Desai Mahesh, Jain Prashant, Ganpule Arvind, Sabnis Ravindra, Patel Snehal, Shrivastav Prajay
Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
BJU Int. 2009 Aug;104(4):542-8; discussion 548. doi: 10.1111/j.1464-410X.2009.08472.x. Epub 2009 Mar 6.
To review the development of the technique of percutaneous nephrolithotomy (PCNL), for ease of learning and development of instrumentation for staghorn calculi at our centre since 1991, and to assess the results and outcomes.
We retrospectively analysed the hospital records of 773 patients (632 males and 141 females, 834 renal units) who underwent PCNL for staghorn calculi at our centre from January 1991 to August 2008. We divided the patients into three groups depending on the changes in treatment policy, global trends and advances in equipment as follows: the first 200 cases (group I) from January 1991 to December 1996 (216 renal units); the next 200 (group II) from January 1997 to December 2001 (212 renal units); and the last 373 (group III) from January 2002 to August 2008 (406 renal units).
The mean (sd, range) operative duration in groups I, II and III, respectively, were 138.2 (52.7, 60-310), 121.4 (42.8, 70-250) and 112.5 (51.5, 55-310) min; the decrease in haemoglobin level was 3.2, 2.6 and 1.6 g/dL, respectively, and continued to decrease with improvements in technique. With increasing experience, the number of stages required for stone clearance and the number of tracts required decreased exponentially. Most of the severe complications occurred early in our experience. The stone clearance rate in groups I, II and III was 81%, 86% and 93%, respectively, after completing the procedure; the overall clearance rate with observation/auxiliary procedures was 86%, 89% and 96%, respectively. The mean hospital stay for groups I, II and III was 11.1 (3.9, 7-25), 9.5 (3.4, 5-22) and 7.1 (3.6, 4-28) days, respectively.
The percutaneous management of staghorn calculi requires considerable expertise. Our data suggest that 'multiperc' PCNL is difficult to learn and requires experience. Although over the years our results improved, complete clearance remains a challenge. A constant review and application of newer techniques and results will improve the overall clearance rates further.
回顾经皮肾镜取石术（PCNL）技术的发展历程，以便于自1991年起在我们中心学习该技术并研发用于鹿角形结石的器械，并评估其结果和疗效。
我们回顾性分析了1991年1月至2008年8月在我们中心接受PCNL治疗鹿角形结石的773例患者（632例男性和141例女性，834个肾单位）的医院记录。根据治疗策略的变化、整体趋势和设备进展，我们将患者分为三组：1991年1月至1996年12月的前200例（I组，216个肾单位）；1997年1月至2001年12月的接下来200例（II组，212个肾单位）；以及2002年1月至2008年8月的最后373例（III组，406个肾单位）。
I组、II组和III组的平均（标准差，范围）手术时长分别为138.2（52.7，60 - 310）、121.4（42.8，70 - 250）和112.5（51.5，55 - 310）分钟；血红蛋白水平下降分别为3.2、2.6和1.6 g/dL，且随着技术改进持续下降。随着经验增加，结石清除所需的分期数和通道数呈指数级减少。大多数严重并发症在我们的经验早期出现。完成手术后，I组、II组和III组的结石清除率分别为81%、86%和93%；经观察/辅助程序后的总体清除率分别为86%、89%和96%。I组、II组和III组的平均住院天数分别为11.1（3.9，7 - 25）、9.5（3.4，5 - 22）和7.1（3.6，4 - 28）天。
鹿角形结石的经皮治疗需要相当多的专业知识。我们的数据表明，“多通道”PCNL难以学习且需要经验。尽管多年来我们的结果有所改善，但完全清除仍然是一项挑战。持续回顾和应用更新的技术及结果将进一步提高总体清除率。
