Endoscopic anatomical classification of renal calyxes applied in retrograde intrarenal surgery
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摘要: 目的 建立一种新的适用于输尿管软镜碎石术(RIRS)的肾盂解剖分类系统，以提高RIRS成功率和缩短学习曲线。方法 收集并分析139例接受RIRS患者的术中影像资料，我们总结了一种新的肾盏解剖分类方法。从2020年12月—2021年9月选取在我院医联体单位进行RIRS手术的40例患者，随机分为A、B两组，每组各20例，手术由该单位2位接受过RIRS培训并有一定手术经验的术者分别完成，其中A组术者继续沿用原有经验和习惯完成本研究，而B组术者在加入本研究前系统接受了我们的肾盏解剖分类方法学习和培训。通过比较两组患者术中肾盏定位时间、手术时间和术后3个月清石率(SFR)，验证这个新分类方法的有效性。结果 我们的分类系统根据中组肾盏的位置将肾脏集合系统分为四类：中盏水平分布型(52.0%)、居上型(6.1%)、居下型(27.7%)和垂直分布型(14.2%)。B组术者经过术前培训，该组患者术中肾盏定位时间和手术时间明显低于A组[(1.3±0.3) min vs.(4.4±1.4) min，P＜0.001；(40.7±8.7) min vs.(57.7±18.7) min，P=0.001]，术后3个月SFR也明显高于A组(95% vs.70%，P=0.037)。结论 我们总结了一个行之有效的新肾盏解剖分类系统，实践证明其易于掌握，能有效缩短学习曲线和提高RIRS的手术效果，值得推广。Abstract: Objective To investigate a new anatomical classification of renal calyxes to improve the success rate and learning curve of retrograde intrarenal surgery(RIRS).Methods The new anatomical classification of renal calyxes was summarized based on the data of 139 cases, and then a total of 40 patients treated by RIRS from December 2020 to September 2021 were divided into group A (n=20) and group B (n=20). Group A followed standard procedure of RIRS by one endourologist, and the other endourologist with identical RIRS skills performed the surgeries of Group B after learning the new anatomical classification of renal calyxes. The time of calyxes orientation, operation time, and stone-free rate (SFR) after 3 months between the two groups were analyzed.Results According to the location of the middle calyceal body, four types of the distribution of renal calyxes were identified: horizontally distribution (52%), upper distribution (6.1%), lower distribution (27.7%) and vertical distribution (14.2%). After the training, the time of calyxes orientation and operation time in group B were significantly shorter than those in group A [(1.3±0.3) min vs. (4.4±1.4) min, P < 0.001; (40.7±8.7) min vs. (57.7±18.7) min, P=0.001], and SFR after 3 months in group B was also significantly higher than that in group A (95% vs. 70%, P=0.037).Conclusion We summarized a new anatomical classification of the kidney collecting system. This holistic observation and anatomical classification is easy to grasp and very helpful to shorten the learning curve and improve the clinical outcome of RIRS.
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Key words:
- retrograde intrarenal surgery /
- renal calyxes /
- anatomy /
- classification
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表 1 两组术者RIRS技术比较
项目 A组 B组 P值 RIRS台数 10 13 肾盏定位时间/min 5.0±1.3 4.6±1.1 0.381 手术时间/min 61.5±14.4 60.6±19.6 0.906 SFR/例(%) 6(60.0) 8(61.5) 0.940 
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表 2 新肾集合系统解剖分类统计
例(%) 类型 中组肾盏个数 比例(n=148) Ⅰ型(水平分布型) 77(52.0) 上、下组肾盏被宽大的中央区域分隔开，中组肾盏则水平分布于此区域上 1 7(4.7) 2 65(43.9) 3 4(2.7) 5 1(0.7) Ⅱ型(居上型) 9(6.1) 中组肾盏紧邻上组肾盏下缘，下组肾盏则与两者明显相隔开 1 4(2.7) 2 5(3.4) Ⅲ型(居下型) 41(27.7) 中组肾盏紧邻下组肾盏上缘，上组肾盏则与两者明显相隔开 2 41(27.7) Ⅳ型(垂直分布型) 21(14.2) 上、下组肾盏被宽大的中央区域分隔开，中组肾盏则垂直分布于此区域上，且位于两端的中组肾盏个数相同 两端各1个 18(12.2) 两端各2个 3(2.0)
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表 3 两组患者一般资料和结石特征比较
项目 A组(n=20) B组(n=20) P值 性别/例(%) 0.736 男 13(65.0) 14(70.0) 女 7(35.0) 6(30.0) 年龄/岁 46.6±11.0 (29~67) 44.6±10.3 (24~62) 0.557 BMI/(kg·m-2) 24.8±3.2 (20.5~33.1) 24.3±2.3 (20.7~31.1) 0.636 结石长径/mm 10.7±2.8 (7~16) 9.7±3.8 (4~18) 0.326 结石部位/例(%) 0.556 肾盂 2(10.0) 1(5.0) 上组肾盏 2(10.0) 2(10.0) 中组肾盏 1(5.0) 4(20.0) 输尿管上段 8(40.0) 9(45.0) 肾盂和输尿管上段 7(35.0) 4(20.0)
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表 4 两组手术相关指标比较
指标 A组(n=20) B组(n=20) P值 肾盏定位时间/min 4.4±1.4 (1.9~7.7) 1.3±0.3 (0.9~1.9) ＜0.001 手术时间/min 57.7±18.3 (25~98) 40.7±8.7 (30~75) 0.001 SFR/例(%) 14(70.0) 19(95.0) 0.037 发热a)/例(%) 3(15.0) 1(5.0) 0.292 术后血红蛋白下降/(g·L-1) 6.4±5.8 5.0±9.1 0.553 注：a)术后体温>38.5℃被界定为发热。
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[1] Ordon M, Urbach D, Mamdani M, et al. A population based study of the changing demographics of patients undergoing definitive treatment for kidney stone disease[J]. J Urol, 2015, 193(3): 869-874. doi: 10.1016/j.juro.2014.09.096
[2] Turney BW, Reynard JM, Noble JG, et al. Trends in urological stone disease[J]. BJU Int, 2012, 109(7): 1082-1087. doi: 10.1111/j.1464-410X.2011.10495.x
[3] Geavlete P, Multescu R, Geavlete B. Pushing the boundaries of ureteroscopy: current status and future perspectives[J]. Nat Rev Urol, 2014, 11(7): 373-382. doi: 10.1038/nrurol.2014.118
[4] Sampaio FJ. Renal collecting system anatomy: its possible role in the effectiveness of renal stone treatment[J]. CurrOpinUrol, 2001, 11(4): 359-366.
[5] Takazawa R, Kitayama S, Uchida Y, et al. Proposal for a Simple Anatomical Classification of the Pelvicaliceal System for Endoscopic Surgery[J]. J Endourol, 2018, 32(8): 753-758. doi: 10.1089/end.2018.0218
[6] Zhu W, Zheng M, Xiong S, et al. Modified Takazawa anatomical classification of renal pelvicalyceal system based on three-dimensional virtual reconstruction models[J]. Transl Androl Urol, 2021, 10(7): 2944-2952. doi: 10.21037/tau-21-309
[7] Karim SS, Hanna L, Geraghty R, et al. Role of pelvicalyceal anatomy in the outcomes of retrograde intrarenal surgery(RIRS)for lower pole stones: outcomes with a systematic review of literature[J]. Urolithiasis, 2020, 48(3): 263-270. doi: 10.1007/s00240-019-01150-0
[8] Kirecci SL, Ilgi M, Yesildal C, et al. The impact of the pelvicalyceal anatomy characteristics on the prediction of flexible ureteroscopy outcomes[J]. Urol Ann, 2021, 13(2): 105-110. doi: 10.4103/UA.UA_19_20
[9] Chew BH, Brotherhood HL, Sur RL, et al. Natural History, Complications and Re-Intervention Rates of Asymptomatic Residual Stone Fragments after Ureteroscopy: a Report from the EDGE Research Consortium[J]. J Urol, 2016, 195(4 Pt 1): 982-986.
[10] 邵剑锋, 宣枫, 孙莉娟, 等. 同期双侧输尿管软镜碎石术安全性及有效性分析[J]. 临床泌尿外科杂志, 2021, 36(2): 102-105. http://lcmw.cbpt.cnki.net/WKC/WebPublication/paperDigest.aspx?paperID=f189ff3c-40db-43cb-ad10-6b2b140f8d32ahttp://lcmw.cbpt.cnki.net/WKC/WebPublication/paperDigest.aspx?paperID=f189ff3c-40db-43cb-ad10-6b2b140f8d32
[11] Wendt-Nordahl G, Mut T, Krombach P, et al. Do new generation flexible ureterorenoscopes offer a higher treatment success than their predecessors?[J]. Urol Res, 2011, 39(3): 185-188. doi: 10.1007/s00240-010-0331-0
[12] Takazawa R, Kitayama S, Tsujii T. Successful outcome of flexible ureteroscopy with holmium laser lithotripsy for renal stones 2 cm or greater[J]. Int J Urol, 2012, 19(3): 264-267. doi: 10.1111/j.1442-2042.2011.02931.x
[13] Sampaio FJB, Mandarim-de-Lacerda CA. Anatomic classification of the kidney collectingsystem for endourologic procedures[J]. J Endourol, 1988, 2(3): 247-251. doi: 10.1089/end.1988.2.247
[14] Binbay M, Akman T, Ozgor F, et al. Does pelvicaliceal system anatomy affect success of percutaneous nephrolithotomy?[J]. Urology, 2011, 78(4): 733-737. doi: 10.1016/j.urology.2011.03.058
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