Guliev B G
Urologiia. 2014 Sep-Oct(5):111-5.
The study was aimed to the evaluation of the effectiveness and results of ultrasound guided percutaneous nephrolithotripsy (PNL) for the treatment of patients with large stones in renal pelvis. The results of PNL in 138 patients who underwent surgery for kidney stones from 2011 to 2013 were analyzed. Seventy patients (Group 1) underwent surgery with combined ultrasound and radiological guidance, and 68 patients (Group 2)--only with ultrasound guidance. The study included patients with large renal pelvic stones larger than 2.2 cm, requiring the formation of a single laparoscopic approach. Using the comparative analysis, the timing of surgery, the number of intra- and postoperative complications, blood loss and length of stay were evaluated. Percutaneous access was successfully performed in all patients. Postoperative complications (exacerbation of chronic pyelonephritis, gross hematuria) were observed in 14.3% of patients in Group 1 and in 14.7% of patients in Group 2. Bleeding requiring blood transfusion, and injuries of adjacent organs were not registered. Efficacy of PNL in the Group 1 was 95.7%; 3 (4.3%) patients required additional interventions. In Group 2, the effectiveness of PNL was 94.1%, 4 (5.9%) patients additionally underwent extracorporeal lithotripsy. There were no significant differences in the effectiveness of PNL, the volume of blood loss and duration of hospitalization. Ultrasound guided PNL can be performed in large pelvic stones and sufficient expansion of renal cavities, thus reducing radiation exposure of patients and medical staff.
本研究旨在评估超声引导经皮肾镜取石术(PNL)治疗肾盂大结石患者的有效性和结果。分析了2011年至2013年接受肾结石手术的138例患者的PNL结果。70例患者(第1组)在超声和放射学联合引导下进行手术,68例患者(第2组)仅在超声引导下进行手术。该研究纳入了肾盂结石大于2.2 cm、需要采用单一腹腔镜入路的患者。通过比较分析,评估了手术时机、术中及术后并发症数量、失血量和住院时间。所有患者均成功建立经皮通道。第1组14.3%的患者和第2组14.7%的患者出现术后并发症(慢性肾盂肾炎加重、肉眼血尿)。未记录到需要输血的出血情况及邻近器官损伤。第1组PNL的有效率为95.7%;3例(4.3%)患者需要额外干预。第2组中,PNL的有效率为94.1%,4例(5.9%)患者另外接受了体外冲击波碎石术。PNL的有效性、失血量和住院时间方面无显著差异。超声引导下的PNL可用于治疗大的肾盂结石和肾腔充分扩张的情况,从而减少患者和医务人员的辐射暴露。