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[同期双侧经皮肾镜取石术:60例病例系列]

[Simultaneous bilateral percutaneous nephrolithotomy: Series of 60 cases].

作者信息

Conort P, Bah O R, Tostivint I, Cardot V, Hadjadj H, Daudon M, Bitker M O, Mozer P

机构信息

Service d'urologie, groupe hospitalier Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France.

出版信息

Prog Urol. 2010 Dec;20(13):1194-9. doi: 10.1016/j.purol.2010.04.001. Epub 2010 Sep 15.

Abstract

OBJECTIVE

Retrospective evaluation of the efficacy and morbidity of simultaneous bilateral percutaneous nephrolithotomy (SB-PCNL).

METHODS

From January 1993 to July 2009, 60 patients have undergone SB-PCNL over a series of 1709 PCNL. Thirty men and 30 women, mean age 45 years old (13-78), were treated for bilateral renal stones (120 kidneys) of 1177 mm(2) (268-4972 mm(2)); 25 were complete staghorn stones.

RESULTS

Operating time for the first side of PCNL was 80 min (30-270) and 45 min (10-90) for the opposite side. Overall OR occupation was 188 min (90-360). Forty-five patients were stone free after one session; 15 patients (25%) have a complementary treatment to be stone free: five PCNL (one bilateral); eight ESWL (four with JJ stent) and two flexible ureteroscopy. No blood transfusion was required. Renal function was unchanged at 1 month. Clavien grade for complications were as follows: two grade IIIb, one grade IVa and one grade IVb. Hospitalization stay was 4±4.9 days (2-35) taking account of two major sepsis (one pulmonary and one septicemia).

CONCLUSION

SB-PCNL was well tolerated with comparable morbidity and efficacy to PCNL performed on each side in two separate sessions. Nevertheless, SB-PCNL has to be performed for selected patients in expert centers.

摘要

目的

回顾性评估同期双侧经皮肾镜取石术(SB-PCNL)的疗效及并发症发生率。

方法

1993年1月至2009年7月,在1709例经皮肾镜取石术患者中,有60例接受了SB-PCNL。其中男性30例,女性30例,平均年龄45岁(13 - 78岁),均为双侧肾结石(120个肾脏),结石面积为1177平方毫米(268 - 4972平方毫米);25例为完全鹿角形结石。

结果

经皮肾镜取石术第一侧的手术时间为80分钟(30 - 270分钟),另一侧为45分钟(10 - 90分钟)。总的手术时间为188分钟(90 - 360分钟)。45例患者一次手术后结石清除;15例患者(25%)需要辅助治疗以清除结石:5例行经皮肾镜取石术(1例双侧);8例行体外冲击波碎石术(4例放置双J管),2例行软性输尿管镜检查。无需输血。1个月时肾功能未改变。并发症的Clavien分级如下:2例Ⅲb级,1例Ⅳa级和1例Ⅳb级。考虑到两例严重脓毒症(1例肺部感染和1例败血症),住院时间为4±4.9天(2 - 35天)。

结论

SB-PCNL耐受性良好,并发症发生率和疗效与分两次分别进行单侧经皮肾镜取石术相当。然而,SB-PCNL必须在专业中心为选定的患者进行。

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