Guliev B G, Stetsik E O
Department of Urology, I.I. Mechnikov North-Western State Medical University, Saint Petersburg.
Urologiia. 2016 Aug(3):44-49.
The study presents the results of percutaneous nephrolithotripsy (PNL) in patients who underwent different methods of urinary diversion.
The study included the results of PNL in 16 patients (study group) with kidney stones who were subjected to different methods of urinary diversion. Earlier, 2 (12.5%) patients underwent bilateral ureterosigmoidostomy for bladder exstrophy, 12 (75%) experienced radical cystectomy with orthotopic ileocystoplasty and 2 (12.5%) - heterotopic cystoplasty. The control group comprised 30 patients with large kidney stones and normal function of the lower urinary tract. In the main group, the mean stone size was 2.5 (2.2-3.6) cm in the control group - 2.6 (2.4-3.8) cm. The puncture of the kidney cavity system and nephrostomy dilatation were performed under ultrasound and fluoroscopic guidance, respectively. We compared such factors as the surgery duration, the number of intra- and postoperative complications, blood loss and length of hospital stay. There were no hemorrhagic complications requiring blood transfusion. Exacerbation of chronic pyelonephritis occurred in 4 (25%) patients of the study group and in 3 (10%) of the control group (p<0.05). The two groups did not differ in the effectiveness of PNL (87.5 and 90.0% in the study and control groups, respectively), the blood loss volume and the length of hospital stay.
PNL enables high effectiveness in removing large kidney stones with minimal complications in patients undergoing different methods of urinary diversion.
本研究展示了接受不同尿流改道方法的患者经皮肾镜取石术（PNL）的结果。
本研究纳入了16例接受不同尿流改道方法的肾结石患者（研究组）的PNL结果。此前，2例（12.5%）膀胱外翻患者接受双侧输尿管乙状结肠吻合术，12例（75%）接受根治性膀胱切除术并原位回肠膀胱术，2例（12.5%）接受异位膀胱成形术。对照组包括30例下尿路功能正常的大肾结石患者。研究组的平均结石大小为2.5（2.2 - 3.6）cm，对照组为2.6（2.4 - 3.8）cm。分别在超声和透视引导下进行肾腔系统穿刺和肾造瘘扩张。我们比较了手术时长、术中和术后并发症数量、失血量和住院时间等因素。未发生需要输血的出血性并发症。研究组4例（25%）患者和对照组3例（10%）患者发生慢性肾盂肾炎加重（p<0.05）。两组在PNL有效性（研究组和对照组分别为87.5%和90.0%）、失血量和住院时间方面无差异。
对于接受不同尿流改道方法的患者，PNL能够高效去除大肾结石且并发症最少。
