Dutov V V, Urenkov S B, Parshenkova I G, Rumjancev A A, Mamedov E A
Urologiia. 2015 Mar-Apr(2):52-5.
The article describes the results of percutaneous nephrolithotomy (PCNL) in 49 urolithiasis patients with a solitary kidney. In 44 (89.8%) patients the calculi were located in the kidney, in 5 (10.2%) patients - in the upper third of the ureter. The calculi were single (18; 36.7%), multiple (14; 28.6%) or stag-horn (17; 34.7%). Efficiency of PCNL estimated immediately after surgery and at the end of the third month of observation was 75.5 and 93.9%, respectively. Stone size (p=0.594), the baseline state of urodynamics of the upper urinary tract (p=0.205) did not affect the renal clearance at PCNL. Enlargement of initial calculus size positively correlated with the number of required treatment sessions (p=0.013), duration of surgery (p<0.0001), and the length of postoperative hospital stay (p<0.0001). Complications were common (44.9%), but the auxiliary manipulations were performed infrequently (26.5%). No associations were found between the size of calculus, the number of complications and secondary manipulations (p=0.361). No correlations were found between the clinical form of a solitary kidneywith urolithiasis and the occurrence of complications during the treatment course (p=0.121), as well as between the presence of complications and the cause of the "loss" of the contralateral kidney (p> 0.05). Thus, percutaneous nephrolithotripsy is a highly effective method modality of treatment of solitary kidney urolithiasis. Appropriate selection of indications and contraindications for PCNL, preoperative preparation, surgical technique, postoperative patient management are of great importance.
本文描述了49例单肾尿石症患者经皮肾镜取石术（PCNL）的结果。44例（89.8%）患者结石位于肾脏，5例（10.2%）患者结石位于输尿管上段。结石为单发（18例；36.7%）、多发（14例；28.6%）或鹿角形（17例；34.7%）。术后即刻及观察第三个月末评估的PCNL效率分别为75.5%和93.9%。结石大小（p = 0.594）、上尿路尿动力学基线状态（p = 0.205）不影响PCNL时的肾脏清除率。初始结石大小增大与所需治疗次数（p = 0.013）、手术持续时间（p < 0.0001）及术后住院时间（p < 0.0001）呈正相关。并发症常见（44.9%），但辅助操作很少进行（26.5%）。未发现结石大小、并发症数量及二次操作之间存在关联（p = 0.361）。未发现单肾尿石症的临床类型与治疗过程中并发症的发生之间存在相关性（p = 0.121），也未发现并发症的存在与对侧肾“丢失”原因之间存在相关性（p > 0.05）。因此，经皮肾镜碎石术是治疗单肾尿石症的一种高效治疗方法。正确选择PCNL的适应证和禁忌证、术前准备、手术技术、术后患者管理非常重要。
