Department of Urology, Ministry of Health, Kecioren Training and Research Hospital, Ankara, Turkey.
Urology. 2011 Jul;78(1):37-42. doi: 10.1016/j.urology.2010.11.004. Epub 2011 Jan 22.
To present our experience with percutaneous nephrolithotomy (PCNL) for treating urolithiasis in patients with scoliosis.
We retrospectively reviewed the records of 5 patients with congenital scoliosis who had undergone PCNL. The demographic data, number and location of access sites, hemoglobin values, stone analyses, and complications were studied. Of the 5 patients, 3 had a history of failed shock wave lithotripsy, and 2 had undergone stone intervention in same kidney. All procedures were performed with the patient in the prone position after retrograde ureteral catheterization. Tract dilation was accomplished using Amplatz dilators of ≤24F or 28F. PCNL was accomplished using a rigid nephroscope with ultrasound and/or pneumatic lithotriptor with the patient under general anesthesia.
Of the 5 patients, 2 were men and 3 were women, and the mean age was 36.8 years (range 32-44), and the mean stone burden was 475 mm2 (range 400-1350). The mean operative and fluoroscopic screening time was 62.2 minutes (range 50-90) and 3.1 minutes (range 2-5), respectively. Of the 5 patients, 3 were stone free after PCNL. Auxiliary procedures were required in 2 patients and included second-look PCNL in 1 and ureteroscopy in 1. Thus, all 5 patients were rendered completely stone free after the final procedure. No severe complications, either from anesthesia or the surgical procedure, were observed in the patients. Two of the patients had to stay for 24 hours to screen for pulmonary and cardiac signs in the intensive care unit after PCNL.
Larger stones or shock wave lithotripsy-refractory stones can be managed safely and effectively with PCNL in patients with scoliosis when they have been appropriately assessed before PCNL.
介绍我们在治疗脊柱侧凸患者肾结石时采用经皮肾镜碎石取石术（PCNL）的经验。
我们回顾性分析了 5 例先天性脊柱侧凸患者行 PCNL 的病历资料。研究了患者的人口统计学数据、入路点的数量和位置、血红蛋白值、结石分析以及并发症。这 5 例患者中，3 例曾有体外冲击波碎石术失败史，2 例同侧肾脏曾进行过结石干预。所有患者均在逆行输尿管置管后取俯卧位进行操作。采用 Amplatz 扩张器≤24F 或 28F 进行通道扩张。全身麻醉下，使用硬性肾镜联合超声和/或气压弹道碎石机进行 PCNL。
5 例患者中，2 例为男性，3 例为女性，平均年龄为 36.8 岁（范围 32-44 岁），平均结石负荷为 475mm2（范围 400-1350mm2）。平均手术和透视筛查时间分别为 62.2 分钟（范围 50-90 分钟）和 3.1 分钟（范围 2-5 分钟）。5 例患者中，3 例 PCNL 后结石完全清除。2 例患者需要辅助治疗，包括 1 例再次 PCNL 和 1 例输尿管镜检查。因此，所有 5 例患者在最后一次手术后均完全清除结石。患者均未出现麻醉或手术相关的严重并发症。2 例患者在 PCNL 后需在重症监护病房留观 24 小时，以筛查心肺征象。
对于经过适当评估的脊柱侧凸患者，当存在较大结石或体外冲击波碎石术难治性结石时，PCNL 可以安全有效地治疗。
