Keheila Mohamed, Leavitt David, Galli Riccardo, Motamedinia Piruz, Theckumparampil Nithin, Siev Micheal, Hoenig David, Smith Arthur, Okeke Zeph
Smith Institute for Urology, Hofstra North Shore Long Island Jewish School of Medicine, New Hyde Park, NY, USA.
BJU Int. 2016 Feb;117(2):300-6. doi: 10.1111/bju.13155. Epub 2015 Jun 6.
To analyse our experience with and the outcomes and lessons learned from percutaneous nephrolithotomy (PCNL) in the super obese (body mass index [BMI] ≥50 kg/m(2) ).
In this institutional review board approved study we retrospectively reviewed our PCNL database between July 2011 and September 2014 and identified all patients with a BMI ≥ 50 kg/m(2) . Patient demographics, peri-operative outcomes and complications were determined. Additionally, we identified a number of special PCNL considerations in the super obese that can maximize safe outcomes.
A total of 21 PCNL procedures performed on 17 super obese patients were identified. The mean patient age was 54.8 years, the mean BMI was 57.2 kg/m(2) and the mean stone area was 1 037 mm(2) . Full staghorn stones were observed in six patients and partial staghorns in four patients. The mean operating time was 106 min and the mean haemoglobin decrease was 1.2 g/dL. The overall stone-free rate was 87%. There were four total complications: two Clavien grade II, one Clavien IIIb and one Clavien IVb. We identified several special considerations for safely preforming PCNL in the suber obese, including using extra-long nephroscopes and graspers, using custom-cut extra long access sheaths with suture 'tails' secured to easily retrieve the sheath, choosing the shortest possible access tract, readily employing flexible nephroscopes, placing nephroureteral tubes rather than nephrostomy tubes postoperatively, and meticulous patient positioning and padding.
With appropriate peri-operative considerations and planning, PCNL is feasible and safe in the super obese. Stone clearance was similar to that reported in previous PCNL series in the morbidly obese, and is achievable with few complications.
分析我们在超级肥胖患者（体重指数[BMI]≥50 kg/m²）中进行经皮肾镜取石术（PCNL）的经验、结果及经验教训。
在这项经机构审查委员会批准的研究中，我们回顾性分析了2011年7月至2014年9月期间的PCNL数据库，确定了所有BMI≥50 kg/m²的患者。记录患者的人口统计学资料、围手术期结果及并发症情况。此外，我们确定了一些针对超级肥胖患者进行PCNL的特殊注意事项，以最大限度地提高手术安全性。
共确定了对17例超级肥胖患者实施的21例PCNL手术。患者平均年龄为54.8岁，平均BMI为57.2 kg/m²，平均结石面积为1037 mm²。6例患者为完全鹿角形结石，4例为部分鹿角形结石。平均手术时间为106分钟，平均血红蛋白下降1.2 g/dL。总体结石清除率为87%。共有4例并发症：2例Clavien II级，1例Clavien IIIb级和1例Clavien IVb级。我们确定了在超级肥胖患者中安全实施PCNL的几个特殊注意事项，包括使用超长肾镜和抓钳，使用定制的带缝线“尾端”的超长穿刺鞘以便轻松取出鞘管，选择尽可能短的穿刺通道，随时使用软性肾镜，术后放置肾输尿管导管而非肾造瘘管，以及精心的患者体位摆放和衬垫。
通过适当的围手术期考虑和规划，PCNL在超级肥胖患者中是可行且安全的。结石清除率与先前报道的病态肥胖患者PCNL系列相似，且并发症较少。
