The Stone Unit, Department of Urology, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
Urology. 2013 Nov;82(5):1013-6. doi: 10.1016/j.urology.2013.06.034. Epub 2013 Aug 16.
To review our experience from a high volume stone center with a focus on efficacy, safety, and renal function.
Stones requiring percutaneous nephrolithotomy (PCNL) in patients with solitary kidneys can pose significant anxiety to the urologist. Limited data are available in published reports in this setting. A comprehensive retrospective review of medical records was performed on patients who underwent PCNL and had a solitary kidney or a single functioning renal unit. Data were collected on patient demographics, stone burden, outcomes, complications, and renal function.
Of 378 PCNLs performed between January 2003 and September 2011, 22 were performed in 17 patients with a single functioning kidney. Three procedures were performed in a transplanted kidney. In those with solitary calculus, the longest mean length and stone surface area were 37 mm and 825 mm(2), respectively. Stone-free rate was 59%. Auxiliary procedures were required in 6 cases, resulting in a stone-free rate of 77%. Median inpatient stay was 4 days. Serum creatinine values improved from 144 to 126 umol/L before and after the procedure and mean estimated glomerular filtration rate improved similarly from 51 to 59 mls/minute, respectively. Blood transfusion was required in 1 patient, sepsis developed in 3, and 2 patients required a stent for obstruction.
PCNL in solitary kidneys is safe with an acceptable complication rate if performed in a high volume center. Outcomes are good, although auxiliary procedures may be necessary. Renal function remains stable or improves after procedure.
回顾我们在一个高容量结石中心的经验，重点关注疗效、安全性和肾功能。
对于患有孤立肾的患者，需要行经皮肾镜碎石取石术（PCNL）的结石可能会给泌尿科医生带来很大的焦虑。在这种情况下，发表的报告中可用的数据有限。对 2003 年 1 月至 2011 年 9 月期间接受 PCNL 且有孤立肾或单个功能肾单位的患者的病历进行了全面回顾性分析。收集了患者人口统计学、结石负荷、结果、并发症和肾功能的数据。
在 2003 年 1 月至 2011 年 9 月期间进行的 378 例 PCNL 中，有 22 例在 17 例单侧肾功能正常的患者中进行。有 3 例在移植肾中进行。在孤立性结石患者中，最长的平均长度和结石表面积分别为 37 毫米和 825 毫米²。无结石率为 59%。有 6 例需要辅助手术，无结石率为 77%。中位数住院时间为 4 天。术前血清肌酐值从 144 微摩尔/升降至 126 微摩尔/升，术前估算肾小球滤过率从 51 毫升/分钟降至 59 毫升/分钟，分别为。有 1 例患者需要输血，3 例患者发生脓毒症，2 例患者需要支架治疗梗阻。
如果在高容量中心进行，PCNL 治疗孤立肾是安全的，并发症发生率可接受。结果良好，尽管可能需要辅助手术。术后肾功能保持稳定或改善。
