Pastore Antonio Luigi, Palleschi Giovanni, Silvestri Luigi, Leto Antonino, Ripoli Andrea, Fuschi Andrea, Al Salhi Yazan, Autieri Domenico, Petrozza Vincenzo, Carbone Antonio
Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, ICOT, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Via Franco Faggiana 1668, Latina 04100, Italy.
Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy and Uroresearch, No Profit Association for Scientific Research in Urology, Latina, Italy.
Ther Adv Urol. 2016 Feb;8(1):3-8. doi: 10.1177/1756287215607417.
Staghorn renal stones are a challenging field in urology. Due to their high recurrence rates, particularly those associated with an infective process, a complete removal is the ultimate goal in their management. We report our experience with a combined approach of laparoscopic pyelolithotomy and endoscopic pyelolithotripsy, the stone clearance rate, and long-term, follow-up outcomes.
From June 2012 to October 2014, nine adult patients with large staghorn renal calculi (mean size, 7.2 cm; range, 6.2-9.0 cm) underwent a combined laparoscopic and endoscopic approach. The technique comprised laparoscopic pyelolithotomy and holmium-YAG laser stone fragmentation with the use of a flexible cystoscope introduced through a 12 mm trocar.
The average operative time was 140 min (range, 90-190 min). The mean estimated hemoglobin loss was 0.6 mmol/l (range 0.5-0.7 mmol/l). None of the patients required an open- surgery conversion. The mean hospital stay was 4 days (range, 2-6 days). A computed tomography urogram control at 6 months of follow up did not show any stone recurrence.
Laparoscopic pyelolithotomy combined with endoscopic pyelolithotripsy could be a therapeutic option in cases where mini-invasive procedures, that is, extracorporeal shock wave lithotripsy, ureteroscopic lithotripsy, and percutaneous nephrolithotomy (PCNL) have failed. This technique has a high stone-clearance rate (75-100%) comparable with open surgery and PCNL. However, it could be technically demanding and should be performed by skilled laparoscopy surgeons.
鹿角形肾结石是泌尿外科领域具有挑战性的疾病。由于其高复发率，尤其是与感染过程相关的复发率，彻底清除结石是其治疗的最终目标。我们报告了我们采用腹腔镜肾盂切开取石术和内镜下肾盂碎石术联合治疗的经验、结石清除率以及长期随访结果。
2012年6月至2014年10月，9例成年大鹿角形肾结石患者（平均大小7.2 cm；范围6.2 - 9.0 cm）接受了腹腔镜和内镜联合治疗。该技术包括腹腔镜肾盂切开取石术以及使用通过12 mm套管针插入的软性膀胱镜进行钬激光碎石。
平均手术时间为140分钟（范围90 - 190分钟）。平均估计血红蛋白损失为0.6 mmol/l（范围0.5 - 0.7 mmol/l）。所有患者均无需转为开放手术。平均住院时间为4天（范围2 - 6天）。随访6个月时的计算机断层扫描尿路造影检查未显示结石复发。
对于体外冲击波碎石术、输尿管镜碎石术和经皮肾镜取石术（PCNL）等微创手术失败的病例，腹腔镜肾盂切开取石术联合内镜下肾盂碎石术可能是一种治疗选择。该技术具有与开放手术和PCNL相当的高结石清除率（75 - 100%）。然而，该技术对技术要求较高，应由熟练的腹腔镜外科医生进行操作。
