Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
World J Urol. 2021 Jun;39(6):2147-2154. doi: 10.1007/s00345-020-03388-5. Epub 2020 Aug 9.
Radiological parameters predicting a postoperative stone-free status (SFS) or a complicated perioperative course of mini-PNL, are scarce. Our aim was to identify such factors for prone 17.5F mini-PNL.
A monocentric cohort of 103 cases was retrospectively analysed for factors predicting SFS and relevant complications, i.e. Clavien-Dindo (CD) ≥ 2. Parameters measured on preoperative supine CT included maximal stone diameter, skin-to-stone distance (SSD), ideal tract length (ITL), access angle, minimal T12-Lower Kidney Pole distance (T12LP) and minimal Iliac Crest-Lower Kidney Pole distance (ICLP). Infundibulopelvic angle (IPA) was measured on intraoperative pyelography.
The median maximal stone diameter was lower in cases with postoperative SFS [16 mm (Min. 10; Max. 35) vs. 20 mm (Min. 6; Max. 85), p = 0.0052]. CD ≥ 2 was more frequent in cases with a bigger stone burden [19 mm (Min. 13; Max. 85) vs. 16 mm (Min. 6; Max. 49), p = 0.0056] and with the ribs in the access angle [7/23 (30.43%) vs. 8/76 (10.53%); p = 0.0454]. T12LP significantly differed in cases with and without CD ≥ 2 [80.48 mm (± 21.31) vs. 90.43 mm (± 19.42), p = 0.0397]; however, it had no influence on SFS (p > 0.05). SSD, ITL, IPA and ICLP were significant regarding neither SFS nor CD ≥ 2 prevalence (p > 0.05). Using multivariate logistic regression, T12LP was confirmed as an independent predictor on CD ≥ 2 prevalence.
Preoperative computed tomographic factors indicating elevated kidney position influence perioperative course of mini-PNL. T12LP and the presence of ribs in the access angle are, apart from stone diameter, the most useful indicators for cases at risk of CD ≥ 2.
预测经皮肾镜取石术（PCNL）术后结石无残留状态（SFS）或复杂围手术期结果的放射学参数较为缺乏。我们的目的是确定俯卧位 17.5F 微创经皮肾镜取石术（mini-PNL）的相关因素。
回顾性分析了 103 例病例的因素，以预测 SFS 和相关并发症，即 Clavien-Dindo（CD）分级≥2 级。术前仰卧 CT 测量的参数包括最大结石直径、皮肤至结石距离（SSD）、理想通道长度（ITL）、入路角度、最小 T12 下极肾盏距离（T12LP）和最小髂嵴下极肾盏距离（ICLP）。术中肾盂造影测量肾盂漏斗角（IPA）。
术后 SFS 组的最大结石直径中位数较低[16mm（最小值 10mm；最大值 35mm）比 20mm（最小值 6mm；最大值 85mm），p=0.0052]。CD 分级≥2 级的病例结石负荷较大[19mm（最小值 13mm；最大值 85mm）比 16mm（最小值 6mm；最大值 49mm），p=0.0056]，肋骨位于入路角度的病例更为常见[7/23（30.43%）比 8/76（10.53%）；p=0.0454]。T12LP 在有和没有 CD 分级≥2 级的病例中差异显著[80.48mm（±21.31）比 90.43mm（±19.42），p=0.0397]；然而，它对 SFS 没有影响（p＞0.05）。SSD、ITL、IPA 和 ICLP 与 SFS 或 CD 分级≥2 级的发生率均无显著相关性（p＞0.05）。多变量逻辑回归证实，T12LP 是 CD 分级≥2 级发生率的独立预测因素。
术前 CT 因素提示肾脏位置升高会影响 mini-PNL 的围手术期过程。T12LP 和入路角度存在肋骨是除结石直径外，CD 分级≥2 级风险病例最有用的指标。
