Division of Urology, University of Manitoba Health Sciences Center, Winnipeg, Manitoba, Canada.
J Urol. 2013 May;189(5):1753-6. doi: 10.1016/j.juro.2012.11.169. Epub 2012 Dec 3.
We retrospectively assessed outcomes in a single institution series of percutaneous nephrolithotomy using retrograde nephrostomy access.
We retrospectively evaluated the records of 333 consecutive patients treated between May 2003 and July 2008. Measured variables included patient demographics, retrograde nephrostomy site, postoperative drainage, operative time, stone clearance rate and degree, requirement for secondary procedures, stone composition and complications.
A total of 333 patients were included in study, including 162 females and 171 males with a median age of 56 years (range 17 to 87). Median hospital stay was 2 days (range 1 to 13). Antegrade access was required in 14 patients (4%) due to difficult or suboptimal anatomy. A nephrostomy tube was placed in 33 of 329 patients (10%), mainly for postoperative irrigation. Mean operative time was 76 minutes (range 25 to 246). Of the patients 79% achieved complete clearance, 19% had residual fragments 4 mm or less and 2% had significant persistent stones greater than 4 mm. Postoperatively 11 patients (3%) required shock wave lithotripsy. Analysis revealed calcium oxalate in 57% of stones, uric acid in 24%, struvite in 5% (infection stones) and other in 21%. Complications included 4 patients (1%) with significant postoperative hemorrhage, including angioembolization in 2, transfusion of 4 U packed red blood cells in 1 and observation in 1.
The retrograde technique to establish a percutaneous nephrostomy tract for percutaneous nephrolithotomy is safe and effective with stone clearance and complication rates comparable to those of antegrade access.
我们回顾性评估了单中心经逆行肾造瘘途径行经皮肾镜取石术的结果。
我们回顾性评估了 2003 年 5 月至 2008 年 7 月期间治疗的 333 例连续患者的记录。测量变量包括患者人口统计学、逆行肾造瘘部位、术后引流、手术时间、结石清除率和程度、需要二次手术、结石成分和并发症。
共有 333 例患者纳入研究，包括 162 例女性和 171 例男性，中位年龄为 56 岁（范围 17 至 87 岁）。中位住院时间为 2 天（范围 1 至 13 天）。由于解剖困难或不理想，14 例患者（4%）需要逆行入路。329 例患者中有 33 例（10%）放置了肾造瘘管，主要用于术后冲洗。平均手术时间为 76 分钟（范围 25 至 246 分钟）。79%的患者结石完全清除，19%的患者结石残留碎片为 4 毫米或更小，2%的患者有明显的持续性大于 4 毫米的结石。术后 11 例（3%）患者需要行体外冲击波碎石术。分析显示，57%的结石为草酸钙，24%为尿酸，5%为鸟粪石（感染性结石），21%为其他结石。并发症包括 4 例（1%）患者出现明显术后出血，其中 2 例需要血管栓塞，1 例需要输注 4 单位浓缩红细胞，1 例仅需观察。
逆行技术建立经皮肾造瘘途径行经皮肾镜取石术是安全有效的，结石清除率和并发症发生率与顺行入路相当。
