Department of Urology, Queen Alexandra Hospital, Portsmouth, UK.
BJU Int. 2013 Apr;111(4):628-32. doi: 10.1111/j.1464-410X.2012.11394.x. Epub 2012 Sep 7.
WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Percutaneous treatment for renal stone disease is associated with a risk of significant morbidity. Our large UK series provides contemporary data on the risk of vascular complications and admission to the Intensive Care Unit (ICU) after PCNL. When compared with recent international databases, these data support the current evidence that better outcomes can be achieved in centres performing large numbers of procedures. These data add to the debate for the centralisation of specialist stone surgery.
To audit the outcome of percutaneous nephrolithotomy (PCNL) at a UK stone centre over a 10-year period, and provide patients with understandable contemporary data on blood loss and vascular risk.
A single centre retrospective analysis of all PCNLs undertaken between April 2000 and December 2010. The association between transfusion and patient age, operative duration and positive preoperative mid-stream urine (MSU) sample was subject to statistical analysis.
Data on 568 patients was analysed. 21 were paediatric cases with a mean (range) age of 8 (2-16) years; 547 were adult cases with a mean (range) age of 55 (17-84) years. 3.8% of adult patients (21/547) received a blood transfusion; mean age 60 years (55 years in those not transfused) with a mean operative duration of 119 min (103 min in those not transfused). 23.8% of patients transfused had a confirmed preoperative urinary tract infection compared with 16.1% of those not transfused. Seven patients underwent angiography, with five having selective arterial embolisation (0.9%). There were no deaths in this series although one patient (0.2%) required an urgent nephrectomy due to cardiovascular instability from bleeding.
Large UK series that provides contemporary data for consent on vascular risk at PCNL. The risk of transfusion is associated with increased patient age, operative duration and the presence of a positive preoperative MSU sample. Data compares favourably with other large published series, and supports the argument for centralisation of percutaneous stone management.
经皮肾镜碎石术（PCNL）治疗肾结石疾病与发生严重发病率的风险相关。我们的英国大型系列研究提供了 PCNL 后血管并发症和入住重症监护病房（ICU）风险的当代数据。与最近的国际数据库相比，这些数据支持目前的证据，即大量手术的中心可以获得更好的结果。这些数据增加了对结石手术专科集中化的讨论。
在英国结石中心对 10 年来的 PCNL 结果进行审核，并为患者提供有关出血和血管风险的可理解的当代数据。
对 2000 年 4 月至 2010 年 12 月期间进行的所有 PCNL 进行单中心回顾性分析。输血与患者年龄、手术时间和术前中段尿（MSU）样本阳性之间的关系进行了统计学分析。
分析了 568 例患者的数据。21 例为儿科病例，平均年龄（范围）为 8 岁（2-16 岁）；547 例为成年患者，平均年龄（范围）为 55 岁（17-84 岁）。3.8%的成年患者（21/547）接受输血；平均年龄 60 岁（未输血者为 55 岁），平均手术时间为 119 分钟（未输血者为 103 分钟）。输血患者中有 23.8%有确诊的术前尿路感染，而未输血患者中有 16.1%有这种情况。7 例患者进行了血管造影，其中 5 例进行了选择性动脉栓塞术（0.9%）。本系列中无死亡病例，但有 1 例患者（0.2%）因出血导致心血管不稳定而紧急肾切除术。
为 PCNL 血管风险的知情同意提供了当代数据的大型英国系列研究。输血风险与患者年龄、手术时间增加以及术前 MSU 样本阳性有关。数据与其他大型已发表系列相比表现良好，并支持对经皮结石治疗进行集中化的论点。
