Chen Xin, Wang Yi, Gao Liang, Song Jin, Wang Jin-You, Wang Deng-Dian, Ma Jia-Xing, Zhang Zhi-Qiang, Bi Liang-Kuan, Xie Dong-Dong, Yu De-Xin
Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China.
Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg 66421, Germany.
World J Clin Cases. 2020 Oct 26;8(20):4753-4762. doi: 10.12998/wjcc.v8.i20.4753.
Horseshoe kidney (HK) with renal stones is challenging for urologists. Although both retroperitoneal and transperitoneal laparoscopic approaches have been reported in some case reports, the therapeutic outcome of retroperitoneal compared with transperitoneal laparoscopic lithotripsy is unknown.
To assess the efficacy of laparoscopic lithotripsy for renal stones in patients with HK.
This was a retrospective study of 12 patients with HK and a limited number ( ≤ 3) of 20-40 mm renal stones treated with either retroperitoneal or transperitoneal laparoscopic lithotripsy (June 2012 to May 2019). The perioperative data of both groups were compared including operation time, estimated blood loss, postoperative fasting time, perioperative complications and stone-free rate (SFR).
No significant difference was observed for age, gender, preoperative symptoms, body mass index, preoperative infection, hydronephrosis degree, largest stone diameter, stone number and isthmus thickness. The mean postoperative fasting time of the patients in the retroperitoneal group and the transperitoneal group was 1.29 ± 0.49 and 2.40 ± 0.89 d, respectively ( = 0.019). There was no significant difference in operation time (194.29 ± 102.48 min 151.40 ± 39.54 min, = 0.399), estimated blood loss (48.57 ± 31.85 mL 72.00 ± 41.47 mL, = 0.292) and length of hospital stay (12.14 ± 2.61 d 12.40 ± 3.21 d, = 0.881) between the retroperitoneal and transperitoneal groups. All patients in both groups had a complete SFR and postoperative renal function was within the normal range. The change in estimated glomerular filtration rate (eGFR) from the preoperative stage to postoperative day 1 in the retroperitoneal group and the transperitoneal group was -3.86 ± 0.69 and -2.20 ± 2.17 mL/(min·1.73 m), respectively ( = 0.176). From the preoperative stage to the 3-mo follow-up, the absolute change in eGFR values for patients in the retroperitoneal group and the transperitoneal group was -3.29 ± 1.11 and -2.40 ± 2.07 mL/(min·1.73 m), respectively ( = 0.581).
Both retroperitoneal and transperitoneal laparoscopic lithotripsy seem to be safe and effective for HK patients with a limited number of 20-40 mm renal stones.
马蹄肾合并肾结石对泌尿外科医生来说是一项具有挑战性的工作。尽管在一些病例报告中已报道了腹膜后和经腹腹腔镜手术方法，但腹膜后与经腹腹腔镜碎石术的治疗效果尚不清楚。
评估腹腔镜碎石术治疗马蹄肾患者肾结石的疗效。
这是一项回顾性研究，纳入了12例马蹄肾且肾结石数量有限（≤3枚）、直径为20 - 40 mm的患者，于2012年6月至2019年5月期间接受了腹膜后或经腹腹腔镜碎石术。比较两组的围手术期数据，包括手术时间、估计失血量、术后禁食时间、围手术期并发症和结石清除率（SFR）。
两组患者在年龄、性别、术前症状、体重指数、术前感染、肾积水程度、最大结石直径、结石数量和峡部厚度方面均无显著差异。腹膜后组和经腹组患者的平均术后禁食时间分别为1.29±0.49天和2.40±0.89天（P = 0.019）。腹膜后组和经腹组在手术时间（194.29±102.48分钟对151.40±39.54分钟，P = 0.399）、估计失血量（48.57±31.85毫升对72.
