Jones Patrick, Dhliwayo Blessing, Rai Bhavan Prasad, Mokete Moeketsi, Amitharaj Ramachandran, Aboumarzouk Omar M, Somani Bhaskar K
1 Department of Urology, Royal Preston Hospital , Preston, United Kingdom .
2 Department of Urology, The James Cook University Hospital , Middlesbrough, United Kingdom .
J Endourol. 2017 Apr;31(4):334-340. doi: 10.1089/end.2016.0851. Epub 2017 Mar 22.
With the evolution of endourologic technology, bilateral synchronous percutaneous nephrolithotomy (BS-PCNL) has emerged as a potentially practical intervention for patients with bilateral lithiasis. Although tradition has favored a staged approach, an increasing number of original studies have reported their experiences with the synchronous approach.
A Cochrane style search was performed after development of a sensitive and predefined search strategy. Primary outcomes measured were initial and final stone-free rate (SFR), drop in hemoglobin, hospital stay, operative time, and complication rates. Additional information was collected on (but not limited to) baseline characteristics, stone complexity, number of tracts made, success rate, and transfusion rate.
From a total 187 studies, 11 were identified (published between 1997 and 2015), and they were included in this review. In total, 594 patients with a mean age of 46 years and a male:female ratio of 3:1 underwent BS-PCNL procedures, the majority of which was under the prone position. In 87.1% (range: 71.4%-100%) of cases, the synchronous approach was performed as planned. Multiple access tracts were established in an average of 16.7% (4.1%-24%) renal units. Mean initial SFR and final SFR were 72.6% (49%-85%) and 92.4% (87%-96.9%), respectively, with a mean operative time of 171.1 minutes (range: 107.4-269 minutes). Mean hospital stay was 3.9 days (range: 1.25-15 days). Mean complication rate per study was 23.4% (range: 12.1%-54% per study). The majority were Clavien Grade 1 (60.9%), of which fever resolving spontaneously was the most common complication. No deaths were reported in any of the papers.
BS-PCNL seems to be a good endourologic approach for patients with bilateral stone disease, which can render high SFRs and maintain a noninferior safety profile compared with the staged approach. This technique demands careful patient selection, counseling and should be preferably performed in endourology centers with large case volumes.
随着腔内泌尿外科技术的发展，双侧同步经皮肾镜取石术（BS-PCNL）已成为双侧结石患者一种潜在可行的治疗方法。尽管传统上倾向于分期手术，但越来越多的原始研究报告了他们采用同步手术的经验。
在制定了敏感且预定义的检索策略后进行了Cochrane式检索。测量的主要结局指标为初始和最终结石清除率（SFR）、血红蛋白下降情况、住院时间、手术时间和并发症发生率。还收集了（但不限于）基线特征、结石复杂性、穿刺通道数量、成功率和输血率等其他信息。
在总共187项研究中，确定了11项（发表于1997年至2015年之间），并纳入本综述。共有594例患者接受了BS-PCNL手术，平均年龄46岁，男女比例为3:1，大多数手术采用俯卧位。在87.1%（范围：71.4%-100%）的病例中，同步手术按计划进行。平均16.7%（4.1%-24%）的肾单位建立了多个穿刺通道。初始平均SFR和最终平均SFR分别为72.6%（49%-85%）和92.4%（87%-96.9%），平均手术时间为171.1分钟（范围：107.4-269分钟）。平均住院时间为3.9天（范围：1.25-15天）。每项研究的平均并发症发生率为23.4%（范围：每项研究12.1%-54%）。大多数为Clavien 1级（60.9%），其中最常见的并发症是发热自行消退。所有论文均未报告死亡病例。
对于双侧结石病患者，BS-PCNL似乎是一种良好的腔内泌尿外科治疗方法，与分期手术相比，它能实现较高的结石清除率并保持相当的安全性。该技术需要仔细选择患者、进行充分的术前咨询，并且最好在病例量大的腔内泌尿外科中心进行。
