Giusti Guido, Proietti Silvia, Luciani Lorenzo G, Peschechera Roberto, Giannantoni Antonella, Taverna Gianluigi, Sortino Giuseppe, Graziotti Pierpaolo
IRCCS Humanitas Clinical and Research Center, Milan, Italy.
Can J Urol. 2014 Apr;21(2):7207-12.
Major kidney stones have traditionally been treated with percutaneous nephrolithotomy. However, retrograde intrarenal surgery (RIRS), which until a few years ago was considered inappropriate for this purpose, is becoming a viable, attractive alternative. The aim of the current study was to assess the efficacy and safety of RIRS combined with holmium laser lithotripsy for the treatment of stones > 2 cm in diameter in a large series of patients, reporting complications according to the Clavien-Dindo classification.
By retrospective analysis, we identified a total of 162 patients who were affected by stones greater than 2 cm in diameter and who had undergone RIRS. We reviewed demographic and stone characteristics, intraoperative and postoperative outcomes, and complications.
The mean stone size was 2.7 cm +/- 0.6 cm. The primary, secondary, and tertiary stone-free rates were 66%, 80.9%, and 87.7%, respectively. The mean number of procedures per patient was 1.48. The complication rates according to the Clavien-Dindo classification were Clavien I in 20.4% of patients, Clavien II in 0%, Clavien III in 4.9%, Clavien IV in 0.6%, and Clavien V in 0%.
As an alternative to standard procedures for the treatment of renal calculi greater than 2 cm in diameter, RIRS is safe and effective, with a low complication rate.
传统上，较大的肾结石采用经皮肾镜取石术治疗。然而，逆行性肾内手术（RIRS），直到几年前还被认为不适用于此目的，如今正成为一种可行且有吸引力的替代方法。本研究的目的是评估RIRS联合钬激光碎石术治疗一系列大量直径>2 cm结石患者的疗效和安全性，并根据Clavien-Dindo分类报告并发症。
通过回顾性分析，我们共确定了162例直径大于2 cm结石且接受了RIRS的患者。我们回顾了人口统计学和结石特征、术中及术后结果以及并发症情况。
平均结石大小为2.7 cm±0.6 cm。一期、二期和三期结石清除率分别为66%、80.9%和87.7%。每位患者的平均手术次数为1.48次。根据Clavien-Dindo分类的并发症发生率为：Clavien I级占20.4%的患者，Clavien II级为0%，Clavien III级为4.9%，Clavien IV级为0.6%，Clavien V级为0%。
作为治疗直径大于2 cm肾结石的标准手术的替代方法，RIRS安全有效，并发症发生率低。
