Wang Yanbo, Lu Zhihua, Hu Jinghai, Wang Xiaoqing, Lu Ji, Hao Yuanyuan, Wang Yan, Chen Qihui, Jiang Fengming, Zhang Haifeng, Xu Ning, Hou Yuchuan, Wang Chunxi
Department of Urology,The First Hospital of Jilin University.Changchun,
Department of Urology,The First Hospital of Jilin University.Changchun, China.
Urol J. 2014 Jan 4;10(4):1035-9.
To evaluate the percutaneous access outcomes and complications following percutaneous nephrolithotomy (PCNL) that was obtained by sonographer or urologist at a single academic institution.
A retrospective chart review of 259 patients who underwent PCNL was performed. Patients were stratified according to percutaneous access by sonographer (group 1) or urologist (group 2) in 174 and 85 patients, respectively. Demographic, stone characteristics, operative variables, percutaneous access complications and stone-free rates were compared between groups.
The major complication rate and minor complication rate, mean blood loss and rates of blood transfusion were comparable between groups. Compared with urologist, sonographer preferred to choose subcostal rib puncture instead of intercostal rib puncture. The lower calyx was the most frequent site of target calyx puncture in group 1 (165 cases, 94.8%), while the percentage of lower calyx in group 2 was 82.3% (72 cases) (P = .001). The overall stone-free rates were significantly higher in group 2 than that in group 1 (90.6% vs. 79.9%, P = .03). In group 1, 23 cases (13.2%) needed post-operative extracorporeal shock wave lithotripsy (SWL), while, the percentage of post-operative SWL in group 2 was only 4.7% (4 cases) (P = .035).
Renal access in PCNL can be safely and successfully obtained by both sonographer and urologist. Infracostal and lower calyx access in our study has poor stone-free rates and sonographer prefers infracostal and lower access. We encourage urologists establish renal access by themselves during PCNL.
评估在单一学术机构中，由超声科医生或泌尿外科医生进行经皮肾镜取石术（PCNL）后的经皮穿刺结果及并发症。
对259例行PCNL的患者进行回顾性病历审查。根据经皮穿刺操作者将患者分层，超声科医生操作组（第1组）174例，泌尿外科医生操作组（第2组）85例。比较两组患者的人口统计学、结石特征、手术变量、经皮穿刺并发症及结石清除率。
两组的主要并发症发生率、次要并发症发生率、平均失血量及输血率相当。与泌尿外科医生相比，超声科医生更倾向于选择肋下穿刺而非肋间穿刺。第1组中，下盏是目标肾盏穿刺最常见的部位（165例，94.8%），而第2组中下盏的比例为82.3%（72例）（P = 0.001）。第2组的总体结石清除率显著高于第1组（90.6%对79.9%，P = 0.03）。第1组中有23例（13.2%）患者术后需要进行体外冲击波碎石术（SWL），而第2组术后SWL的比例仅为4.7%（4例）（P = 0.035）。
超声科医生和泌尿外科医生均可安全、成功地完成PCNL的肾穿刺。在本研究中，肋下及下盏穿刺的结石清除率较低，且超声科医生更倾向于肋下及低位穿刺。我们鼓励泌尿外科医生在PCNL过程中自行建立肾穿刺通道。
