Resorlu Berkan, Kara Cengiz, Senocak Cagri, Cicekbilek Izzet, Unsal Ali
Kecioren Training and Research Hospital, Department of Urology, Ankara, Turkey.
J Endourol. 2010 Jan;24(1):13-6. doi: 10.1089/end.2009.0291.
We evaluated the effects of previous open renal surgery and unsuccessful extracorporeal shockwave lithotripsy (SWL) treatment on the performance and outcomes of percutaneous nephrolithotomy (PCNL).
A total of 410 consecutive PCNL procedures for renal calculi were performed at our institution from November 2006 to March 2009. Of these 410 patients, 86 (20.9%) with a history of failed SWL on the same side were categorized as group I, and 132 (32.2%) who had previous open renal surgery (+/-SWL) on the same kidney were categorized as group II. The remaining 192 patients (46.9%) without a history of SWL or open renal surgery comprised group III. Patient demographics, stone characteristics, operative findings, including operative time, time to access the collecting system, flouroscopy time, success rate, need for auxiliary treatments, and complications were documented in detail and compared in each group.
There were no differences between the three groups in age, sex, weight, and stone laterality. In the post-SWL group, mean stone burden was significantly lower than in groups II and III. Mean operative time, time to access the collecting system, fluoroscopic screening time, complication rates, nephrostomy removal times, and hospitalization times were similar in the each groups (P > 0.05 for each parameter). The stone-free rates after PCNL were 89.5% in group I; 87.1% in group II; and 88.5% in group III. These rates increased to 98.8%, 96.2%, and 96.8%, in groups I, II and III, respectively, after a second intervention (PCNL, SWL, or ureterorenoscopy).
Our study clearly demonstrates that PCNL with standard technique can be performed safely in patients with a history of open nephrolithotomy or SWL without a higher risk of complications and with a success rate similar to that of PCNL in patients with no previous intervention.
我们评估了既往开放性肾脏手术和体外冲击波碎石术（SWL）治疗失败对经皮肾镜取石术（PCNL）操作及结果的影响。
2006年11月至2009年3月，我们机构共连续进行了410例针对肾结石的PCNL手术。在这410例患者中，86例（20.9%）同侧SWL治疗失败的患者被归为I组，132例（32.2%）同侧曾接受开放性肾脏手术（±SWL）的患者被归为II组。其余192例（46.9%）无SWL或开放性肾脏手术史的患者组成III组。详细记录了每组患者的人口统计学资料、结石特征、手术发现，包括手术时间、进入集合系统的时间、透视时间、成功率、辅助治疗需求及并发症情况，并进行了比较。
三组患者在年龄、性别、体重和结石部位方面无差异。SWL治疗后组的平均结石负荷明显低于II组和III组。每组的平均手术时间、进入集合系统的时间、透视筛查时间、并发症发生率、肾造瘘管拔除时间及住院时间相似（各参数P>0.05）。PCNL术后I组的结石清除率为89.5%；II组为87.1%；III组为88.5%。在第二次干预（PCNL、SWL或输尿管肾镜检查）后，I、II、III组的这些比率分别升至98.8%、96.2%和96.8%。
我们的研究清楚地表明，采用标准技术的PCNL可安全地应用于有开放性肾切开取石术或SWL病史的患者，并发症风险不会更高，成功率与未接受过先前干预的患者的PCNL相似。
