Dai X, Zuo M N, Zhang X P, Hu H, Xu T
Department of Urology, Peking University People's Hospital, Beijing 100044, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2021 Aug 18;53(4):704-709. doi: 10.19723/j.issn.1671-167X.2021.04.014.
To compare the short-term effects and long-term outcomes of incisional procedure and dilatation procedure to manage diverticular neck in percutaneous nephrolithotomy for diverticular stones.
Clinical data of 61 patients with diverticular stones who underwent percutaneous nephrolithotomy from June 2009 to January 2019 were retrospectively collected and analyzed, which was as follous: (1) basic information: age, gender, body mass index (BMI), American Society of Anesthesiology (ASA) classifications and preoperative symptoms.(2)stone characteristic and procedure-related data: location and size of stone, skinned renal access length and procedure time.(3)perioperative clinical data: hemoglobin drop, Clavien's classification and stone-free rate. Long-term follow-ups were performed for more than 5 years after the patients were discharged.
Fifty-three patients were included based on the inclusion and exclusion criteria, and were divided into the dilation group (=37) and the incision group (=16) by the treatment methods of diverticular neck. There were 24 male patients (45.3%) and 29 female patients (54.7%), with a mean age of 39.96±12.88 years. Stones were mainly located in the upper pole (=32, 60.38%) and posterior area (=41, 77.4%), with a predominance of single stone (=36, 67.9%). There was no statistically significant difference in demographic data and stone characteristics between the two groups except for age and stone burden. Forty-five patients (84.9%) reached stone-free status after surgeries, and 44 patients (83.0%) postoperative symptoms improved. Twelve patients were lost to the follow-ups, and 41 cases were followed up for an average of 77 months. One recurrence occurred 1 year after surgery. Fifteen patients underwent operations within the past 5 years and the overall 5-year recurrence rate for the remaining 26 patients was 34.6%. There was no statistically significant difference in the incidence of perioperative complications, postoperative stone-free rate and recurrence rate between the two groups, and the recurrence rate was significantly higher 5 years postoperatively than 1 year postoperatively. The proportion of the patients who remained lithotripsy-free and residual stone status decreased significantly.
Both incisional and dilatation procedures in percutaneous nephrolithotomy to manage diverticular neck could bring the satisfactory postoperative stone free rate. The recurrence rate was about 30% to 40% 5 years after surgery.
比较切开法与扩张法处理憩室结石经皮肾镜取石术中憩室颈部的短期效果和长期结局。
回顾性收集并分析2009年6月至2019年1月行经皮肾镜取石术的61例憩室结石患者的临床资料，具体如下：(1)基本信息：年龄、性别、体重指数(BMI)、美国麻醉医师协会(ASA)分级及术前症状。(2)结石特征及手术相关数据：结石位置和大小、皮肤肾穿刺通道长度及手术时间。(3)围手术期临床资料：血红蛋白下降情况、Clavien分级及结石清除率。患者出院后进行超过5年的长期随访。
根据纳入和排除标准纳入53例患者，根据憩室颈部的治疗方法分为扩张组(=37)和切开组(=16)。男性患者24例(45.3%)，女性患者29例(54.7%)，平均年龄39.96±12.88岁。结石主要位于上极(=32，60.38%)和后区(=41，77.4%)，以单发结石为主(=36，67.9%)。除年龄和结石负荷外，两组患者的人口统计学数据和结石特征无统计学差异。45例(84.9%)患者术后达到无结石状态，44例(83.0%)患者术后症状改善。12例患者失访，41例患者平均随访77个月。1例患者术后1年复发。15例患者在过去5年内接受了手术，其余26例患者的总体5年复发率为34.6%。两组围手术期并发症发生率、术后结石清除率和复发率无统计学差异，术后5年复发率显著高于术后1年。结石清除且无残留结石状态的患者比例显著下降。
经皮肾镜取石术中处理憩室颈部的切开法和扩张法均可带来满意的术后结石清除率。术后5年复发率约为30%至40%。
