conservativetreatment.) and11cases in total.6cases were on the left side, and right side in5cases. The stone diameter was20.1±3.9mm. The main clinical symptoms werebackache, recurrent urinary tract infection, and hematuria.11cases were all clearlydiagnosis by CT or IVP.2cases had taken extracorporeal shock wave lithotripsy, butdidn’t work well, and then took further treatment with minimally invasivepercutaneous nephrolithotomy. Preoperative examination showed no obvious surgicalcontraindication was found in all patients. The patients all toke prone posture orlateral posture, and MPCNL was given by the assistance of ultrasound. Take colorultrasonography and abdominal plain film examination one month after pulling outureteral stents to evaluate the position of ureteral stents and residual stones. If there isno stone or the diameter of residual stone <3mm, the method can be considered as asuccess.［3］If residual stones.were larger, the patients need to take the second-stageMPCNL. This was a retrospective study.. In order to evaluate the the safety andeffectiveness of the method, all cases have collected the data of the perioperativeperiod operation, postoperative complications and the disposal of the case,Postoperative follow-up of stone clearance rate and other projects.ResultsThis research included9patients, totally11cases and all took MPCNLunderintravenous anesthesia.11cases underwent the first-stage MPCNL(Cases ofbilateral kidney stone respectively underwent MPCNL, and the operation intervaltime was1month.), and its stone clearance rate was81.8%（9/11）. Residual stone inthe renal calyces was removed by the second-stage MPCNL in one case. And stoneclearance rate of the second-stage MPCNL was90.9%(10/11). Residual stone’sdiameter in1case was5mm, and it didn’t take further disposal for the clinicalsymptoms have disappeared. Totally, stone clearance rate was90.9%. This group contains18pieces of stone, and the rate of total optimization is94.4%(17/18). Nobleeding, adjacent organ damage and death case occurred during the operation.1patient suffered from postoperative fever, and the highest temperature was about39.4℃. The temperature returned to normal after giving blood culture and antibiotictherapy. Re-examine KUB to observe stone destruction and the position of ureteralstent tube three days after the operation. Pull out catheter5-7days after the operation.Pull out ureteral stents2-3weeks after the operation. Re-examine B ultrasound orKUB to judge the effect of stone destruction4weeks after the operation.Conclusion1.The design of Minimally invasive percutaneous nephrostomy passage based onthe preoperative CT and plain film examination, and remove the stone from singlechannel can reduce its medical complications.2.The use of ultrasound can design the ideal stone removal and position punctureaccurately channel during the operation. And it can reduce the operationcomplications; Intraoperative real-time ultrasound examination and guide can reducethe residual stone and can also raise the first-stage stone clearance rate.3.Application of MPCNL in the treatment of the patients with horseshoe kidneycombined stones can increase the single channel’s first-stage stone clearance rate.4.The application of MPCNL is a new, safe and efficient mini-percutaneousoperation.