Duvdevani Mordechai, Razvi Hassan, Sofer Mario, Beiko Darren T, Nott Linda, Chew Ben H, Denstedt John D
Division of Urology, The University of Western Ontario, London, Ontario, Canada.
J Endourol. 2007 Aug;21(8):824-9. doi: 10.1089/end.2007.9936.
The approach to urinary-stone disease has changed dramatically over the last three decades with a transition from open surgery to minimally invasive procedures. Percutaneous nephrolithotripsy (PCNL) is a cornerstone of the treatment of kidney and selected upper-ureteral stones and continues to evolve with advances in techniques and instrumentation. The purpose of this study was to assess outcomes and trends prospectively in a large contemporary group of patients undergoing PCNL.
Between July 1990 and December 2005, all 1338 patients at a single center scheduled for PCNL (N = 1585 procedures) were enrolled. Their mean age was 53 years (range 4-89 years). Data including comorbidities, stone burden, stone location, surgical time, hospital length of stay, rate of secondary procedures, and adverse events were collected prospectively. The primary outcome measures were stone-free rate and complications.
There was a substantial incidence of comorbid medical conditions (48.8%) and anatomic renal abnormalities (25.3%), demonstrating the diverse and challenging patient population in this contemporary series. The overall stone-free rate at 3 to 6 months of follow-up was 94.8%.
Percutaneous nephrolithotripsy is a highly effective procedure and may be performed in a diverse group of patients with comorbid conditions and renal abnormalities. Improved intracorporeal lithotripters, balloon dilation of the tract, use of flexible instruments, and liberal use of secondary nephroscopy result in excellent stone-free rates with low morbidity.
在过去三十年中，尿路结石病的治疗方法发生了巨大变化，从开放手术过渡到了微创手术。经皮肾镜取石术（PCNL）是治疗肾结石和部分上段输尿管结石的基石，并且随着技术和器械的进步不断发展。本研究的目的是对一大组接受PCNL的当代患者进行前瞻性的疗效和趋势评估。
在1990年7月至2005年12月期间，纳入了单一中心计划接受PCNL的所有1338例患者（共进行了1585次手术）。他们的平均年龄为53岁（范围4 - 89岁）。前瞻性收集了包括合并症、结石负荷、结石位置、手术时间、住院时间、二次手术率和不良事件等数据。主要结局指标为结石清除率和并发症。
合并内科疾病的发生率较高（48.8%），解剖性肾脏异常的发生率为25.3%，表明该当代系列中的患者群体多样且具有挑战性。随访3至6个月时的总体结石清除率为94.8%。
经皮肾镜取石术是一种高效的手术，可在患有合并症和肾脏异常的不同患者群体中进行。改进的体内碎石器、通道球囊扩张、使用软性器械以及广泛应用二次肾镜检查可实现出色的结石清除率且发病率较低。
