Department of Urology, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, No. 168 Litang Road, Changping District, Beijing, 102218, China.
Department of Geriatric Medicine, Peking University First Hospital, Beijing, China.
World J Urol. 2019 May;37(5):951-956. doi: 10.1007/s00345-018-2458-5. Epub 2018 Sep 25.
To report our experience with total ultrasound-guided percutaneous nephrolithotomy (PCNL) in the management of patients with solitary kidney, and evaluate the safety and feasibility of this technique.
Between October 2014 and December 2016, 48 patients with solitary kidneys underwent total ultrasound-guided PCNL at our institution. Stone-free rate (SFR), auxiliary procedures, and complications were recorded. Changes in renal function were evaluated by comparing preoperative and postoperative estimated glomerular filtration rates (eGFRs). Perioperative factors that may affect renal function were analyzed to define factors predicting renal function improvement on long-term follow-up. Of 48 patients, 44 were followed at least 6 months, whereas four patients were lost to follow-up.
Among all patients, staghorn calculi were found in 18 (37.5%) patients. 14 (29.2%) patients required a two-stage PCNL. Struvite was found in six (12.5%) patients. Complications were reported in eight (16.7%) patients. Severe bleeding was noticed in three patients; no angioembolization was required. After a median follow-up of 12 (6-26) months, the final SFR was 81.8% after auxiliary treatments. There was a significant improvement of eGFR from 53.9 ± 24.0 to 61.3 ± 25.4 mL/min/1.73 m (P < 0.01). Renal function was stable, improved and worse in 65.9% (n = 29), 27.3% (n = 12), and 6.8% (n = 3) of patients, respectively, compared with preoperative levels.
Ultrasound-guided PCNL is a safe and feasible procedure with an acceptably low complication rate in patients with solitary kidneys. At long-term follow-up, the renal function in more than 90% of the patients with solitary kidneys can be improved or stabilized after ultrasound-guided PCNL.
报告我们在处理孤立肾患者时，采用完全超声引导经皮肾镜取石术（PCNL）的经验，并评估该技术的安全性和可行性。
2014 年 10 月至 2016 年 12 月，我院对 48 例孤立肾患者进行了完全超声引导 PCNL。记录结石清除率（SFR）、辅助治疗和并发症。通过比较术前和术后估算肾小球滤过率（eGFR）来评估肾功能的变化。分析可能影响肾功能的围手术期因素，以确定预测长期随访肾功能改善的因素。48 例患者中，44 例至少随访 6 个月，4 例失访。
所有患者中，鹿角形结石 18 例（37.5%），两阶段 PCNL 14 例（29.2%），六例（12.5%）为感染性结石，8 例（16.7%）出现并发症。3 例患者出现严重出血，未行血管栓塞。中位随访 12（6-26）个月后，辅助治疗后最终 SFR 为 81.8%。eGFR 从 53.9±24.0 升至 61.3±25.4 mL/min/1.73 m2（P<0.01），有显著改善。与术前相比，65.9%（n=29）、27.3%（n=12）和 6.8%（n=3）的患者肾功能稳定、改善和恶化。
在孤立肾患者中，超声引导 PCNL 是一种安全、可行的方法，并发症发生率低。在长期随访中，90%以上的孤立肾患者经超声引导 PCNL 后肾功能可得到改善或稳定。
