Merinov D S, Kazachenko A V, Artemov A V, Arustamov L D, Gurbanov S S, Konstantinova O V, Shamkhalova K K
N.A. Lopatkin Research Institute of Urology and Interventional Radiology branch of the National Medical Research Radiologial Center.
Moscow, Russia.
Urologiia. 2022 Mar(1):11-16.
In order to improve clinical efficiency and reduce the risk of postoperative complications in patients with staghorn stones, we compared the results of original technique of biportal percutaneous nephrolithotomy (PCNL) with the standard PCNL.
The total of 221 patients with staghorn stones of K3-K4 was included in the study. The biportal PCNL was used in 109 patients, while the control group consisted of 112 patients. Inclusion criteria were stone size more or equal 2 cm, age over 18 years, absence of coagulopathy and width of the renal parenchyma more or equal 1 cm. On 1st postoperative day, ultrasound or plain urography was performed, while in patient with radiolucent stones, multi-slice computed tomography was used. In addition, complete blood count and biochemical profile were done. The main difference from the standard PCNL with sequential renal tracts is the simultaneous creation of the main and additional accesses when performing biportal PCNL. This method allowed two surgeons to simultaneously and synergistically perform lithotripsy and stone extraction from two accesses using a standard nephroscope in the main tract of 24 Ch and a miniaturized nephroscope in the additional tract of 16.5 Ch.
The stone-free rate in the group of biportal PCNL was 80.7% (n=88), compared to 72.3% in the control group (n=81). Secondary interventions and additional procedures were required in 29 (26.6%) and 40 (39.2%) cases, respectively. The total number of infectious and hemorrhagic complications was higher in the control group.
According to our data, significant advantages are observed in the group of biportal PCNL compared to the standard technique.
Biportal PCNL can be recommended as a promising advancement of the technique traditionally used in the clinical practice.
为提高鹿角形结石患者的临床效率并降低术后并发症风险，我们比较了双通道经皮肾镜取石术（PCNL）的原始技术与标准PCNL的结果。
本研究共纳入221例K3 - K4级鹿角形结石患者。109例患者采用双通道PCNL，对照组有112例患者。纳入标准为结石大小≥2 cm、年龄超过18岁、无凝血功能障碍且肾实质宽度≥1 cm。术后第1天进行超声或腹部平片检查，对于透光结石患者则使用多层螺旋计算机断层扫描。此外，还进行了血常规和生化检查。与标准序贯肾通道PCNL的主要区别在于，双通道PCNL在操作时同时建立主通道和辅助通道。该方法允许两名外科医生使用标准肾镜，通过24F的主通道和16.5F辅助通道中的小型肾镜，同时协同地从两个通道进行碎石和取石操作。
双通道PCNL组的结石清除率为80.7%（n = 88），而对照组为72.3%（n = 81）。分别有29例（26.6%）和40例（39.2%）患者需要二次干预和额外手术。对照组的感染和出血并发症总数更高。
根据我们的数据，与标准技术相比，双通道PCNL组具有显著优势。
双通道PCNL可作为临床实践中传统使用技术的一项有前景的进展而被推荐。
