Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, , 110004, Liaoning, People's Republic of China.
World J Urol. 2022 Mar;40(3):795-800. doi: 10.1007/s00345-021-03895-z. Epub 2021 Dec 1.
The management of complete staghorn stones remains a challenge for urologists, owing to the high stone burden, low stone free rate, and high rate of complications. Hence, we aimed to evaluate the outcomes of a technique involving combination laparoscopy and nephrolithotomy in the same session in patient with complete staghorn stones and poor performance status.
We retrospectively evaluated seven patients with complete staghorn stones who underwent a combination of laparoscopy and nephrolithotomy in the same session in our center between December 2016 and October 2019. The surgical technique was as follows. Through a four-port transperitoneal laparoscopic approach, the kidney was mobilized after complete dissection of the renal pedicle. The renal pelvis was then incised with a cold scalpel. A nephroscope was inserted into the renal collecting system through both a laparoscopic port and the renal pelvis incision. This method enabled visualization of and access to almost all calyces for clearing the stones from the affected kidneys in a hand-assisted manner which a hand was inserted in the peritoneal cavity. The outcome data included the stone-free rate, short-term and long-term complication rates, and stone recurrence rate.
The stone free rate was 85.70% (6/7). No patients had sepsis or required blood transfusion perioperatively, and no major short-term complications occurred. After 24.00 (15.00, 48.00) months' follow-up, no patients had long-term complications, and only one patient had stone recurrence.
The technique of combining laparoscopy and nephrolithotomy in the same session was an effective and safe treatment for patients with complete staghorn stones and poor performance status. The method was scarcely affected by the stone burden and morphology, had a satisfactory stone free rate, and resulted in no major complications, particularly life-threatening sepsis. It might be an option for such patients.
由于结石负荷大、结石清除率低和并发症发生率高，鹿角状结石的治疗仍然是泌尿外科医生面临的挑战。因此，我们旨在评估一种在同一手术期内结合腹腔镜和经皮肾镜取石术治疗完全鹿角状结石和身体状况不佳的患者的技术的结果。
我们回顾性评估了 2016 年 12 月至 2019 年 10 月期间在我们中心接受同一手术期内腹腔镜和经皮肾镜取石术联合治疗的 7 例完全鹿角状结石患者。手术技术如下：通过四孔经腹腹腔镜入路，在完全解剖肾蒂后，将肾脏游离。然后用冷手术刀切开肾盂。通过腹腔镜端口和肾盂切口将肾镜插入肾盂集合系统。这种方法使手能够进入腹膜腔，以手辅助的方式可视化和进入几乎所有的肾盂，从而清除受累肾脏中的结石。结局数据包括结石清除率、短期和长期并发症发生率以及结石复发率。
结石清除率为 85.70%（6/7）。无患者围手术期发生脓毒症或需要输血，无重大短期并发症发生。随访 24.00（15.00，48.00）个月后，无患者发生长期并发症，仅 1 例患者结石复发。
在同一手术期内结合腹腔镜和经皮肾镜取石术是治疗完全鹿角状结石和身体状况不佳患者的一种有效且安全的方法。该方法几乎不受结石负荷和形态的影响，结石清除率令人满意，且无重大并发症，特别是无威胁生命的脓毒症。对于此类患者，这可能是一种选择。
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