Chung Doo Yong, Lee Joo Yong, Kim Kyu Hyun, Choi Jae Hyeok, Cho Kang Su
Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Chonnam Med J. 2014 Aug;50(2):52-7. doi: 10.4068/cmj.2014.50.2.52. Epub 2014 Aug 20.
We evaluated the feasibility and efficacy of intermediate-supine percutaneous nephrolithotomy (PCNL) in patients with renal calculi. Fifteen patients were included in this study. The intermediate-supine operative position was modified by using a 1-L saline bag below the ipsilateral upper flank. A nephrostomy and stone extraction were performed as usual. After completion of the stone removal, a nephrostomy tube was used when necessary according to the surgeon's decision. If there was no significant bleeding or renal pelvic injury, tubeless PCNL was performed. The mean stone size was 5.48±5.69 cm(2), the mean operative time was 78.93±38.72 minutes, and the mean hospital stay was 2.60±1.29 days. Tubeless PCNL was performed in 13 cases (86.7%), and retrograde procedures were simultaneously performed without a change of position in 2 patients (ureteroscopic ureterolithotomy in one patient and transurethral placement of an occlusion catheter in one patient). There were two complications according to the Clavien-Dindo classification (Grade I in one patient and Grade II in one patient). The success rate was 80.0% and the complete stone-free rate was 73.3%. Three patients with a significant remnant stone were also successfully managed with additional procedures (one patient underwent a second-look operation, and the remaining two patients were treated with shock wave lithotripsy). In the treatment of renal calculi, intermediate-supine PCNL may be a safe and effective choice that offers several advantages with excellent outcomes. Thus, a prospective study with a larger population is needed to verify our outcomes.
我们评估了仰卧位经皮肾镜取石术（PCNL）治疗肾结石患者的可行性和疗效。本研究纳入了15例患者。仰卧位手术体位通过在同侧上腹部下方放置一个1升的生理盐水袋进行改良。按常规进行肾造瘘和结石取出。结石清除完成后，根据外科医生的决定必要时使用肾造瘘管。如果没有明显出血或肾盂损伤，则进行无管PCNL。结石平均大小为5.48±5.69 cm²，平均手术时间为78.93±38.72分钟，平均住院时间为2.60±1.29天。13例（86.7%）患者进行了无管PCNL，2例患者在不改变体位的情况下同时进行了逆行操作（1例患者进行输尿管镜输尿管取石术，1例患者经尿道放置阻塞导管）。根据Clavien-Dindo分类有2例并发症（1例Ⅰ级，1例Ⅱ级）。成功率为80.0%，结石完全清除率为73.3%。3例有明显残留结石的患者也通过额外的手术成功处理（1例患者进行了二次手术，其余2例患者接受了冲击波碎石治疗）。在肾结石的治疗中，仰卧位PCNL可能是一种安全有效的选择，具有多种优势且效果良好。因此，需要进行一项更大样本量的前瞻性研究来验证我们的结果。
