Department of Urology, The Kidney Centre Postgraduate Training Institute, Karachi, Pakistan.
J Coll Physicians Surg Pak. 2020 Nov;30(11):1201-1205. doi: 10.29271/jcpsp.2020.11.1201.
To ascertain the safety and efficacy of percutaneous nephrolithomy in patients with previous open renal surgery.
Descriptive study.
The Kidney Centre Postgraduate Training Institute, Karachi from January to December 2018.
Patients with previous open renal surgery underwent percutaneous nephrolithomy during study period (Group A). Equal number of percutaneous nephrolithomy patients without previous open surgery taken as controls (Group B). Safety was defined in terms of 'blood loss' as change in hemoglobin (HB) level and 'blood transfusion,' while efficacy was defined in terms of 'stone clearance' and were compared between both the groups.
There were a total of 87 patients. Both groups had comparative gender ratio [p = 0.858]. Mean age [p = 0.132] and BMI [p = 0.879] of patients in both groups was not significantly different from each other. Both groups showed no statistically significant difference in terms of values of stone size [p = 0.186], stone laterality [p = 0.437] stone location [p = 0.949], preoperative Hb [p = 0.095], postoperative Hb [p = 0.423] and change in Hb (indicating blood loss, p = 0.398). Puncture levels were significantly different among both groups (supracostal puncture in 18 and 36 patients; infracostal puncture in 63 and 51 patients in groups A and B, respectively, p = 0.006), while operative time [p = 0.787], calyx punctured [p = 0.051], double puncture [p = 0.787], nephrostomy tube [p = 0.288] were statistically not different among groups. Similar number of patients demonstrated residual stones [p = 0.773], along with residual stone sizes [Group A (0.5; 0.5) and Group B (0.65; 0.38)] [p = 0.445]. Intra- and postoperative complications like blood transfusion [p = 0.700] and fever [p = 1.000] along with hospital stay [p = 0.614] were comparable among groups.
Percutaneous nephrolithomy is safe and effective in previously operated kidneys despite the possibility of calyceal anatomy distortion and scarring. Key Words: Percutaneous nephrolithotomy, Open surgery, Kidney calculi.
确定经皮肾镜取石术治疗既往开放性肾脏手术患者的安全性和疗效。
描述性研究。
卡拉奇肾脏中心研究生培训学院，2018 年 1 月至 12 月。
研究期间，对既往接受过开放性肾脏手术的患者进行经皮肾镜取石术（A 组）。选择数量相等的无既往开放手术的经皮肾镜取石术患者作为对照组（B 组）。安全性定义为血红蛋白（HB）水平变化的“出血量”和“输血”，而疗效定义为“结石清除率”，并在两组之间进行比较。
共有 87 名患者。两组的性别比例相当[P = 0.858]。两组患者的平均年龄[P = 0.132]和体重指数[P = 0.879]无显著差异。两组结石大小[P = 0.186]、结石侧位[P = 0.437]、结石位置[P = 0.949]、术前 HB [P = 0.095]、术后 HB [P = 0.423]和 HB 变化（表示失血，P = 0.398）无统计学差异。两组穿刺水平差异有统计学意义（A 组 18 例和 36 例为肋上穿刺；B 组 63 例和 51 例为肋下穿刺，P = 0.006），而手术时间[P = 0.787]、肾盏穿刺[P = 0.051]、双穿刺[P = 0.787]、肾造瘘管[P = 0.288]在组间无统计学差异。两组患者均有相似数量的残余结石[P = 0.773]，残余结石大小[A 组（0.5；0.5）和 B 组（0.65；0.38）][P = 0.445]。术中及术后并发症如输血[P = 0.700]、发热[P = 1.000]和住院时间[P = 0.614]在组间相似。
尽管可能存在肾盏解剖结构变形和瘢痕形成，但经皮肾镜取石术治疗既往手术肾脏是安全有效的。关键词：经皮肾镜取石术；开放性手术；肾结石。
