Martov A G, Dutov S V, Andronov A S
Moscow ity linical Hospital 57 of Moscow Healthcare Department.
A.I. Burnazyan SSC Federal Medical Biophysical Center of FMBA of Russia, Department of Urology and Andrology.
Urologiia. 2016 Apr(2):82-88.
Percutaneous nephrolithotripsy (PNL) is the recommended method of surgical treatment of kidney stones of size greater than 2 cm. Trends in the development of modern urology have been steadily toward less traumatic method to treat nephrolithiasis - minimally invasive PNL. The present work aimed to explore of the possibilities of one of the modern variants of minimally invasive PNL - ultra-mini-PNL in treating nephrolithiasis.
The study included 60 patients (mean age 45.6+/-7.2 years) with isolated kidney calculus, up to 2.0 cm or several stones with a total size of up to 2.5 cm. All patients were found to have 77 kidney stones, six of which had a size of 10 mm, 51 had a size of 11-15 mm and 20 had a size of 16-20 mm. 45% of patients had isolated renal pelvic stones and 28.3% had stones in the renal pelvis and lower calyx. All patients underwent ultra-mini-PNL using nephroscope size 7.5 Ch and tube size 12 Fr.
The average duration of surgery from the moment of the puncture of the pyelocaliceal system to installing the nephrostomy tube was 65.4 minutes. Complete clearance of stones after single-stage ultra-mini-PNL was observed in 80% of cases. Nephrostomy tube was removed on days 2-3. The average postoperative hospital stay was 5.1 days. The most common complication was postoperative exacerbation of pyelonephritis (13.3% of patients), successfully treated with conservative measures. There were no cases of postoperative bleeding, accompanied by anemia and needed a blood transfusion.
Considering high effectiveness and low rate of complications of ultra-mini-PNL, it can be successfully used in treating nephrolithiasis among a wide group of patients.
经皮肾镜取石术（PNL）是治疗直径大于2 cm肾结石的推荐手术方法。现代泌尿外科的发展趋势一直是朝着创伤性更小的肾结石治疗方法——微创经皮肾镜取石术稳步前进。本研究旨在探讨微创经皮肾镜取石术的一种现代变体——超微经皮肾镜取石术治疗肾结石的可能性。
该研究纳入了60例患者（平均年龄45.6±7.2岁），这些患者患有孤立肾结石，直径达2.0 cm或多个结石，总大小达2.5 cm。所有患者共发现77颗肾结石，其中6颗直径为10 mm，51颗直径为11 - 15 mm，20颗直径为16 - 20 mm。45%的患者有孤立肾盂结石，28.3%的患者肾盂和下盏有结石。所有患者均使用7.5 Ch肾镜和12 Fr导管进行超微经皮肾镜取石术。
从肾盂肾盏系统穿刺到安装肾造瘘管的平均手术时间为65.4分钟。80%的病例在单阶段超微经皮肾镜取石术后结石完全清除。肾造瘘管在术后2 - 3天拔除。平均术后住院时间为5.1天。最常见的并发症是肾盂肾炎术后加重（13.3%的患者），经保守治疗成功治愈。没有术后出血伴有贫血且需要输血的病例。
考虑到超微经皮肾镜取石术的高效性和低并发症发生率，它可成功用于广泛患者群体的肾结石治疗。
