Department of Urology, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, No. 168 Litang Road, Changping District, Beijing, 102218, China.
Urolithiasis. 2022 Jun;50(3):349-355. doi: 10.1007/s00240-021-01299-7. Epub 2022 Feb 18.
Our aim was to investigate the safety and efficacy of needle-perc-assisted percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS), namely, needle-perc-assisted endoscopic surgery (NAES), in a series of patients with large and/or complex renal stones. From May 2018 to August 2021, a total of 119 patients underwent NAES at our institute. Among them, 94 patients underwent needle-perc-assisted standard PCNL in prone position and 25 underwent needle-perc-assisted RIRS in the Galdakao-modified supine Valdivia position or prone split-leg position. Clinical factors including age, sex, medical history, and stone characteristics were collected. Intraoperative and postoperative outcomes were retrospectively evaluated. The patients' mean age ± standard deviation was 50.3 ± 14.3 years. The mean stone size was 7.6 ± 3.7 and 1.7 ± 0.8 cm for needle-perc-assisted PCNL and RIRS, respectively. Of the 119 patients, 51 had staghorn stones, 16 had solitary kidneys, 17 had a history of ipsilateral renal surgery, and 6 had calyceal diverticular stones. The mean operative time was 83.4 ± 25.9 min for needle-perc-assisted PCNL and 66.3 ± 21.8 min for needle-perc-assisted RIRS. The stone-free rate (SFR) for needle-perc-assisted PCNL was 77.7% after the first treatment and 88.3% after auxiliary treatments. The SFR for needle-perc-assisted RIRS was 88.0% and no auxiliary treatments were carried out in this group. Eleven (11.7%) patients who underwent needle-perc-assisted standard PCNL developed Clavien-Dindo grade I or II complications. Three (12.0%) patients who underwent needle-perc-assisted RIRS developed a fever (grade I). The overall complication rate for NAES was 11.8%, with no urosepsis, angioembolization, or other grade III to V complications. In conclusion, NAES is a safe and effective procedure for one-step complete resolution of large and/or complex renal stones with no additional procedure-related complications.
我们的目的是研究经皮肾镜取石术（PCNL）或逆行肾内手术（RIRS），即经皮肾镜取石术（NAES）在一系列大/复杂肾结石患者中的安全性和疗效。从 2018 年 5 月至 2021 年 8 月，我院共对 119 例患者进行了 NAES。其中，94 例行经皮肾镜取石术，25 例行经皮肾镜取石术，Galdakao 改良仰卧位瓦尔迪维亚位或俯卧位分体位。收集患者的年龄、性别、病史和结石特征等临床因素。回顾性评估术中及术后结果。患者的平均年龄为 50.3±14.3 岁。经皮肾镜取石术和 RIRS 的平均结石大小分别为 7.6±3.7cm 和 1.7±0.8cm。119 例患者中，鹿角形结石 51 例，孤立肾 16 例，同侧肾手术史 17 例，肾盏憩室结石 6 例。经皮肾镜取石术的平均手术时间为 83.4±25.9min，经皮肾镜取石术为 66.3±21.8min。首次治疗后经皮肾镜取石术的结石清除率（SFR）为 77.7%，辅助治疗后为 88.3%。经皮肾镜取石术的 SFR 为 88.0%，无需辅助治疗。11 例（11.7%）行标准经皮肾镜取石术的患者出现 Clavien-DindoⅠ级或Ⅱ级并发症。3 例（12.0%）行经皮肾镜取石术的患者发热（Ⅰ级）。NAES 的总并发症发生率为 11.8%，无尿脓毒症、血管栓塞或其他Ⅲ至Ⅴ级并发症。总之，NAES 是一种安全有效的方法，可一步完成大/复杂肾结石的完全清除，无额外的手术相关并发症。
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