Ugras Murat Y, Gedik Ender, Gunes Ali, Yanik Metin, Soylu Ahmet, Baydinc Can
Department of Urology, Inonu University Medical Faculty, Malatya, Turkey.
Urology. 2008 Nov;72(5):996-1000. doi: 10.1016/j.urology.2008.08.002. Epub 2008 Sep 26.
To determine the validity of some criteria that could guide in the decision to cancel or proceed with the second side of planned bilateral simultaneous percutaneous nephrolithotomy (bsPCNL).
Patients with an indication for bilateral PCNL were enrolled in this study. The operation was stopped at the end of the initial side if operative time was >180 min, the hemoglobin level was <11 g/dL, the hemoglobin decrease was >3 g/dL, the systolic arterial pressure was <100 mm Hg, the arterial oxygen saturation was <95%, the arterial blood pH was <7.35, or the blood sodium was <128 mg/mL. The success and complication rates were compared in patients who underwent second side PCNL (group 1) and those for whom the procedure was stopped after the initial side (group 2).
Of 42 planned bsPCNLs, 12 were stopped after the initial side, with the cause being prolonged operative time in 7, hemoglobin decrease in 6, systolic arterial pressure decrease in 2, arterial oxygen saturation decrease in 2, pH decrease in 1, and sodium decrease in 1. Differences in patient characteristics, stone burdens, and overall success and complication rates were insignificant. Transfusion, postoperative urinary infection, and prolonged urine drainage rates were similar, but the total hospitalization time was significantly longer in group 2. One hydrothorax and one renal pelvic perforation occurred in group 2. The need for transfusion correlated positively with the number of nephrostomy tracts in group 2 (r = 0.895, P = .001). No such correlation was found in group 1.
Despite the best of intentions, about 30% of anticipated bsPCNL cases might be limited to single-sided PCNL, depending on the intraoperative events. Our criteria seem reasonable, because similar success and complication rates were obtained with bilateral, separate-session PCNL and bsPCNL. These criteria can be considered in the decision making to omit the advantages of a single session for safety.
确定一些标准的有效性，这些标准可用于指导决定取消或继续进行计划中的双侧同期经皮肾镜取石术（bsPCNL）的另一侧手术。
纳入有双侧PCNL指征的患者。如果手术时间>180分钟、血红蛋白水平<11 g/dL、血红蛋白下降>3 g/dL、收缩压<100 mmHg、动脉血氧饱和度<95%、动脉血pH<7.35或血钠<128 mg/mL，则在初始侧手术结束时停止手术。比较接受另一侧PCNL的患者（第1组）和在初始侧手术后停止手术的患者（第2组）的成功率和并发症发生率。
在42例计划进行的bsPCNL中，12例在初始侧手术后停止，原因包括手术时间延长7例、血红蛋白下降6例、收缩压下降2例、动脉血氧饱和度下降2例、pH下降1例、血钠下降1例。患者特征、结石负荷以及总体成功率和并发症发生率的差异无统计学意义。输血、术后尿路感染和尿液引流时间延长的发生率相似，但第2组的总住院时间明显更长。第2组发生1例胸腔积液和1例肾盂穿孔。第2组输血需求与肾造瘘通道数量呈正相关（r = 0.895，P = 0.001）。第1组未发现此类相关性。
尽管初衷良好，但根据术中情况，约30%预期的bsPCNL病例可能只能进行单侧PCNL。我们的标准似乎合理，因为双侧分期PCNL和bsPCNL的成功率和并发症发生率相似。在决策时可考虑这些标准，为了安全起见而放弃一期手术的优势。
