Marguet Charles G, Springhart W Patrick, Tan Yeh H, Patel Anup, Undre Shabnam, Albala David M, Preminger Glenn M
Department of Urology, Duke University Medical Center, Durham, NC 27710, USA.
BJU Int. 2005 Nov;96(7):1097-100. doi: 10.1111/j.1464-410X.2005.05808.x.
To present early experience in managing complex renal calculi using a combined ureteroscopic and percutaneous approach, as complex and branched renal calculi often require multiple access tracts during percutaneous nephrolithotomy (PNL), and the combined use of flexible ureteroscopy and PNL has the potential to reduce the inherent morbidity of several tracts.
The study included seven patients (mean age 54 years) with multiple, branched, large-volume renal calculi suitable for management with PNL. Preoperative data, including patient demographics, stone location and stone surface area, were recorded. After informed consent, the patients underwent combined PNL and ureteroscopy in one session. Intraoperative data, including the location of PNL puncture sites, operative duration and complications, were analysed. Stone-free rates were determined by follow-up imaging at 3 months.
All patients had either two or more stones in separate locations in the collecting system, or staghorn stones involving multiple calyces. The mean stone burden was 666 mm(2). All patients had only one percutaneous access tract. The mean operative duration was 142 min and the mean blood loss 79 mL. Two patients had small residual stones (< 3 mm), that required ureteroscopic intervention as they failed to pass spontaneously by 3 months after the initial combined procedure. The convalescence was similar to that in our current PNL practice; imaging showed that five of the patients were stone-free.
Combined PNL and ureteroscopic management can effectively reduce the number of percutaneous access tracts which would otherwise be required for managing complex and branched renal calculi, as stones in an unfavourable location relative to the access tract can be relocated and fragmented within easy reach of the single nephrostomy tract. This manoeuvre reduces potential patient morbidity and blood loss but with no significant effect on stone-free rates and operative durations.
介绍采用输尿管镜和经皮肾镜联合入路处理复杂性肾结石的早期经验，因为复杂性分支肾结石在经皮肾镜取石术（PNL）期间通常需要多个穿刺通道，而软性输尿管镜与PNL联合使用有可能降低多个通道带来的固有并发症发生率。
本研究纳入了7例（平均年龄54岁）适合行PNL治疗的多发、分支、大体积肾结石患者。记录术前数据，包括患者人口统计学资料、结石位置和结石表面积。在获得知情同意后，患者在同一次手术中接受了PNL和输尿管镜联合治疗。分析术中数据，包括PNL穿刺部位的位置、手术时间和并发症。通过3个月后的随访影像确定结石清除率。
所有患者在集合系统的不同位置均有2个或更多结石，或为累及多个肾盏的鹿角形结石。平均结石负荷为666 mm²。所有患者均仅有1个经皮穿刺通道。平均手术时间为142分钟，平均失血量为79毫升。2例患者有小的残留结石（<3 mm），由于在初次联合手术后3个月未能自行排出，需要输尿管镜干预。康复情况与我们目前的PNL治疗实践相似；影像显示5例患者结石清除。
PNL与输尿管镜联合治疗可有效减少处理复杂性分支肾结石所需的经皮穿刺通道数量，因为相对于穿刺通道位置不佳的结石可在单个肾造瘘通道易于到达的范围内重新定位并破碎。这一操作降低了潜在的患者并发症发生率和失血量，但对结石清除率和手术时间无显著影响。
