Department of Urology, Xiang Ya Hospital, Central South University, No. 87 Xiangya Road, 410008, Changsha, Hunan Province, People's Republic of China.
Urolithiasis. 2013 Feb;41(1):59-64. doi: 10.1007/s00240-012-0529-4. Epub 2013 Jan 5.
It is challenging to treat renal stones in patients with scoliosis. The present study was designed to study the safety and efficacy of minimally invasive percutaneous nephrolithotomy (mPCNL, 18 Fr) and standard tract PCNL (24 Fr) in patients with scoliosis. Twenty cases treated with mPCNL and 18 cases with standard tract PCNL were included in the present study. Laboratory data included preoperative routine complete blood count, serum creatinine, urine bacterial culture, etc. KUB, intravenous urography or CT scanning was done. Fifteen had lumbar and 23 had thoracolumbar scoliosis. Pulmonary function test was performed in all cases. Demographic and clinical details, operative characteristics and complications were studied and compared between two groups retrospectively. The stone burdens of two groups were averagely 754.4 and 816.2 mm(2), respectively (P = 0.194). Pulmonary function test indicated that 18 (47 %) out of 38 patients had decreased function for surgery and anesthesia. The stone clearance rates were 55 and 67 %, respectively, after the first session (P = 0.522). The requirements of auxiliary treatments including second-look PCNL procedure or SWL (shock wave lithotripsy) were not significantly different for both groups. All patients from both groups achieved final stone clearance after auxiliary treatments. Complications of urinary collecting system injury or fever were observed in one and two cases in each group, respectively, (P = 0.548). There were no injuries to neighboring organs or pneumothorax. The requirement of blood transfusion for four cases in mPCNL group and three cases in the standard tract PCNL group, respectively, indicated no significant difference between two groups (P = 0.999). We are able to successfully and safely perform both mPCNL and standard tract PCNL in patients with scoliosis in our hospital. Compared with mPCNL, standard tract PCNL is even more efficient due to its shorter operative time.
治疗脊柱侧弯患者的肾结石具有挑战性。本研究旨在研究微创经皮肾镜取石术（mPCNL，18Fr）和标准通道 PCNL（24Fr）在脊柱侧弯患者中的安全性和有效性。本研究纳入了 20 例接受 mPCNL 治疗和 18 例接受标准通道 PCNL 治疗的患者。实验室数据包括术前常规全血细胞计数、血清肌酐、尿细菌培养等。进行了 KUB、静脉尿路造影或 CT 扫描。15 例为腰椎侧弯，23 例为胸腰椎侧弯。所有患者均进行了肺功能检查。回顾性研究和比较了两组的人口统计学和临床特征、手术特点和并发症。两组的结石负荷分别为 754.4 和 816.2mm²（P=0.194）。肺功能检查表明，38 例患者中有 18 例（47%）因手术和麻醉而功能下降。第一次手术后的结石清除率分别为 55%和 67%（P=0.522）。两组的辅助治疗需求，包括第二探査 PCNL 或 SWL（体外冲击波碎石术），没有显著差异。两组患者均在辅助治疗后最终结石清除。两组各有 1 例和 2 例分别出现尿路收集系统损伤或发热并发症（P=0.548）。均无邻近器官损伤或气胸。mPCNL 组 4 例和标准通道 PCNL 组 3 例需要输血，两组间无显著差异（P=0.999）。我们能够成功且安全地在我院脊柱侧弯患者中进行 mPCNL 和标准通道 PCNL。与 mPCNL 相比，标准通道 PCNL 由于手术时间更短，因此效率更高。
