Micro-percutaneous nephrolithotomy in the treatment of postoperative residual stones for patients with renal staghorn calculi
-
摘要: 目的:探讨可视穿刺经皮肾镜取石术(micropercutaneous nephrolithotomy,Microperc)治疗鹿角形结石术后残留结石的安全性及有效性。方法:自2015~2016年,采用可视穿刺经皮肾镜取石术治疗鹿角形结石术后残石16例(Microperc组),采用微创经皮肾镜取石术治疗鹿角形肾结石术后残石12例(mPCNL组),收集两组患者的年龄、残石数目、结石负荷、手术时间、通道数目、清石率、并发症发生率、术后疼痛评分、住院天数进行统计学分析。结果:Microperc组结石清石率高于mPCNL组(87.50% vs.50.00%,P<0.05),术后疼痛评分较mPCNL组为轻[(2.62±2.24)vs.(5.04±3.42),P<0.05],住院时间短于mPCNL组[(3.46±3.03)d vs.(6.88±4.91)d,P<0.05],手术时间长于mPCNL组[(93.75±12.80)min vs.(52.25±8.53)min,P<0.05],术后并发症发生率两组差异无统计学意义(P>0.05)。结论:Microperc治疗鹿角形结石术后残石安全、有效,可提高残石的清石率,缩短住院时间。
-
关键词:
- 可视穿刺经皮肾镜取石术 /
- 鹿角形肾结石 /
- 残留结石
Abstract: Objective: To evaluate the efficacy and safety of the micro-percutaneous nephrolithotomy (Microperc) for the management of residual stones after one-stage percutaneous nephrolithotomy (PCNL) for renal staghorn calculi.Method: Patients with residual stones after one-stage PCNL for renal staghorn calculi treated with microperc (Group-Microperc 16 cases) or mini-PCNL (Group-mPCNL 1 2cases) between 2015 and 2016 were retrospectively analyzed.Parameters of the patients were compared, including age, residual stone number, stone burden, operation time, tract number, stone free rate, complication rate, visual analogue scale and hospital stay etc.Result: In Group-Microperc, the stone free rate (SFR) was significantly higher than that in Group-mPCNL (87.50% vs.50.00%, P<0.05), visual analogue scale (VAS) was significantly lower than that in Group-mPCNL[(2.62±2.24) vs. (5.04±3.42), P<0.05], hospital stay was significantly shorter than that in GroupmPCNL[(3.46±3.03) vs. (6.88±4.91) days, P<0.05)], the mean operation time was significantly longer than that in Group-mPCNL[(93.75±12.80) min vs. (52.25±8.53) min, P<0.05].However, overall complication rates exhibited no statistically significant difference (P>0.05).Conclusion: Microperc in the treatment of residual stones after one-stage PCNL for renal staghorn calculi is a safe and effective method, being associated with higher SFR and shorter hospital stay. -
-
[1] 那彦群, 叶章群, 孙颖浩, 等.中国泌尿外科疾病诊断治疗指南[M].人民卫生出版社, 2014:166-184.
[2] Assimos D, Krambeck A, Miller N L.et al.Surgical Management of Stones:American Urological Association/Endourological Society Guideline, PART I[J].J Urol, 2016, 196 (4):1153-1160.
[3] Türk C, Petík A, Sarica K.et al.EAU Guidelines on Interventional Treatment for Urolithiasis[J].Eur Urol, 2016, 69 (3):475-482.
[4] Soucy F, Ko R, Duvdevani M, et al.Percutaneous nephrolithotomy for staghorn calculi:a single center's experience over 15years[J].J Endourol, 2009, 23 (10):1669-1673.
[5] Ghani K R, Sammon J D, Bhojani N, et al.Trends in percutaneous nephrolithotomy use and outcomes in the United States[J].J Urol, 2013, 190 (2):558-564.
[6] Kalayci O T, Bozdag Z, Sonmezgoz F, et al.Squamous cell carcinoma of the renal pelvis associated with kidney stones:radiologic imaging features with gross and histopathological correlation[J].J Clin Imaging Sci, 2013, 3:14.
[7] Aminsharifi A, Irani D, Masoumi M, et al.The management of large staghorn renal stones by percutaneous versus laparoscopic versus open nephrolithotomy:a comparative analysis of clinical efficacy and functional outcome[J].Urolithiasis, 2016, 44 (6):551-557.
[8] Gu S P, Zeng G H, You Z Y, et al.Types of Renal Calculi and Management Regimen for Chinese Minimally Invasive Percutaneous Nephrolithotomy[J].Indian J Surg, 2015, 77 (Suppl 3):872-876.
[9] Goktug G, Karakoyunlu N, Sener N C.Standard percutaneous nephrolithotomy alone versus in combination with intraoperative anterograde flexible nephroscopy for staghorn stones:A retrospective study[J].Kaohsiung J Med Sci, 2015, 31 (11):568-571.
[10] Choi S W, Bae W J, Ha U S, et al.Prognostic Impact of Stone-Scoring Systems After Percutaneous Nephrolithotomy for Staghorn Calculi:A Single Center's Experience Over 10 Years[J].J Endourol, 2016, 30 (9):975-981.
[11] Lojanapiwat B, Tanthanuch M, Pripathanont C, et al.Alkaline citrate reduces stone recurrence and regrowth after shockwave lithotripsy and percutaneous nephrolithotomy[J].Int Braz J Urol, 2011, 37 (5):611-616.
[12] Altunrende F, Tefekli A, Stein R J, et al.Clinically insignificant residual fragments after percutaneous nephrolithotomy:medium-term follow-up[J].J Endourol, 2011, 25 (6):941-945.
[13] Akman T, Binbay M, Kezer C, et al.Factors affecting kidney function and stone recurrence rate after percutaneous nephrolithotomy for staghorn calculi:outcomes of a long-term followup[J].J Urol, 2012, 187 (5):1656-1661.
[14] Oner S, Okumus M M, Demirbas M, et al.Factors Influencing Complications of Percutaneous Nephrolithotomy:A Single-Center Study[J].Urol J, 2015, 12 (5):2317-2323.
[15] Labate G, Modi P, Timoney A, et al.The percutaneous nephrolithotomy global study:classification of complications[J].J Endourology, 2011, 25 (8):1275-1280.
[16] Ghani K R, Andonian S, Bultitude M, et al.Percutaneous Nephrolithotomy:Update, Trends, and Future Directions[J].Eur Urol, 2016, 70 (2):382-396.
[17] Bader M J, Gratzke C, Seitz M, et al.The "all-seeing needle":initial results of an optical puncture system confirming access in percutaneous nephrolithotomy[J].J Eur Urol, 2011, 59 (6):1054-1059.
[18] Desai M R, Sharma R, Mishra S, et al.Single-step percutaneous nephrolithotomy (microperc):the initial clinical report[J].J Urol, 2011, 186 (1):140-145.
[19] Kukreja R, Desai M, Patel S, et al.Factors affecting bloodloss during percutaneous nephrolithotomy:prospective study[J].J Endourol, 2004, 18 (8):715-722.
[20] Turna B, Nazli O, Demiryoguran S, et al.Percutaneous nephrolithotomy:variables that influence hemorrhage[J].J Urology, 2007, 69 (4):603-607.
[21] Gazelle G S, Haaga J R, Rowland D Y.Effect of needle gauge, level of anticoagulation, and target organ on bleeding associated with aspiration biopsy[J].Radiology, 1992, 183 (2):509-513.
[22] Michel M S, Trojan L, Rassweiler J J.Complications in percutaneous nephrolithotomy[J].Eur Urol, 2007, 51 (4):899-906.
[23] DoréB.Complications of percutaneous nephrolithotomy:risk factors and management[J].Ann Urol (Paris), 2006, 40 (3):149-160.
[24] Tepeler A, Akman T, Silay M S, et al.Comparison of intrarenal pelvic pressure during micro-percutaneous nephrolithotomy and conventional percutaneous nephrolithotomy[J].Urolithiasis, 2014, 42 (3):275-279.
[25] Sabnis R B, Ganesamoni R, Doshi A, et al.Micropercutaneous nephrolithotomy (microperc) vs retrograde intrarenal surgery for the management of small renal calculi:a randomized controlled trial[J].BJU Int, 2013, 112 (3):355-361.
-
计量
- 文章访问数: 165
- PDF下载数: 488
- 施引文献: 0