Emmott Anthony S, Brotherhood Hilary L, Paterson Ryan F, Lange Dirk, Chew Ben H
1 Faculty of Medicine, University of British Columbia , Vancouver, Canada .
2 Department of Urologic Sciences, University of British Columbia , Vancouver, Canada .
J Endourol. 2018 Jan;32(1):28-32. doi: 10.1089/end.2017.0618. Epub 2017 Nov 17.
The management of residual fragments (RFs) that persist after percutaneous nephrolithotomy (PCNL) has been poorly studied. Fragments have the potential to grow or cause symptoms. The aim of this study was to follow patients with fragments after PCNL to identify predictors of stone-related events (re-interventions and complications) after PCNL.
Data were retrospectively collected from patients who underwent surgery from 2008 to 2013 at our hospital. Patients with fragments of any size on postoperative day 1 computed tomography of the kidney, ureter, and bladder radiograph (CT-KUB) were included, and patients with planned secondary interventions were excluded. Subgroup analysis was performed on subjects with CT-plain X-ray to determine fragment growth or passage.
Of the 658 patients who received a postoperative CT-KUB on day 1, 299 patients (45%) had fragments that were 1 mm or larger. From this, 263 patients met the study criteria and were included. The size of fragments, using a 4 mm cutoff, did not predict the passage of fragments (p = 0.173) or growth (p = 0.572). On multivariable logistic regression analysis, previous history of renal stones and size of fragment were found to be predictive for stone-related events (p = 0.002 and 0.027, respectively). Kaplan-Meier analysis identified patients with fragments >4 mm having a shorter survival time before the occurrence of stone-related events (p = 0.044).
The true stone-free rate was 55% after PCNL. However, 82.5% were stone free or had RFs 4 mm or less, which correlates with previous studies. Larger RFs had higher rates of stone-related events and shorter time to occurrence of stone-related events. The growth and spontaneous passage of RFs was independent of RF size, emphasizing the importance of obtaining a stone-free status after PCNL.
经皮肾镜取石术（PCNL）后残留碎片（RFs）的处理尚未得到充分研究。碎片有可能增大或引发症状。本研究的目的是对PCNL术后有碎片的患者进行随访，以确定PCNL术后结石相关事件（再次干预和并发症）的预测因素。
回顾性收集2008年至2013年在我院接受手术的患者数据。纳入术后第1天肾脏、输尿管和膀胱平扫CT（CT-KUB）显示有任何大小碎片的患者，排除计划进行二次干预的患者。对CT平扫X线检查的受试者进行亚组分析，以确定碎片的生长或排出情况。
在术后第1天接受CT-KUB检查的658例患者中，299例（45%）有1毫米或更大的碎片。其中，263例患者符合研究标准并被纳入。以4毫米为界值，碎片大小不能预测碎片的排出（p = 0.173）或生长（p = 0.572）。多变量逻辑回归分析发现，既往肾结石病史和碎片大小是结石相关事件的预测因素（分别为p = 0.002和0.027）。Kaplan-Meier分析确定，碎片>4毫米的患者在发生结石相关事件前的生存时间较短（p = 0.044）。
PCNL术后真正的无石率为55%。然而，82.5%的患者无结石或有4毫米或更小的RFs，这与先前的研究结果相关。较大的RFs发生结石相关事件的几率更高，发生结石相关事件的时间更短。RFs的生长和自然排出与RF大小无关，强调了PCNL术后获得无石状态的重要性。
