Wang M R, Wang Q, Hu H, Lai J H, He Y X, Xiong J, Liu X H, Liu S J, Xu K X, Xu T
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Aug 18;52(4):663-666. doi: 10.19723/j.issn.1671-167X.2020.04.012.
To evaluate the long-term efficacy and safety of ultrasound-guided percutaneous nephrolithotomy (PCNL) in the treatment of patients with solitary kidney stones.
The clinical data of 22 patients with solitary kidney stones treated with PCNL in Peking University People's Hospital from September 2008 to June 2014, with the follow-up data of more than 5 years were analyzed retrospectively. Perioperative indicators, postoperative stone free rate (SFR) and incidence of complications were recorded. Ultrasonography was used to evaluate the long-term stones recurrence rate. Serum creatinine and estimated glomerular filtration rate (eGFR) were used to assess the long-term renal function.
In this group of 22 patients, the average age was (50.3±11.8) years, with 10 cases of anatomic solitary kidneys, 12 functional solitary kidneys, and the median stone diameter was 1.65 (1.1-3.9) cm. All the patients had multiple stones, including 7 cases of staghorn stones. The median pre-operative serum creatinine was 104.5 (60.0-460.0) μmol/L, and the mean eGFR was (60.3±29.4) mL/min, showing no statistically significant difference compared with that before surgery. The mean operative time was (88.2±42.0) min, and there were 11 cases of single-channel and double-channel PCNL. The median serum creatinine on the first day after surgery was 102.0 (63.0-364.0) μmol/L, and the mean eGFR was (58.0±25.1) mL/min. The mean postoperative hospital stay was (8.7±5.2) days. In this group, 5 patients (22.7%) presented short-term complications, among which 4 patients presented postoperative infection and massive hemorrhage at the same time, which improved after conservative treatment, and 1 patient presented pleural injury and improved after closed thoracic drainage. Two patients (9.1%) developed long-term complications, and ureteral stricture occurred 3 months after operation, which improved after balloon dilatation. The median follow-up time was 6.2 (4.7-11.1) years. The median serum creatinine at the last follow-up was 104.0 (72.4-377.0) μmol/L, and the mean eGFR was (60.1±23.7) mL/min, showing no statistically significant difference compared with that before surgery. Renal function decreased in 6 patients (27.3%). Initial and final SFR were 72.7% and 100%, respectively. During the 6.2-year follow-up, 9 patients (40.9%) experienced recurrence of kidney stone. After stone recurrence, 13 lithotomy surgeries were performed, and the SFR by the latest follow-up was 63.6%.
This study had the longest follow-up time for patients with solitary kidney stones after PCNL reported at home and abroad. Ultrasound-guided standard PCNL was safe and effective in the treatment of solitary kidney stones. Long-term follow-up results showed that the recurrence rate of kidney stones was still high, but the long-term renal function was stable after operation, and some patients showed mild renal function decline.
评估超声引导经皮肾镜取石术（PCNL）治疗孤立肾结石患者的长期疗效及安全性。
回顾性分析2008年9月至2014年6月在北京大学人民医院接受PCNL治疗的22例孤立肾结石患者的临床资料，随访时间超过5年。记录围手术期指标、术后结石清除率（SFR）及并发症发生率。采用超声评估长期结石复发率。采用血清肌酐和估算肾小球滤过率（eGFR）评估长期肾功能。
该组22例患者，平均年龄（50.3±11.8）岁，其中解剖性孤立肾10例，功能性孤立肾12例，结石中位直径1.65（1.1 - 3.9）cm。所有患者均为多发结石，其中鹿角形结石7例。术前血清肌酐中位数为104.5（60.0 - 460.0）μmol/L，平均eGFR为（60.3±29.4）mL/min，与术前相比差异无统计学意义。平均手术时间为（88.2±42.0）min，单通道和双通道PCNL各11例。术后第1天血清肌酐中位数为102.0（63.0 - 364.0）μmol/L，平均eGFR为（58.0±25.1）mL/min。术后平均住院时间为（8.7±5.2）天。该组5例（22.7%）出现短期并发症，其中4例术后同时出现感染和大出血，经保守治疗后好转，1例出现胸膜损伤，经胸腔闭式引流后好转。2例（9.1%）出现长期并发症，术后3个月发生输尿管狭窄，经球囊扩张后好转。中位随访时间为6.2（4.7 - 11.1）年。末次随访时血清肌酐中位数为104.0（72.4 - 377.0）μmol/L，平均eGFR为（60.1±23.7）mL/min，与术前相比差异无统计学意义。6例（27.3%）患者肾功能下降。初始和最终SFR分别为72.7%和100%。在6.2年的随访期间，9例（40.9%）患者出现肾结石复发。结石复发后，进行了13次取石手术，最新随访时SFR为63.
