Department of Urology, St. John of God Hospital, Teaching Hospital of the Medical University of Vienna, Austria.
Eur Urol. 2012 Jan;61(1):146-58. doi: 10.1016/j.eururo.2011.09.016. Epub 2011 Sep 28.
Incidence, prevention, and management of complications of percutaneous nephrolitholapaxy (PNL) still lack consensus.
To review the epidemiology of complications and their prevention and management.
A literature review was performed using the PubMed database between 2001 and May 1, 2011, restricted to human species, adults, and the English language. The Medline search used a strategy including medical subject headings (MeSH) and free-text protocols with the keywords percutaneous, nephrolithotomy, PCNL, PNL, urolithiasis, complications, and Clavien, and the MeSH terms nephrostomy, percutaneous/adverse effects, and intraoperative complications or postoperative complications.
Assessing the epidemiology of complications is difficult because definitions of complications and their management still lack consensus. For a reproducible quality assessment, data should be obtained in a standardized manner, allowing for comparison. An approach is the validated Dindo-modified Clavien system, which was originally reported by seven studies. No deviation from the normal postoperative course (Clavien 0) was observed in 76.7% of PNL procedures. Including deviations from the normal postoperative course without the need for pharmacologic treatment or interventions (Clavien 1) would add up to 88.1%. Clavien 2 complications including blood transfusion and parenteral nutrition occurred in 7%; Clavien 3 complications requiring intervention in 4.1.%; Clavien 4, life-threatening complications, in 0.6%; and Clavien 5, mortality, in 0.04%. High-quality data on complication management of rare but potentially debilitating complications are scarce and consist mainly of case reports.
Complications after PNL can be kept to a minimum in experienced hands with the development of new techniques and improved technology. A modified procedure-specific Clavien classification should be established that would need to be validated in prospective trials.
经皮肾镜碎石取石术（PCNL）相关并发症的发生率、预防及处理仍缺乏共识。
综述并发症的流行病学及其预防和处理。
检索 2001 年至 2011 年 5 月 1 日期间 PubMed 数据库，限定研究对象为人类、成年人和英文文献，使用医学主题词（MeSH）和关键词（包括 percutaneous、nephrolithotomy、PCNL、PNL、urolithiasis、complications、Clavien 及 nephrostomy、percutaneous/adverse effects、intraoperative complications、postoperative complications）的组合策略进行检索。
评估并发症的流行病学情况较为困难，因为并发症的定义及其处理仍缺乏共识。为了实现可重复性的质量评估，数据应该以标准化的方式获取，以便于比较。一种方法是采用经改良的 Dindo-Clavien 分级系统，该系统最初由 7 项研究报道。76.7%的 PCNL 术后患者未出现术后异常（Clavien 0 级）。将术后异常但无需药物治疗或干预（Clavien 1 级）也包括在内，则上升至 88.1%。Clavien 2 级并发症（包括输血和肠外营养）的发生率为 7%；Clavien 3 级并发症（需要干预）为 4.1%；Clavien 4 级并发症（危及生命）为 0.6%；Clavien 5 级并发症（死亡）为 0.04%。对于罕见但潜在严重的并发症，高质量的处理数据较少，主要是病例报告。
在技术改进和新方法的开发下，经验丰富的术者可将 PCNL 相关并发症的发生率降到最低。需要建立改良的术式特异性 Clavien 分级系统，并在前瞻性试验中进行验证。
