Eryildirim Bilal, Kucuk Eyup Veli, Atis Gokhan, Ozturk Metin, Senkul Temucin, Tuncer Murat, Tahra Ahmet, Turan Turgay, Koca Orhan, Ates Ferhat, Yilmaz Omer, Gurbuz Cenk, Sarica Kemal
Health Sciences University, Dr. Lütfi Kirdar Training and Research Hospital, Urology Clinic, Istanbul.
Arch Ital Urol Androl. 2018 Sep 30;90(3):149-154. doi: 10.4081/aiua.2018.3.149.
To assess the efficacy and safety of two different techniques (Percutaneous nephrolithotomy (PNL) vs Retrograde intrarenal surgery (RIRS)) in the management of stones in patients with horseshoe kidneys (HSK).
Departmental files of 88 cases with radiopaque kidney stones in horseshoe kidneys undergoing two different approaches (PNL vs RIRS) were evaluated with respect to the success and complication rates of in a retrospective manner. In addition to the factors related with the procedures (success and complication rates, additional procedures), patient and stone characteristics were all well evaluated. Findings obtained in both groups were evaluated in a comparative manner with respect to the statistical significance.
Stone free rates were comparable in both groups after 1-week period (81.6% PNL vs 80% RIRS). As well as 3 months evaluation (84.2% PNL and 82.0% RIRS). The percentage of the cases with residual fragments (> 4 mm) were similar in both groups and while all PNL procedures were completed in one session, mean number of RIRS sessions was higher (1.22 ± 0.05). Mean duration of the procedure was slightly higher in RIRS group and based on Clavien scoring system, despite a higher risk of Hb drop noted in patients treated with PNL, all complication rates were found to be similar in both groups.
Our results demonstrate that of the available minimally invasive treatment alternatives, both PNL and RIRS could be safe and effective alternatives for renal stone removal in patients with HSK.
评估两种不同技术（经皮肾镜取石术（PNL）与逆行肾内手术（RIRS））治疗马蹄肾（HSK）患者结石的疗效和安全性。
回顾性评估88例接受两种不同方法（PNL与RIRS）治疗的马蹄肾不透X线肾结石患者的科室档案，评估成功率和并发症发生率。除了与手术相关的因素（成功率和并发症发生率、额外手术）外，还对患者和结石特征进行了全面评估。对两组获得的结果进行比较，评估其统计学意义。
1周后两组结石清除率相当（PNL为81.6%，RIRS为80%）。3个月评估时也是如此（PNL为84.2%，RIRS为82.0%）。两组残留碎片（>4mm）病例的百分比相似，虽然所有PNL手术均在一次手术中完成，但RIRS手术的平均次数更高（1.22±0.05）。RIRS组手术平均持续时间略长，根据Clavien评分系统，尽管PNL治疗患者血红蛋白下降风险较高，但两组所有并发症发生率相似。
我们的结果表明，在现有的微创治疗选择中，PNL和RIRS都是HSK患者肾结石清除的安全有效选择。
