Martov A G, Dutov S V, Popov S V, Emelyanenko A V, Andronov A S, Orlov I N, Adilhanov M M, Kozachihina S I
GBUZ City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow, Moscow, Russia.
A.I. Burnazyan SRC FMBC, FMBA of Russia, Moscow, Russia.
Urologiia. 2019 Jul(3):72-79.
The least invasive technique of PCNL is micropercutaneous nephrolithotripsy (micro-PCNL). A possibility of kidney puncture under direct endoscopic control with the creation of a working channel sized of 8-4.85 F is a characteristic feature of this system.
To study the possibilities of micro-PCNL and to determine its role in the treatment of kidney stones.
A total of 74 patients aged 49.8+/-16.3 years were included in the study. In majority cases an isolated kidney stone was diagnosed (86.4%). The most common stone localization was pelvis (51.5%), followed by lower pole (35.9%). Considering the technical aspects of microPCNL, all patients were divided into 2 groups depending on the stone burden. In 46 patients (62.1%), the stone size was < 1.5 cm, while in 28 patients (37.9%) stones were bigger than 1.5 cm. Prestenting was performed in 54.0% due to renal colic or obstructive pyelonephritis. For the purpose of passive flushing of stone fragments during the lithotripsy, in most patients with a stone size > 1.5 cm, as well as in some prestented patients a ureteral access sheath with a diameter of 10/12 F (56.7%) was placed under x-ray control. In most patients with stones less than 1.5 cm, a 4.85 Ch sheath was utilized. In patients with larger stones, working sheath of 8 Ch was put. For stone disintegration, 50 W and 100 W holmium lasers, as well as the Russian innovative thulium fiber laser were used.
The average duration of surgery from the puncture was 30.6+/-11.6 minutes. The effectiveness was determined by use of a non-contrast computed tomography, performed one month after the surgery. An overall stone-free rate after one-session was 89.1%, and it was 93.4% and 82.4%, respectively, in patients with stones sized less and more than 1.5 cm. In 32.4% cases the stenting was placed due to the large number of small residual fragments and risk of obstruction. In one case, a conversion into a mini-PCNL was done. Two patients (2.7%) required stenting because of renal colic caused by the migration of stone fragments into the ureter. There was no bleeding. In 8.1% of cases, acute pyelonephritis was developed that was treated conservatively. In 9.4% of patients, ESWL was required due to residual stones diagnosed one month after the surgery.
Micro-PCNL is highly effective and safe method for treatment of kidney stones. Placing of ureteral access sheath of size 10/12 F contributes to the passive flushing of fragments during lithotripsy, which, together with the use of the 8 F working sheath, makes it possible to effectively perform micro-PCNL in patients with kidney stones larger than 1.5 cm.
经皮肾镜取石术（PCNL）的微创技术是微通道经皮肾镜取石术（微通道PCNL）。该系统的一个特点是能够在内镜直接控制下进行肾脏穿刺，并建立直径为8-4.85F的工作通道。
研究微通道PCNL的可行性，并确定其在肾结石治疗中的作用。
本研究共纳入74例年龄为49.8±16.3岁的患者。大多数病例诊断为孤立性肾结石（86.4%）。最常见的结石位置是肾盂（51.5%），其次是下极（35.9%）。考虑到微通道PCNL的技术方面，根据结石负荷将所有患者分为两组。46例患者（62.1%）结石大小<1.5 cm，28例患者（37.9%）结石大于1.5 cm。54.0%的患者因肾绞痛或梗阻性肾盂肾炎而进行了预置支架。为了在碎石过程中被动冲洗结石碎片，大多数结石大小>1.5 cm的患者以及一些预置支架的患者在X线控制下放置了直径为10/12F的输尿管通路鞘（56.7%）。大多数结石小于1.5 cm的患者使用了4.85Ch鞘。结石较大的患者放置8Ch工作鞘。为了碎石，使用了50W和100W的钬激光以及俄罗斯创新的铥光纤激光。
从穿刺开始的平均手术时间为30.6±11.6分钟。通过术后1个月进行的非增强计算机断层扫描确定疗效。单次手术后的总体无石率为89.1%，结石大小小于和大于1.5 cm的患者分别为93.4%和82.4%。32.4%的病例因大量小残留碎片和梗阻风险而放置了支架。1例患者转为迷你PCNL。2例患者（2.7%）因结石碎片移入输尿管引起肾绞痛而需要放置支架。无出血情况。8.1%的病例发生了急性肾盂肾炎，经保守治疗。9.4%的患者因术后1个月诊断出残留结石而需要进行体外冲击波碎石术（ESWL）。
微通道PCNL是治疗肾结石的高效、安全方法。放置10/12F的输尿管通路鞘有助于在碎石过程中被动冲洗碎片，这与使用8F工作鞘一起，使得在结石大于=1.5 cm的患者中有效进行微通道PCNL成为可能。
