Bilateral simultaneous percutaneous nephrolithotomy versus staged approach for upper urinary system stones
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摘要: 目的 探讨同期与分期经皮肾镜取石术治疗双侧肾输尿管结石的临床疗效。方法 回顾性分析2016年1月—2020年12月肇庆市第一人民医院收治的双侧肾输尿管结石患者233例，其中行双侧同期经皮肾镜取石术128例(BSPCNL组)，双侧分期经皮肾镜取石术105例(分期PCNL组)，比较两组患者一般资料、结石特征、手术情况及术后疗效。结果 BSPCNL组患者中双肾结石、肾结石+输尿管上段结石及输尿管上段结石分别为22、92、14例，分期PCNL组患者中双肾结石、肾结石+输尿管上段结石及输尿管上段结石分别为23、74、8例，两组结石分布及结石负荷比较差异无统计学意义(P>0.05)；两组患者性别、年龄、BMI、术前血红蛋白、术后血红蛋白、术前血肌酐、术后血肌酐等比较差异均无统计学意义(P>0.05)。BSPCNL组总手术时间、出血量、总住院时间及住院费用分别为(99.83±33.61) min、(158.52±78.52) mL、(13.36±4.45) d及(20 831.81±6 774.00)元，分期PCNL组总手术时间、出血量、总住院时间及住院费用分别为(131.84±47.94) min、(202.98±115.65) mL、(25.41±7.17) d及(30 517.95±11 976.65)元，两组比较差异有统计学意义(P < 0.05)。两组患者结石清除率分别为85.9%和88.6%，并发症发生率分别为14.8%和15.2%，差异均无统计学意义(P>0.05)。结论 对于合适的双侧肾输尿管结石患者，BSPCNL较分期PCNL并不增加并发症及结石残留率，同时可减少患者手术时间、住院时间及住院费用，是安全可行的手术方案。但选择行BSPCNL需要术者具有足够的经验与技术，并在患者自身允许的情况下去完成。Abstract: Objective To analyze the efficacy and safety of bilateral simultaneous and staged percutaneous nephrolithotomy for the treatment of upper urinary system stones.Methods Clinical data of 233 patients with bilateral upper urinary calculi admitted in First People's Hospital of Zhaoqing from January 2016 to December 2020 were retrospectively analyzed. One hundred and twenty-eight patients underwent bilateral synchronous percutaneous nephrolithotomy, while 105 patients underwent staged approach. The general conditions, calculi characteristics, surgical conditions and postoperative curative effects of the two groups were compared.Results In the bilateral simultaneous group, there were 22, 92, and 14 cases of kidney stones, kidney + upper ureteral stones, and upper ureteral stones, respectively. The corresponding distribution of stones in the staging group were 23, 74, and 8 cases. There were no significant differences in stone distribution or stone load between the two groups (P > 0.05). There were no significant differences in gender, age, BMI, preoperative hemoglobin, postoperative hemoglobin, preoperative blood creatinine or postoperative blood creatinine between the two groups (P > 0.05). The mean total operation time, estimated blood loss, total hospital stay and hospitalization expenses were (99.83±33.61) min, (158.52±78.52) mL, (13.36±4.45) d and (20 831.81±6 774.00) ￥, respectively, in BS group. The corresponding parameters in staging groups were (131.84±47.94) min, (202.98±115.65) mL, (25.41±7.17) d and (30 517.95±11 976.65) ￥, making it significant difference between two groups (P < 0.05). The stone clearance rates of the two groups were 85.9% and 88.6%, and the complication rates were 14.8% and 15.2%, respectively, and the differences were not statistically significant (P > 0.05).Conclusion For suitable patients with bilateral renal and ureteral stones, bilateral simultaneous percutaneous nephrolithotomy can reduce the patient's operation time, hospital stay and hospitalization costs but do not increase complications and stone residues when compared with staging approach, so it is a safe and feasible surgical scheme. However, the surgeon must possess rich experience and skill when perform bilateral simultaneous percutaneous nephrolithotomy, and good condition of patient is also mandatory.
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Key words:
- simultaneous /
- staged /
- upper urinary calculi /
- percutaneous nephrolithotomy
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表 1 两组患者基本资料比较
例，x±S 项目 BSPCNL组(n=128) 分期PCNL组(n=105) P值 年龄/岁 52.09±10.24 52.07±10.08 0.722 性别(男/女) 66/62 47/58 0.301 BMI/(kg·m-2) 24.5±4.2 24.2±3.9 0.718 结石部位 0.508 肾 22 23 肾+输尿管 92 74 输尿管 14 8 结石数量 0.130 肾内 265 235 输尿管内 138 96 结石成分 0.845 v草酸钙 89 75 磷酸钙 5 3 尿酸 18 14 混合成分a) 16 13 结石负荷b)/cm2 7.90±0.87 8.13±1.03 0.735 注：a)混合成分结石为草酸钙、磷酸钙及尿酸结石的2种或3种成分组成；b)结石负荷为各结石大小之和，单个结石大小为CT平扫中结石的长×宽×π×0.25[5]。 
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表 2 两组患者各临床指标比较
X±S 项目 BSPCNL组(n=128) 分期PCNL组(n=105) P值 术前单侧存在造瘘/个 21 18 0.886 分肾穿刺通道个数/个 0.266 1 226 192 2 30 18 手术时间/min 99.83±33.61 131.84±47.94 0.018 术前Hb/(g·L-1) 118.66±24.84 121.25±23.37 0.417 术后Hb/(g·L-1) 108.70±21.46 112.51±21.55 0.323 Hb下降量/(g·L-1) 8.95±11.38 8.74±11.09 0.535 术前Cr/(μmol·L-1) 178.48±149.29 171.28±172.65 0.733 术后Cr/(μmol·L-1) 164.93±103.71 139.06±93.10 0.049 住院时间/d 13.36±4.45 25.41±7.17 ＜0.001 住院费用/元 20831.81±6774.00 30517.95±11976.65 ＜0.001 结石清除率/% 85.9 88.6 0.550 并发症/例 19 16 0.933 输血 4 3 尿漏 2 2 伤口疼痛 6 7 发热 7 4
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[1] Ghani KR, Andonian S, Bultitude M, et al. Percutaneous Nephrolithotomy: Update, Trends, and Future Directions[J]. Eur Urol, 2016, 70(2): 382-396. doi: 10.1016/j.eururo.2016.01.047
[2] Angerri O, Mayordomo O, Kanashiro AK, et al. Simultaneous and synchronous bilateral endoscopic treatment of urolithiasis: a multicentric study[J]. Cent European J Urol, 2019, 72(2): 178-182.
[3] 李建兴, 肖博. 经皮肾镜手术通道的发展与创新[J]. 临床泌尿外科杂志, 2020, 35(9): 679-683. https://lcmw.chinajournal.net.cn/WKC/WebPublication/paperDigest.aspx?paperID=dadec092-4a18-48b2-8619-15d78ba8d05c
[4] 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. doi: 10.1089/end.2016.0851
[5] ElSheemy MS, Ghoneima W, Elmarakbi AA, et al. Bilateral Single-session vs Staged Mini-percutaneous Nephrolithotomy for Renal Stones: A Comparative Study[J]. Urology, 2018, 120: 62-67. doi: 10.1016/j.urology.2018.07.015
[6] Wang CJ, Chang CH, Huang SW. Simultaneous bilateral tubeless percutaneous nephrolithotomy of staghorn stones: a prospective randomized controlled study[J]. Urol Res, 2011, 39(4): 289-294. doi: 10.1007/s00240-010-0342-x
[7] Ugras MY, Gedik E, Gunes A, et al. Some criteria to attempt second side safely in planned bilateral simultaneous percutaneous nephrolithotomy[J]. Urology, 2008, 72(5): 996-1000. doi: 10.1016/j.urology.2008.08.002
[8] Wang CJ, Chang CH, Huang SW. Simultaneous bilateral tubeless percutaneous nephrolithotomy of staghorn stones: a prospective randomized controlled study[J]. Urol Res, 2011, 39(4): 289-294. doi: 10.1007/s00240-010-0342-x
[9] Marchini GS, Mello MF, Levy R, et al. Contemporary Trends of Inpatient Surgical Management of Stone Disease: National Analysis in an Economic Growth Scenario[J]. J Endourol, 2015, 29(8): 956-962. doi: 10.1089/end.2015.0021
[10] Rivera ME, Bhojani N, Heinsimer K, et al. A Survey Regarding Preference in the Management of Bilateral Stone Disease and a Comparison of Clavien Complication Rates in Bilateral vs Unilateral Percutaneous Nephrolithotomy[J]. Urology, 2018, 111: 48-53. doi: 10.1016/j.urology.2017.09.020
[11] 邵志强, 郭丰富, 王广建, 等. 双侧肾输尿管结石同期或分期经皮肾镜取石术的选择[J]. 中华泌尿外科杂志, 2011, 32: 392-395. doi: 10.3760/cma.j.issn.1000-6702.2011.06.011
[12] 郭志军, 杨军涛, 唐文龙, 等. 双侧同期经皮肾镜取石术治疗双侧上尿路结石[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2011, 5: 25-28.
[13] Purkait B, Kumar M, Sokhal AK, et al. Percutaneous nephrolithotomy of bilateral staghorn renal calculi in pediatric patients: 12 years experience in a tertiary care centre[J]. Urolithiasis, 2017, 45(4): 393-399. doi: 10.1007/s00240-016-0920-7
[14] Maheshwari PN, Andankar M, Hegde S, et al. Bilateral single-session percutaneous nephrolithotomy: a feasible and safe treatment[J]. J Endourol, 2000, 14(3): 285-287. doi: 10.1089/end.2000.14.285
[15] Darabi MR, Soltani S, Rezayat AA, et al. Clinical outcomes of the simultaneous bilateral percutaneous nephrolithotomy(PCNL)in patients with kidney stones: A prospective cohort study[J]. Electron Physician, 2018, 10(2): 6377-6382. doi: 10.19082/6377
[16] Sofer M, Proietti S, Bar-Yosef Y, et al. Assessment of bilateral supine and prone tubeless percutaneous nephrolithotomy[J]. Can J Urol, 2017, 24(6): 9114-9120.
[17] Kadlec AO, Greco KA, Fridirici ZC, et al. Comparison of complication rates for unilateral and bilateral percutaneous nephrolithotomy(PCNL)using a modified Clavien grading system[J]. BJU Int, 2013, 111(4 Pt B): E243-E248.
[18] Canvasser NE, Alken P, Lipkin M, et al. The economics of stone disease[J]. World J Urol, 2017, 35(9): 1321-1329. doi: 10.1007/s00345-017-2003-y
[19] Torricelli F, Carvalho RS, Marchini GS, et al. Bilateral simultaneous percutaneous nephrolithotomy versus staged approach: a critical analysis of complications and renal function[J]. Rev Assoc Med Bras(1992), 2020, 66(12): 1696-1701. doi: 10.1590/1806-9282.66.12.1696
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