同期双侧微通道经皮肾镜取石术联合顺行输尿管软镜碎石术治疗马蹄肾双肾结石病例报告并可行性分析

Simultaneous bilateral mPCNL combined with antegrade flexible ureteroscopic lithotripsy for calculi in horseshoe kidney: a case report and feasibility analysis

摘要

目的 报道中国首例同期双侧微通道经皮肾镜取石术（SB-mPCNL）联合顺行输尿管软镜碎石术（A-FURS）治疗马蹄肾（HSK）双肾结石，并进行可行性分析。病例报告 患者男性，57岁，因“右侧腰腹部疼痛10 d”入院。计算机断层扫描尿路成像（CTU）提示HSK双肾结石，行SB-mPCNL联合A-FURS，手术时间185 min，碎石清石时间80 min，出血量约30 mL。术后4 d复查腹部平片可见结石完全清除，术后第6天拔除双肾造瘘管，术后第7天顺利康复出院。结合相关文献分析其安全性及可行性。结论 SB-mPCNL联合A-FURS治疗HSK双肾结石安全、高效、可行，值得进一步开展临床验证。

Abstract

Objective To report the first case of renal calculi in a patient with horseshoe kidney (HSK) treated with simultaneous bilateral minimally invasive percutaneous nephrolithotomy (SB-mPCNL) combined with antegrade flexible ureteroscopy lithotripsy (A-FURS), and to analyze the feasibility of the surgical approach. Case Report A 57-year-old male patient was admitted due to "right lumbago and abdominal pain for 10 days". Computed tomography urography (CTU) revealed bilateral nephrolithiasis with HSK. The patient underwent SB-mPCNL combined with A-FURS. The operation time was 185 min, with the lithotripsy and stone clearance time accounting for 80 min, and the estimated blood loss being approximately 30 mL. A plain abdominal radiograph conducted on the 4th postoperative day showed complete clearance of stones. Bilateral nephrostomy tubes were removed on the 6th postoperative day. The patient recovered uneventfully and was discharged on the 7th postoperative day. The safety and feasibility of this combined surgical modality were analyzed based on relevant literature. Conclusion SB-mPCNL combined with A-FURS is a safe, effective and feasible therapeutic option for bilateral nephrolithiasis in patients with HSK, which is worthy of further clinical verification.

关键词

马蹄肾 / 双肾结石 / 微通道经皮肾镜取石术 / 顺行输尿管软镜

Key words

horseshoe kidney / bilateral renal calculi / minimally invasive percutaneous nephrolithotomy / antegrade flexible ureteroscopy

参考文献

[1] WEIZER AZ, SILVERSTEIN AD, AUGE BK, et al. Determining the incidence of horseshoe kidney from radiographic data at a single institution[J]. J Urol, 2003, 170(5): 1722-1726.

[2] 吴晃, 付宇强, 何綦琪, 等. 马蹄肾合并常见泌尿系疾病的诊疗进展[J]. 国际泌尿系统杂志, 2022, 42(6): 1137-1140.

[3] SPINOS T, TATANIS V, SEITZ C, et al. Percutaneous nephrolithotomy (PCNL) versus other treatments for stone management in horseshoe kidneys: a systematic review[J]. Arab J Urol, 2024, 22(4): 243-252.

[4] WU W, ZHAO Z, ZHU H, et al. Safety and efficacy of minimally invasive percutaneous nephrolithotomy in treatment of calculi in horseshoe kidneys[J]. J Endourol, 2014, 28(8): 926-929.

[5] LIM EJ, TEOH JY, FONG KY, et al. Propensity score-matched analysis comparing retrograde intrarenal surgery with percutaneous nephrolithotomy in anomalous kidneys[J]. Minerva Urol Nephrol, 2022, 74(6): 738-746.

[6] 邢浩楠, 彭忠胜, 祁元炯, 等. 顺行输尿管软镜在经皮肾镜取石术治疗复杂肾结石中的应用价值[J]. 临床泌尿外科杂志, 2023, 38(1): 20-23.

[7] QI Y, XING H, YANG S, et al. Antegrade flexible ureteroscopy-assisted percutaneous nephrolithotomy for staghorn calculi: a prospective randomized controlled study[J]. Urolithiasis, 2024, 52(1): 33.

[8] SKOLARIKOS A, JUNG H, NEISIUS A, et al. EAU Guidelines on Urolithiasis[M]. Arnhem, the Netherlands: EAU Guidelines Office, 2024.

[9] YI X, CAO D, YOU P, et al. Comparison of the efficacy and safety of extracorporeal shock wave lithotripsy and flexible ureteroscopy for treatment of urolithiasis in horseshoe kidney patients: a systematic review and meta-analysis[J]. Front Surg, 2021, 8: 726233.

[10] ZENG G, TRAXER O, ZHONG W, et al. International Alliance of Urolithiasis guideline on retrograde intrarenal surgery[J]. BJU Int, 2023, 131(2): 153-164.

[11] GIUSTI G, PROIETTI S, PESCHECHERA R, et al. Sky is no limit for ureteroscopy: extending the indications and special circumstances[J]. World J Urol, 2015, 33(2): 257-273.

[12] ERYILDIRIM B, KUCUK EV, ATIS G, et al. Safety and efficacy of PNL vs. RIRS in the management of stones located in horseshoe kidneys: a critical comparative evaluation[J]. Arch Ital Urol Androl, 2018, 90(3): 149-154.

[13] NOURALIZADEH A, DARZI MM, ADIB A, et al. An assessment of the efficacy and safety of balloon nephrostomy traction in minimizing postoperative bleeding of percutaneous nephrolithotomy: a randomized controlled clinical trial[J]. Langenbecks Arch Surg, 2025, 410(1): 26.

[14] ZENG GH, ZHONG W, MAZZON G, et al. International Alliance of Urolithiasis (IAU) consensus on miniaturized percutaneous nephrolithotomy[J]. Mil Med Res, 2024, 11(1): 70.

[15] WU W, ZHAO Z, ZHU H, et al. Safety and efficacy of minimally invasive percutaneous nephrolithotomy in treatment of calculi in horseshoe kidneys[J]. J Endourol, 2014, 28(8): 926-929.

[16] AGRAWAL MS, MISHRA DK, SOMANI B. Minimally invasive percutaneous nephrolithotomy[M]. Singapore: Springer, 2022.

[17] SHEN YM, CHEN PH. Simultaneous single-tract bilateral percutaneous nephrolithotomy in bilateral large complex renal stones is not associated with increased complications: series of 36 consecutive patients[J]. BMC Urol, 2025, 25(1): 137.

[18] HOLMAN E, KHAN AM, PASZTOR I, et al. Simultaneous bilateral compared with unilateral percutaneous nephrolithotomy[J]. BJU Int, 2002, 89(4): 334-338.

[19] JONES P, DHLIWAYO B, RAI BP, et al. Safety, feasibility, and efficacy of bilateral synchronous percutaneous nephrolithotomy for bilateral stone disease: evidence from a systematic review[J]. J Endourol, 2017, 31(4): 334-340.

[20] 杨杰, 王坤杰, 王佳. 经皮肾镜碎石取石术清石率影响因素分析[J]. 四川大学学报(医学版), 2019, 50(3): 445-447.