Telli Onur, Haciyev Perviz, Karimov Seymur, Sarici Hasmet, Karakan Tolga, Ozgur Berat Cem, Demirbas Arif, Resorlu Berkan, Soygur Tarkan, Burgu Berk
Department of Paediatric Urology, School of Medicine, Ankara University, Sihhiye, Ankara, 06100, Turkey,
Urolithiasis. 2015 Apr;43(2):141-5. doi: 10.1007/s00240-014-0739-z. Epub 2014 Nov 13.
In this study we aimed to determine the effects of previous open renal surgery, percutaneous nephrolithotomy and extracorporeal shockwave lithotripsy (ESWL) on the results and complications of subsequent percutaneous nephrolithotomy (PCNL) in pediatric patients. We reviewed the files of all 105 patients with 116 renal units (RU) undergoing PCNL at two main institutions between December 2000 and February 2014. The 116 RUs were divided into four groups: primary PCNL patients with 44 RU (37.9%) were categorized as group 1, 29 RU (25%) with a history of failed ESWL on the same side were categorized as group 2, 23 RU (19.8%) with previous PCNL surgery were categorized as group 3 and 20 RU (17.2%) with open renal surgery were categorized as group 4. Patient characteristics, mean operative time, mean fluoroscopy time, time to access the collecting system, hemoglobin change, number of more than 1 access, stone-free rates, postoperative hospitalization time and complications in four groups were compared. There were no differences between the groups in age, sex, mean stone size and stone laterality. Mean operative time, mean fluoroscopy time, time to access the collecting system, hemoglobin change, complication rates, number of more than one access hospitalization times were similar in the each group (p > 0.05 for each parameter). The stone-free rates after PCNL were 81.8% in group 1, 79.3% in group 2, 78.3% in group 3 and 80 % in group 4 (p = 0.67). Percutaneous nephrolithotomy is effective and safe in children who have previously had open nephrolithotomy, history of ESWL or PCNL without no more complications than are seen with primary PCNL of kidneys and with similar success rate.
在本研究中，我们旨在确定既往开放性肾脏手术、经皮肾镜取石术和体外冲击波碎石术（ESWL）对小儿患者后续经皮肾镜取石术（PCNL）的结果及并发症的影响。我们回顾了2000年12月至2014年2月期间在两家主要机构接受PCNL的105例患者共116个肾单位（RU）的病历。这116个肾单位被分为四组：44个肾单位（37.9%）的初次PCNL患者被归类为第1组，同一侧ESWL失败史的29个肾单位（25%）被归类为第2组，既往有PCNL手术史的23个肾单位（19.8%）被归类为第3组，有开放性肾脏手术史的20个肾单位（17.2%）被归类为第4组。比较了四组患者的特征、平均手术时间、平均透视时间、进入集合系统的时间、血红蛋白变化、多次穿刺次数、结石清除率、术后住院时间及并发症情况。四组患者在年龄、性别、平均结石大小及结石部位方面无差异。每组的平均手术时间、平均透视时间、进入集合系统的时间、血红蛋白变化、并发症发生率、多次穿刺次数及住院时间相似（各参数p>0.05）。PCNL术后第1组的结石清除率为81.8%，第2组为79.3%，第3组为78.3%，第4组为80%（p = 0.67）。对于既往有开放性肾结石手术史、ESWL史或PCNL史的儿童，经皮肾镜取石术是有效且安全的，其并发症并不比初次肾脏PCNL更多，成功率相似。
