Soucy Frédéric, Ko Raymond, Duvdevani Mordechai, Nott Linda, Denstedt John D, Razvi Hassan
Department of Surgery, The University of Western Ontario, London, Ontario, Canada .
J Endourol. 2009 Oct;23(10):1669-73. doi: 10.1089/end.2009.1534.
Percutaneous nephrolithotomy (PCNL) for staghorn calculi is one of the more challenging endourologic procedures. Although excellent stone-free rates are universally reported in the literature, complication rates vary widely, especially related to the need for blood transfusion. The purpose of this study was to evaluate the outcomes of PCNL for patients with staghorn calculi in a large series of patients at a single, tertiary referral, endourologic stone center.
Between July 1990 and December 2005, 1338 patients underwent PCNL for renal stone disease at our institution. Among this group, 509 procedures were performed for patients with a partial or complete staghorn calculus. Data analysis included procedure time, length of hospital stay, number of access tracts, transfusion rates, other early and late complications, and stone-free status.
Mean patient age was 53.8 years (range 4-84 yrs). The average procedure time was 104 minutes. Sixteen percent of the cases needed multiple access tracts (range 2-5), with the lower calix being the most commonly used in 64.1%, followed by the upper calix in 18.5% and the middle calix in 17.4%. Various intracorporeal lithotriptors were used, including ultrasound, pneumatic, electrohydraulic, and holmium:yttrium-aluminium-garnet laser. The transfusion rate among this group was 0.8%. There was no statistically significant difference in transfusion rates (0.7%-1.2% P = 0.24) or other major complications in patients who were treated with either a single tract or among those needing multiple tracts. Stone-free rates at hospital discharge and at 3 months follow-up were 78% and 91%, respectively.
PCNL is a safe and effective procedure in the management of staghorn calculi, with outcomes similar to those reported for percutaneous management of smaller volume nonstaghorn stones. Attention to accurate tract selection and placement as well as possession of the full array of endourologic equipment are essential to achieving an excellent outcome.
经皮肾镜取石术（PCNL）治疗鹿角形结石是较具挑战性的腔内泌尿外科手术之一。尽管文献中普遍报道了出色的无石率，但并发症发生率差异很大，尤其是与输血需求相关的并发症。本研究的目的是在一家单一的三级转诊腔内泌尿外科结石中心，对大量鹿角形结石患者进行PCNL的治疗结果进行评估。
1990年7月至2005年12月期间，1338例患者在我院接受了PCNL治疗肾结石疾病。在这组患者中，509例手术是针对部分或完全鹿角形结石患者进行的。数据分析包括手术时间、住院时间、穿刺通道数量、输血率、其他早期和晚期并发症以及无石状态。
患者平均年龄为53.8岁（范围4 - 84岁）。平均手术时间为104分钟。16%的病例需要多个穿刺通道（范围2 - 5个），其中下盏最常用，占64.1%，其次是上盏，占18.5%，中盏占17.4%。使用了各种体内碎石设备，包括超声、气压、液电和钬:钇铝石榴石激光。该组患者的输血率为0.8%。单通道治疗患者与需要多个通道的患者在输血率（0.7% - 1.2%，P = 0.24）或其他主要并发症方面无统计学显著差异。出院时和3个月随访时的无石率分别为78%和91%。
PCNL是治疗鹿角形结石的一种安全有效的手术，其结果与经皮治疗较小体积非鹿角形结石的报道相似。注意准确的通道选择和放置以及拥有全套腔内泌尿外科设备对于取得良好结果至关重要。
