Balaji Sudharsan, Ganpule Arvind, Herrmann Thomas, Sabnis Ravindra, Desai Mahesh
Department of Urology, Muljhibhai Patel Urological Hospital, Nadiad, Gujarat, India.
Department of Urology, Spital Thurgau AG STGAG Kantonspital Frauenfeld and Kantonspital Münsterlingen, Thurgau, Switzerland.
Asian J Urol. 2020 Apr;7(2):102-109. doi: 10.1016/j.ajur.2019.12.012. Epub 2019 Dec 28.
Complex renal calculi remain to be a challenge for the treating urologist due to sheer bulk and the technicalities involved. Percutaneous nephrolithotomy (PCNL) remains the treatment modality of choice in dealing with these large and complex stones. The limiting factor in their treatment continues to be the need for using additional tracts or the use of flexible nephroscopy for complete stone clearance. This systematic review focuses on the need for multi-tract PCNL for complex renal calculi. The literature review was performed using PubMed database using the keywords "multiple tract PCNL" or "multiperc". We identified original articles published on the usage of multiple tracts for stone clearance in renal calculi between January 2000 to October 2018, and the search was restricted to available literature in English language only. Ten studies with >20 were included for the final analysis. We analyzed the technical efficacy with respect to the number of tracts and stages that were required for stone clearance, outcomes and complications, especially, procedural bleeding and post-procedure infective complications of multiple-tract PCNL for large burden renal stones. Multiperc is found to be safe, feasible and effective for the management of large burden complex renal calculi with respect to stone clearance and morbidity associated with the procedure. It is cost effective and complete stone clearance as a single procedure is higher in comparison to flexible ureteroscopy and shockwave lithotripsy.
复杂肾结石因其体积庞大及所涉及的技术问题，仍然是泌尿外科医生面临的一项挑战。经皮肾镜取石术（PCNL）仍是处理这些大而复杂结石的首选治疗方式。其治疗的限制因素仍然是需要使用额外的通道或采用软性肾镜来实现结石的完全清除。本系统评价聚焦于复杂肾结石多通道PCNL的必要性。通过PubMed数据库，使用关键词“多通道PCNL”或“multiperc”进行文献检索。我们检索了2000年1月至2018年10月间发表的关于使用多通道进行肾结石清除的原始文章，检索仅限于英文文献。最终纳入分析的有10项研究，每项研究纳入超过20例患者。我们分析了结石清除所需通道数量和阶段方面的技术疗效、结局及并发症，尤其是多通道PCNL治疗大负荷肾结石的术中出血和术后感染性并发症。就结石清除及与手术相关的发病率而言，多通道PCNL被发现对于处理大负荷复杂肾结石是安全、可行且有效的。与软性输尿管镜检查和冲击波碎石术相比，它具有成本效益，且单次手术实现结石完全清除的比例更高。
