Singla Manish, Srivastava Aneesh, Kapoor Rakesh, Gupta Nitin, Ansari Mohd S, Dubey Deepak, Kumar Anant
Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Urology. 2008 Jun;71(6):1039-42. doi: 10.1016/j.urology.2007.11.072. Epub 2008 Feb 15.
To evaluate the safety and efficacy of an aggressive approach to staghorn calculi using multiple-tract percutaneous nephrolithotomy.
We retrospectively analyzed the data from 149 patients with staghorn calculi, who underwent percutaneous nephrolithotomy using multiple (two or more) access tracts, at our institute from 1999 to 2006. The data were analyzed with regard to stone burden, stone clearance, perioperative morbidity, complications, and the number of ancillary procedures.
A total of 164 renal units in 149 patients (118 men and 31 women, mean age 39.8 years, range 12 to 65 years) were treated. Of the 164 renal units, 43 (26.2%) had a complete staghorn, 85 (51.8%) had a partial staghorn and 36 (21.9%) had a borderline stone bulk. A total of 420 tracts were established in the 164 renal units. The maximal number of tracts used in a single renal unit was six (range two to six), most required three tracts. Supracostal access was established in 98 renal units (59.7%). The complications included blood transfusion in 46 patients, pseudoaneurysm in 4, sepsis in 8, hydrothorax in 7, hemothorax in 1, and perinephric collection in 1 patient. A complete stone clearance rate of 70.7% was achieved after a single session of percutaneous nephrolithotomy that increased to 89% after a second-look procedure (n = 30) and extracorporeal shock wave lithotripsy (n = 16).
The results of our study have shown that an aggressive approach to staghorn calculi using multiple-tract percutaneous nephrolithotomy is safe and effective in achieving a greater stone clearance rate with acceptable morbidity. A supracostal approach can be used more often without increasing the risk of significant complications.
评估采用多通道经皮肾镜取石术治疗鹿角形结石的积极方法的安全性和有效性。
我们回顾性分析了1999年至2006年在我院接受多通道（两个或更多）经皮肾镜取石术的149例鹿角形结石患者的数据。分析了结石负荷、结石清除率、围手术期发病率、并发症及辅助手术数量等数据。
共治疗了149例患者（118例男性和31例女性，平均年龄39.8岁，范围12至65岁）的164个肾单位。在这164个肾单位中，43个（26.2%）为完全鹿角形结石，85个（51.8%）为部分鹿角形结石，36个（21.9%）为临界结石体积。164个肾单位共建立了420个通道。单个肾单位使用的通道最多为6个（范围为2至6个），大多数需要3个通道。98个肾单位（59.7%）采用了肋上入路。并发症包括46例患者输血、4例假性动脉瘤、8例脓毒症、7例胸腔积液、1例血胸和1例患者肾周积液。单次经皮肾镜取石术后结石完全清除率为70.7%，二次手术（n = 30）和体外冲击波碎石术（n = 16）后升至89%。
我们的研究结果表明，采用多通道经皮肾镜取石术积极治疗鹿角形结石在获得更高结石清除率且发病率可接受方面是安全有效的。肋上入路可更频繁使用而不增加严重并发症风险。
