Wynberg Jason B, Paik Lynn J, Odom Brian D, Kruger Michael, Atalla Christopher S
1 Department of Urology, Detroit Medical Center , Detroit, Michigan.
J Endourol. 2014 Sep;28(9):1071-7. doi: 10.1089/end.2014.0204. Epub 2014 Jun 12.
Several clinical series of retrograde nephrostomy for percutaneous nephrolithotomy (PCNL) have been published over the past 30 years demonstrating good outcomes and safety. We previously reported our adaptation of the Lawson technique, wherein we deploy the puncture wire through a flexible ureteroscope. We herein aim to clarify the performance characteristics of this nephrostomy creation technique.
Institutional Review Board approval and informed consent were obtained. A ureteroscopy-assisted retrograde nephrostomy (UARN) procedure was performed as described previously. Data were collected prospectively. Multiple patient and operative factors were evaluated for association with UARN success and nephrostomy creation time: body mass index (BMI), skin-to-stone distance, Guy's score, Clinical Research of the Endourological Society nephrolithometric score, hydronephrosis, stone burden, location of nephrostomy, exit from a stone-bearing calix, and use of holmium laser to access calix.
Nephrostomy was successful in 49/52 UARN procedures (94%). Only single access was placed: upper-18, mid-27, and lower-7. Median BMI was 29 kg/m(2) and median time for nephrostomy creation was 39 minutes. Fluoroscopy time for the entire PCNL including nephrostomy creation was 84 and 16 seconds for case numbers 1-25 and 26-52, respectively. By stepwise linear regression, variables correlating with nephrostomy creation time were BMI (r(2)=0.219), stone burden (r(2)=0.094), use of holmium laser to access calix (r(2)=0.104), and total r(2) linear=0.416.
UARN is an intuitive safe procedure that offers dramatic reductions in fluoroscopy times. UARN is best suited to cases requiring only one nephrostomy tract. Upper pole access is commonly performed with a subcostal technique to navigate the puncture wire below the ribs. Increasing BMI best predicts longer nephrostomy creation times; procedure failure was associated with BMI exceeding 40 kg/m(2). UARN is a robust technique for nephrostomy creation in appropriately selected patients.
在过去30年中，已经发表了几篇关于经皮肾镜取石术（PCNL）逆行肾造瘘术的临床系列报道，显示出良好的效果和安全性。我们之前报道了我们对劳森技术的改良，即通过柔性输尿管镜置入穿刺导丝。我们在此旨在阐明这种肾造瘘术创建技术的性能特征。
获得了机构审查委员会的批准并取得了知情同意。按照之前描述的方法进行输尿管镜辅助逆行肾造瘘术（UARN）。前瞻性收集数据。评估了多个患者和手术因素与UARN成功及肾造瘘术创建时间的相关性：体重指数（BMI）、皮肤至结石距离、盖伊评分、腔内泌尿外科协会肾石测量评分、肾积水、结石负荷、肾造瘘位置、从含结石肾盏穿出情况以及使用钬激光进入肾盏情况。
52例UARN手术中有49例（94%）肾造瘘成功。仅进行了单次穿刺通道建立：上极18例，中极27例，下极7例。BMI中位数为29kg/m²，肾造瘘术创建的中位时间为39分钟。包括肾造瘘术创建在内的整个PCNL的透视时间，病例1 - 25号为84秒，26 - 52号为16秒。通过逐步线性回归分析，与肾造瘘术创建时间相关的变量有BMI（r² = 0.219）、结石负荷（r² = 0.094）、使用钬激光进入肾盏（r² = 0.104），总线性r² = 0.416。
UARN是一种直观安全的手术，可显著减少透视时间。UARN最适合仅需一个肾造瘘通道的病例。上极穿刺通常采用肋下技术，将穿刺导丝置于肋骨下方。BMI增加最能预测肾造瘘术创建时间延长；手术失败与BMI超过40kg/m²相关。对于经过适当选择的患者，UARN是一种可靠的肾造瘘术创建技术。
