Department of Urology, Beijing Tsinghua Changgung Hospital, Beijing, China.
Division of Urology, University of Maryland School of Medicine, Baltimore, MD, USA.
BJU Int. 2019 Jul;124(1):109-115. doi: 10.1111/bju.14601. Epub 2018 Nov 22.
To evaluate the efficacy and safety of ultrasound (US)-guided percutaneous nephrolithotomy (PCNL) in managing upper urinary tract calculi in patients with spinal deformity based on our experience over the last decade.
A retrospective study was conducted on patients with spinal deformity who were admitted to Beijing Tsinghua Changgung Hospital and collaborative hospitals from August 2004 to August 2017. Patients diagnosed with urolithiasis and who underwent US-guided PCNL, performed by the same surgeon, were included. Patients' data were collected and the following variables were analysed: age; sex; plain abdominal radiograph of the kidneys, ureters and bladder (KUB); computed tomography (CT); stone burden; evaluation of spinal anatomy; respiratory function; operative time; and postoperative findings. The severity of surgical complications was determined according to the modified Clavien classification system (MCCS).
A total of 72 patients (41 males and 31 females) were included, with a mean (range) age of 35 (21-69) years. The mean (range) stone diameter was 38 (19-68) mm. Seven patients had bilateral PCNL, completed in staged surgery with a 1-week interval. Five kidneys received staged PCNL because of either large residual stones or the potential risk of a long operation time. In all, 19 patients underwent the surgery in a prone position, 29 lateral, nine oblique supine, and the other 27 in unconventional positions (lateral prone, lateral supine, and lateral jackknife position). All procedures were successfully completed with no major complications during the operation. The mean (SD) tract building time was 8.5 (1.7) min. The mean (SD) stone disintegration time was 39.3 (14.6) min. The mean (range) temperature and postoperative haemoglobin (Hb) drop on the first postoperative day were 37.6 (36.7-39.2) °C and 1.5 (0.2-4.3) g/dL, respectively. Four patients needed blood transfusions and none of the patients had septic shock or severe renal bleeding requiring angiographic renal embolisation or nephrectomy. A stone-free status was achieved in 71 kidneys (89.87%). Eight patients with residual fragments ≥4 mm were either observed without treatment during follow-up or re-treated with shockwave lithotripsy (SWL) according to clinical significance.
PCNL in patients with spinal deformities is challenging but safe and effective. US-guided puncture and access establishment has its unique advantages when such patients are placed in unconventional positions.
基于我们过去十年的经验，评估超声引导经皮肾镜取石术（PCNL）治疗脊柱畸形患者上尿路结石的疗效和安全性。
对 2004 年 8 月至 2017 年 8 月在北京清华长庚医院及协作医院因脊柱畸形就诊、接受同一位医生行超声引导 PCNL 治疗的患者进行回顾性研究。纳入标准：诊断为尿路结石，且接受超声引导 PCNL 治疗的患者。收集患者的资料，分析以下变量：年龄、性别、腹部 KUB 平片、CT、结石负荷、脊柱解剖评估、呼吸功能、手术时间和术后发现。根据改良 Clavien 分类系统（MCCS）评估手术并发症的严重程度。
共纳入 72 例患者（41 例男性，31 例女性），平均（范围）年龄为 35（21-69）岁。平均（范围）结石直径为 38（19-68）mm。7 例患者行双侧 PCNL，分两期手术，间隔 1 周。5 例患者因残留结石较大或手术时间长有潜在风险而行分期 PCNL。19 例患者采取俯卧位，29 例采取侧卧位，9 例采取斜仰卧位，27 例采取非常规体位（侧俯卧位、侧仰卧位、侧卧位截石位）。所有手术均顺利完成，术中无重大并发症。平均（SD）通道建立时间为 8.5（1.7）min，平均（SD）结石粉碎时间为 39.3（14.6）min。平均（范围）术后第 1 天体温和血红蛋白（Hb）下降值分别为 37.6（36.7-39.2）°C 和 1.5（0.2-4.3）g/dL。4 例患者需要输血，无患者发生感染性休克或严重肾出血需行血管造影肾栓塞或肾切除术。71 例（89.87%）患者结石清除率达到无残石状态。8 例患者残留结石碎片≥4mm，根据临床意义，或在随访期间不治疗，或行体外冲击波碎石（SWL）治疗。
脊柱畸形患者行 PCNL 具有挑战性，但安全有效。在患者采用非常规体位时，超声引导穿刺和通道建立具有独特的优势。
