Li Jianxing, Xiao Bo, Hu Weiguo, Yang Bo, Chen Liang, Hu Hao, Wang Xiaofeng
Department of Urology, Tsinghua Changgung Hospital, Beijing 102218, China. Email:
Department of Urology, Tsinghua Changgung Hospital, Beijing 102218, China.
Chin Med J (Engl). 2014;127(24):4184-9.
Percutaneous nephrolithotomy (PCNL) was mostly performed with fluoroscopy and/or ultrasonography. The safety and feasibility of PCNL performed totally under ultrasound are not clearly defined. Therefore, we introduce the 9-year experience of 8 025 ultrasound guided PCNL procedures from multiple centers in China performed by the same surgeon, to evaluate the feasibility and security of this technique.
From September 2004 to August 2013, 8 025 cases, 4 398 males (54.8%) and 3 627 females (45.2%), whose age ranged from 6 months to 85 years old, with upper urinary tract stones, underwent PCNL in our center and the supported hospitals. Puncture site selection and channel dilation were all guided using only Doppler ultrasound. Single stones were treated in 1 356 cases, there were 2 817 cases of multi stones, and 3 852 cases of staghorn calculi. The pre- and post-operative imaging data, the intraoperative findings, operation time, perioperative complications, and related parameters were recorded.
All procedures were successful. No patients died during the operation. Average operation time was 42 minutes (range 10 to 168 minutes), 4 cases converted to open surgery, and 2 patients lost the diseased kidney due to refractory bleeding in the early stage of the PCNL. Ninety-four (1.2%) patients received blood transfusions and 20 (0.25%) patients needed highly selective renal artery embolization. Fifteen (0.19%) patients had a pleural injury. 5 457 (68%) cases were completed by a single tract and 2 568 (32%) cases added more tracts. The mean stone size (longest diameter) was 2.8 cm (range 1.2 to 26.5 cm). The final stone-free rate was 85.5%. Residual stones occurred mainly in patients with renal dysfunction, medullary sponge kidney, and complete staghorn calculi with a slim calyceal neck.
X-ray free Doppler ultrasound guided percutaneous nephrolithotomy is feasible and safe in a variety of cases of renal and/or upper ureteral stones. The probability of radiation hazard and adjacent organ injury is low. The morbidity from major complications was reduced remarkably after special training. It is worthy of wider use compared with fluoroscopy in patients with special kidneys (e.g. solitary kidney, spinal deformity, ectopic kidney) and in infants.
经皮肾镜取石术（PCNL）大多在荧光透视和/或超声检查引导下进行。完全在超声引导下进行PCNL的安全性和可行性尚未明确界定。因此，我们介绍了同一外科医生在中国多个中心进行的8025例超声引导下PCNL手术的9年经验，以评估该技术的可行性和安全性。
2004年9月至2013年8月，我们中心及协作医院对8025例上尿路结石患者进行了PCNL，其中男性4398例（54.8%），女性3627例（45.2%），年龄范围为6个月至85岁。仅使用多普勒超声引导穿刺点选择和通道扩张。单发性结石1356例，多发性结石2817例，鹿角形结石3852例。记录术前和术后影像学资料、术中发现、手术时间、围手术期并发症及相关参数。
所有手术均成功。术中无患者死亡。平均手术时间为42分钟（范围10至168分钟），4例转为开放手术，2例患者因PCNL早期难治性出血而切除患肾。94例（1.2%）患者接受输血，20例（0.25%）患者需要进行超选择性肾动脉栓塞。15例（0.19%）患者发生胸膜损伤。5457例（68%）手术通过单通道完成，2568例（32%）手术增加了通道。结石平均大小（最长直径）为2.8cm（范围1.2至26.5cm）。最终无结石率为85.5%。残留结石主要发生在肾功能不全、髓质海绵肾以及肾盏颈部狭窄的完全鹿角形结石患者中。
无X线多普勒超声引导下经皮肾镜取石术在各种肾和/或输尿管上段结石病例中是可行且安全的。辐射危害和邻近器官损伤的可能性较低。经过特殊培训后，严重并发症的发生率显著降低。与荧光透视相比，在特殊肾脏（如孤立肾、脊柱畸形、异位肾）患者和婴儿中更值得广泛应用。
