Department of Urology, Wake Forest Baptist Medical Center, Winston Salem, North Carolina; Department of Urology, University of Alabama (DGA), Birmingham, Alabama.
Department of Urology, Wake Forest Baptist Medical Center, Winston Salem, North Carolina; Department of Urology, University of Alabama (DGA), Birmingham, Alabama.
J Urol. 2016 Jul;196(1):131-6. doi: 10.1016/j.juro.2016.01.121. Epub 2016 Feb 27.
Renal function following percutaneous nephrolithotomy has long been a concern to urologists, especially in the setting of multi-tract access. We determined whether the risk of renal injury after multi-tract percutaneous nephrolithotomy was greater than after a single access approach.
We retrospectively reviewed the records of 307 consecutive patients treated with percutaneous nephrolithotomy from 2011 to 2012 at Wake Forest Health. Perioperative (99m)Tc-mercaptoacetyltriglycine nuclear renogram parameters along with serum creatinine values were assessed within 1 year of the procedure. Patients were stratified by single access vs multi-access (2 or more).
We identified 110 cases in which renography was done before and after percutaneous nephrolithotomy. A total of 74 patients (67.3%) underwent single access percutaneous nephrolithotomy while 36 (32.7%) underwent multi-access percutaneous nephrolithotomy. Serum creatinine did not significantly differ between the 2 cohorts postoperatively (p = 0.09). There was a significant 2.28% decrease in renal function based on mercaptoacetyltriglycine nuclear renogram results after percutaneous nephrolithotomy of the affected kidney in patients with multiple accesses (p <0.01). This relationship was not observed when patients were stratified by multiple comorbidities associated with nephrolithiasis.
Multi-access percutaneous nephrolithotomy is associated with a small reduction in the function of the targeted kidney compared to a single access approach.
经皮肾镜取石术后的肾功能一直是泌尿科医生关注的焦点，尤其是在多通道入路的情况下。我们确定多通道经皮肾镜取石术后肾损伤的风险是否大于单通道入路。
我们回顾性分析了 2011 年至 2012 年在维克森林健康中心接受经皮肾镜取石术的 307 例连续患者的记录。在术后 1 年内评估了围手术期（99m）Tc-巯基乙酰三甘氨酸核肾图参数和血清肌酐值。患者按单通道与多通道（2 个或更多）进行分层。
我们发现有 110 例患者在经皮肾镜取石术前和术后进行了肾图检查。共有 74 例（67.3%）患者接受了单通道经皮肾镜取石术，36 例（32.7%）患者接受了多通道经皮肾镜取石术。术后两组患者的血清肌酐值无显著差异（p = 0.09）。在多通道入路患者中，经皮肾镜取石术后受影响肾脏的巯基乙酰三甘氨酸核肾图结果显示肾功能显著下降 2.28%（p <0.01）。当患者按与肾结石相关的多种合并症分层时，并未观察到这种关系。
与单通道入路相比，多通道经皮肾镜取石术与目标肾脏功能的轻微下降相关。
