Gandhi Himesh Ramesh, Thomas Appu, Nair Balagopal, Pooleri Ginilkumar
Department of Urology and Renal Transplantation, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Arab J Urol. 2015 Jun;13(2):139-45. doi: 10.1016/j.aju.2014.10.004. Epub 2014 Nov 26.
To evaluate the effectiveness of laparoscopic pyelolithotomy (LP) for staghorn stones (>3-4 cm) in patients with chronic liver disease or coronary artery disease.
In all, 49 patients underwent LP; they were divided into four groups, with stones in group 1 in the renal pelvis only, in group 2 in the renal pelvis and one calyx, in group 3 in the renal pelvis and two calyces, and in group 4, in the renal pelvis and more than two calyces. Patient demography, stone characteristics, surgical outcomes and complications were evaluated.
The mean stone-free rate in one session was 90% among all groups. The mean (SD) stone size was 4.27 (1.72) cm. The stone-free rate decreased with greater stone burden, but the operative time, estimated blood loss and need for ancillary procedures increased with stone burden. No blood transfusion was required and one patient each in groups 2 and 4 had a urine leak.
LP provides acceptable results in complex cases for managing renal stone disease with a larger stone burden in high-risk situations.
评估腹腔镜肾盂切开取石术（LP）治疗慢性肝病或冠状动脉疾病患者鹿角形结石（>3 - 4厘米）的有效性。
共有49例患者接受了LP手术；他们被分为四组，第1组结石仅位于肾盂，第2组结石位于肾盂和一个肾盏，第3组结石位于肾盂和两个肾盏，第4组结石位于肾盂和两个以上肾盏。对患者人口统计学、结石特征、手术结果和并发症进行了评估。
所有组一次手术的平均无石率为90%。平均（标准差）结石大小为4.27（1.72）厘米。无石率随结石负荷增加而降低，但手术时间、估计失血量和辅助手术需求随结石负荷增加而增加。无需输血，第2组和第4组各有1例患者发生尿漏。
对于高风险情况下结石负荷较大的肾结石疾病复杂病例，LP可提供可接受的治疗效果。
