Department of Urology, The Adelaide and Meath Hospital Dublin, Incorporating The National Children's Hospital, Tallaght, Dublin 24, Ireland.
Ir J Med Sci. 2013 Sep;182(3):357-61. doi: 10.1007/s11845-012-0888-4. Epub 2012 Dec 10.
To present our experience in patients with spina bifida with severe spinal abnormality undergoing percutaneous nephrolithotomy (PCNL) for large stone burden.
A retrospective review identified five spina bifida patients with abnormal spinal curvature who had a PCNL for large kidney stones. The mean age was 28 years. In two patients, stones were on the concave side of the scoliotic spine further limiting percutaneous access. Mean stone burden was 940 mm2. All patients were paraplegic, three patients had symptomatic stone disease. We performed initial percutaneous renal access in radiology department and staged nephrolithotomy in operating room. Tract dilatation was accomplished using Amplatz dilators and a 24 Ch or 26 Ch nephroscope was used. Fragmentation and stone removal were accomplished in all patients using pneumatic and or ultrasound lithotripter and a retrieval grasper.
No anaesthetic complications were recorded. One patient required multiple percutaneous tracts, four had single tract to access stones. Three patients were stone free after PCNL. One required second PCNL through the same tract and another patient had multiple adjunctive ESWL. All five patients were stone clear after the final procedure. Two patients required blood transfusion. No patient had major complication or admission to intensive care unit.
Percutaneous nephrolithotomy in patients with spina bifida is challenging but safe. Detailed pre-operative anaesthetic assessment and precise uroradiological evaluation of renal anatomy is essential. Second-look PCNL and additional ESWL/URS treatment may be required to completely clear stones.
介绍我们在患有严重脊柱异常的脊髓裂患者中进行经皮肾镜取石术（PCNL）治疗大结石负荷的经验。
回顾性分析确定了 5 例脊柱弯曲异常的脊髓裂患者，他们因大肾结石而行 PCNL。平均年龄为 28 岁。在 2 例患者中，结石位于脊柱侧凸的凹侧，进一步限制了经皮进入。平均结石负荷为 940mm²。所有患者均为截瘫，3 例有症状性结石病。我们在放射科进行初始经皮肾通道建立，并在手术室进行分期肾镜取石术。通道扩张采用 Amplatz 扩张器，使用 24Ch 或 26Ch 肾镜。所有患者均使用气压和/或超声碎石器以及取石抓钳进行碎石和结石清除。
无麻醉并发症记录。1 例患者需要多个经皮通道，4 例患者采用单通道进入结石。3 例患者 PCNL 后结石清除。1 例患者需要通过同一通道进行第二次 PCNL，另 1 例患者需要多次辅助体外冲击波碎石术。所有 5 例患者最终治疗后结石均清除。2 例患者需要输血。无患者发生严重并发症或入住重症监护病房。
脊髓裂患者的经皮肾镜取石术具有挑战性，但安全。详细的术前麻醉评估和精确的尿路影像学评估肾脏解剖结构至关重要。可能需要二次 PCNL 和额外的 ESWL/URS 治疗才能完全清除结石。
