Rizvi Syed Adibul Hasan, Hussain Manzoor, Askari Syed Hassan, Hashmi Altaf, Lal Murli, Zafar Mirza Naqi
Department of Urology, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan.
Department of Pathology, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan.
BJU Int. 2017 Nov;120(5):702-709. doi: 10.1111/bju.13848. Epub 2017 Apr 17.
To report our experience of a series of percutaneous nephrolithotomy (PCNL) procedures in a single centre over 18 years in terms of patient and stone characteristics, indications, stone clearance and complications, along with the results of chemical analysis of stones in a subgroup.
We retrospectively analysed the outcomes of PCNL in 3402 patients, who underwent the procedure between 1997 and 2014, obtained from a prospectively maintained database. Data analysis included patients' age and sex, laboratory investigations, imaging, punctured calyx, duration of operation, volume of irrigation fluid, radiation exposure time, blood transfusion, complications and stone-free status at 1-month follow-up. For the present analysis, outcomes in relation to complications and success were divided in two eras, 1997-2005 and 2006-2014, to study the differences.
Of the 3402 patients, 2501 (73.5%) were male and 901 (26.5%) were female, giving a male:female ratio of 2.8:1. Staghorn (partial or complete) calculi were found in 27.5% of patients, while 72.5% had non-staghorn calculi. Intracorporeal energy sources used for stone fragmentation included ultrasonography in 917 patients (26.9%), pneumatic lithoclast in 1820 (53.5%), holmium laser in 141 (4.1%) and Lithoclast master in 524 (15.4%). In the majority of patients (97.4%) a 18-22-F nephrostomy tube was placed after the procedure, while 69 patients (2.03%) underwent tubeless PCNL. The volume of the irrigation fluid used ranged from 7 to 37 L, with a mean of 28.4 L. The stone-free rate after PCNL in the first era studied was 78%, vs 83.2% in the second era, as assessed by combination of ultrasonography and plain abdominal film of the kidney, ureter and bladder. The complication rate in the first era was 21.3% as compared with 10.3% in the second era, and this difference was statistically significant. Stone analysis showed pure stones in 41% and mixed stones in 58% of patients. The majority of stones consisted of calcium oxalate.
This is the largest series of PCNL reported from any single centre in Pakistan, where there is a high prevalence of stone disease associated with infective and obstructive complications, including renal failure. PCNL as a treatment method offers an economic and effective option in the management of renal stone disease with acceptable stone clearance rates in a resource-constrained healthcare system.
报告我们在单一中心18年间一系列经皮肾镜取石术（PCNL）的经验，内容涉及患者及结石特征、适应证、结石清除情况和并发症，以及亚组结石化学分析结果。
我们回顾性分析了从前瞻性维护数据库中获取的1997年至2014年间接受PCNL手术的3402例患者的手术结果。数据分析包括患者的年龄和性别、实验室检查、影像学检查、穿刺肾盏、手术时长、冲洗液量、辐射暴露时间、输血情况、并发症以及1个月随访时的结石清除状态。为进行本次分析，将与并发症和手术成功相关的结果分为两个时期，即1997 - 2005年和2006 - 2014年，以研究差异。
3402例患者中，男性2501例（73.5%），女性901例（26.5%），男女比例为2.8:1。27.5%的患者有鹿角形（部分或完全）结石，72.5%的患者有非鹿角形结石。用于碎石的体内能量源包括917例患者（26.9%）使用超声、1820例（53.5%）使用气压弹道碎石、141例（4.1%）使用钬激光以及524例（15.4%）使用Lithoclast master。大多数患者（97.4%）术后放置了18 - 22F肾造瘘管，69例患者（2.03%）接受了无管PCNL。冲洗液用量为7至37L，平均为28.4L。通过超声和肾脏、输尿管及膀胱腹部平片联合评估，在第一个研究时期PCNL术后结石清除率为78%，第二个时期为83.2%。第一个时期的并发症发生率为21.3%，第二个时期为10.3%，差异具有统计学意义。结石分析显示，41%的患者为单纯结石，58%的患者为混合结石。大多数结石由草酸钙组成。
这是巴基斯坦单一中心报告的最大系列PCNL病例，该国结石病患病率高，伴有包括肾衰竭在内的感染性和梗阻性并发症。在资源有限的医疗系统中，PCNL作为一种治疗方法，在肾结石病管理中提供了一种经济有效的选择，结石清除率可接受。
