1 School of Medicine, Case Western Reserve University , Cleveland, Ohio.
2 Glickman Urological and Kidney Institute , Cleveland Clinic Foundation, Cleveland, Ohio.
J Endourol. 2019 Apr;33(4):274-278. doi: 10.1089/end.2018.0502. Epub 2019 Jan 2.
To develop a contemporary complication profile for supracostal upper pole endoscopic-guided prone tubeless "maxi-PCNL" to evaluate the need for change.
MATERIALS/METHODS: We identified patients undergoing supracostal upper pole percutaneous nephrolithotomy (PCNL) by a single surgeon at a high volume tertiary care stone center between October 2010 and April 2017. Access was obtained with ureteroscopic guidance. The tract was dilated to 30F through radial balloon dilation. All cases were tubeless with ureteral stent for 5-7 days. Preoperative, operative, and postoperative variables were recorded. We recorded need for blood transfusion, angioembolization, thoracentesis and/or chest tube insertion, intensive care unit (ICU) admission, and 30-day readmission.
A total of 375 patients were included. Mean age was 57 years and 59% were women. Mean body mass index was 33 kg/m. Mean stone burden was 35 mm. The mean operative time was 99 minutes. Median stay was 1 day. There were no complications because of prone position. Postoperative complications included pleural drain (4%), transfusion (6.7%), and angioembolization (0.5%). Transfusion rates were higher in patients with preoperative hemoglobin <10 mg/dL (28% vs 5.1%, p < 0.00001). Rate of ICU admission and readmission was 4.5% and 7.5%, respectively. Transfusion (p ≤ 0.001), pleural drain (p = 0.0002), and readmission (p = 0.030) were associated with ICU admission. Male gender was associated with readmission (10.3% vs 5.5%, odds ratio = 3.1, p = 0.012).
In supracostal upper pole endoscopic-guided prone tubeless Maxi-PCNL, pulmonary complication rate was lower than previously reported and bleeding complications were comparable with mini-PCNL series. Establishing contemporary complication rates will help to assess the need for evolution to mini-PCNL or lower pole supine PCNL.
为经肋缘上极内镜引导下俯卧位无管“超大经皮肾镜取石术（Maxi-PCNL）”建立当代并发症概况，以评估是否需要改变。
材料/方法：我们在 2010 年 10 月至 2017 年 4 月期间，在一家高容量的三级护理结石中心，由一位外科医生对接受经肋缘上极经皮肾镜取石术（PCNL）的患者进行了识别。采用输尿管镜引导进行入路。通过径向球囊扩张将通道扩张至 30F。所有病例均为无管留置输尿管支架 5-7 天。记录术前、术中和术后变量。我们记录了输血、血管栓塞、胸腔穿刺和/或胸腔引流管插入、重症监护病房（ICU）入院和 30 天再入院的需求。
共纳入 375 例患者。平均年龄为 57 岁，59%为女性。平均体重指数为 33kg/m。平均结石负荷为 35mm。平均手术时间为 99 分钟。中位数住院时间为 1 天。由于俯卧位没有并发症。术后并发症包括胸腔引流管（4%）、输血（6.7%）和血管栓塞（0.5%）。术前血红蛋白<10mg/dL 的患者输血率较高（28% vs 5.1%，p<0.00001）。ICU 入院率和再入院率分别为 4.5%和 7.5%。输血（p≤0.001）、胸腔引流（p=0.0002）和再入院（p=0.030）与 ICU 入院相关。男性与再入院相关（10.3% vs 5.5%，优势比=3.1，p=0.012）。
在经肋缘上极内镜引导下俯卧位无管 Maxi-PCNL 中，肺部并发症发生率低于先前报道，出血并发症与 mini-PCNL 系列相当。建立当代并发症发生率将有助于评估是否需要向 mini-PCNL 或下极仰卧位 PCNL 发展。
