Chanprasopon Pontape, Kongchareonsombat Wisoot, Leenanupunth Charoen, Kijvikai Kittinut, Viseshsindh Wit
Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand.
J Med Assoc Thai. 2013 May;96(5):575-9.
To compare the perioperative outcomes of percutaneous nephrolithotomy (PCNL) performed via the upper middle, and lower calyces.
The authors retrospectively reviewed 92 renal units in 92 patients who required PCNL at our institution between 2006 and 2010. Patients with partial and full staghorn stones with total stone size > or = 2 cm were included in the present study. Patients were excluded if they had multiple small stones or a single stone < 2 cm. The present study analyzed 92 renal units in 92 patients. The authors divided the patients into three groups (groups 1, 2, and 3) based on the surgical approach, which was the upper middle, and lower calyceal approaches. PCNL was performed using a standard ultrasonic lithotriptor with a rigid nephroscope, and holmium: YAG laser lithotripsy was carried out with a flexible nephroscope, with simultaneous nitinol tipless basket extraction of fragments. Procedures were repeated until the patients were rendered stone-free (confirmed visually or by nephrostogram). Estimated blood loss, length of hospital stay, operative time, and the number of procedures (to achieve stone-free status) were analyzed and compared among the groups, and complications were reported.
The present study showed that the length of hospital stay, estimated blood loss, number of procedures, and operative time were not significantly different between the three groups. In Group 1, four patients had complications and included two patients with mid-ureteral stone, and one patient each with renal pelvic perforation and urinary tract infection with sepsis. One patient from Group 2 contracted a urinary tract infection. In Group 3, five patients exhibited complications and included one with mid-ureteral stone, two with renal hemorrhage, and two with urinary tract infection.
The estimated blood loss, duration of hospital stay, operative time, number of procedures (to achieve stone-free status), and complications did not statistically differ between the three groups. Moreover very few complications occurred in the different surgical approaches. Therefore, PCNL via all the three approaches were deemed safe and effective.
比较经上、中、下肾盏进行经皮肾镜取石术（PCNL）的围手术期结果。
作者回顾性分析了2006年至2010年间在本机构接受PCNL的92例患者的92个肾单位。本研究纳入了结石总体积≥2 cm的部分鹿角形结石和完全鹿角形结石患者。若患者有多个小结石或单个结石<2 cm，则予以排除。本研究分析了92例患者的92个肾单位。作者根据手术入路将患者分为三组（第1组、第2组和第3组），即经上、中、下肾盏入路。使用标准超声碎石机和硬性肾镜进行PCNL，使用软性肾镜进行钬激光碎石，并同时用镍钛合金无尖端网篮取出碎片。重复操作直至患者结石清除（通过直视或肾造影片确认）。分析并比较各组的估计失血量、住院时间、手术时间和操作次数（以达到结石清除状态），并报告并发症情况。
本研究表明，三组之间的住院时间、估计失血量、操作次数和手术时间无显著差异。第1组有4例患者出现并发症，包括2例输尿管中段结石患者、1例肾盂穿孔患者和1例并发脓毒症的尿路感染患者。第2组有1例患者发生尿路感染。第3组有5例患者出现并发症，包括1例输尿管中段结石患者、2例肾出血患者和2例尿路感染患者。
三组之间的估计失血量、住院时间、手术时间、操作次数（以达到结石清除状态）和并发症在统计学上无差异。此外，不同手术入路的并发症很少。因此，三种入路的PCNL均被认为是安全有效的。
