Falahatkar Siavash, Asli Mani Mohiti, Emadi Seyedeh Atefeh, Enshaei Ahmad, Pourhadi Hedayat, Allahkhah Aliakbar
Razi Hospital, Urology Research Center, Guilan University of Medical Sciences, Sardar Jangal Street, Rasht, Guilan, Iran.
Urol Res. 2011 Aug;39(4):295-301. doi: 10.1007/s00240-010-0341-y. Epub 2010 Dec 16.
To determine the effects of previous stone surgery on the results of complete supine percutaneous nephrolithotomy (csPCNL), we reviewed 81 patients undergoing csPCNL at our center between March 2008 and March 2009. The principal aim in our study was whether prior renal surgery affects the outcome of PCNL. The results of the study were analyzed using SPSS 11 software. Our patients were divided to in two groups. Group 1 consisted of patients with a previous history of renal stone surgery and group 2 consisted of patients without history of renal surgery. Mean operative time in group 1 was 98.75 ± 56.31 min, and in group 2 99.71 ± 45.9 min (p = 0.93). Bleeding requiring transfusion occurred in four (14.2%) patients in group 1, and in eight (15.09%) patients in group 2 (p = 0.826). Fever was detected in no patients in group 1, and in four (7.5%) patients in group 2 (p = 0.136). Postoperative hematoma was seen in one (3.5%) patient in group 1 and in no patient in group 2 (p = 0.166). Other major complications including extravasations, sepsis, pleural effusion, pelvis perforation, and visceral organ trauma were not seen in any groups. This is the first experience of csPCNL in patients with and without a previous history of renal surgery. We found that there was no difference in results between the two groups that underwent complete supine PCNL. So csPCNL in patients with a history of stone surgery can be safe and effective. csPCNL offers the potential advantages of less patient handling, easier access to the urethra, easier possibility of changing spinal or regional anesthesia to general anesthesia if needed, better airway control and less hazard, especially for patients with compromised cardiopulmonary function, morbid obesity, or those who require a prolonged procedure and easier access to upper calyx. Its popularity is still minimal in the field of urology as a whole, because of fear of colon injury and a lack of training in this position in educational centers.
为了确定既往结石手术对完全仰卧位经皮肾镜取石术（csPCNL）结果的影响，我们回顾了2008年3月至2009年3月期间在本中心接受csPCNL的81例患者。我们研究的主要目的是既往肾脏手术是否会影响PCNL的结果。使用SPSS 11软件对研究结果进行分析。我们的患者被分为两组。第1组由有既往肾结石手术史的患者组成，第2组由无肾脏手术史的患者组成。第1组的平均手术时间为98.75±56.31分钟，第2组为99.71±45.9分钟（p = 0.93）。第1组有4例（14.2%）患者需要输血，第2组有8例（15.09%）患者需要输血（p = 0.826）。第1组无患者发热，第2组有4例（7.5%）患者发热（p = 0.136）。第1组有1例（3.5%）患者出现术后血肿，第2组无患者出现术后血肿（p = 0.166）。其他主要并发症，包括外渗、脓毒症、胸腔积液、肾盂穿孔和内脏器官损伤，在任何一组中均未见到。这是首次对有和无既往肾脏手术史的患者进行csPCNL的经验。我们发现，接受完全仰卧位PCNL的两组患者的结果没有差异。因此，有结石手术史的患者进行csPCNL可以是安全有效的。csPCNL具有潜在的优势，如减少对患者的操作、更容易进入尿道、如果需要更容易将脊髓或区域麻醉改为全身麻醉、更好的气道控制和更低的风险，特别是对于心肺功能受损、病态肥胖或需要长时间手术以及更容易进入上肾盏的患者。由于担心结肠损伤以及教育中心在该体位方面缺乏培训，其在整个泌尿外科领域的普及程度仍然很低。
