经肋缘下皮肾镜取石术，一种安全有效的方法：临床审计。

Supracostal percutaneous nephrolithotomy, a safe and effective approach: A clinical audit.

机构信息

South Asian Institute of Urology and Nephrology (SAIUN) A Unit NSM Health Care Karachi, Pakistan.

出版信息

J Pak Med Assoc. 2022 Feb;72(2):287-291. doi: 10.47391/JPMA.916.

DOI:10.47391/JPMA.916

PMID:35320179

Abstract

OBJECTIVE

To emphasize on safety principles through anatomic approach in Supracostal Percutaneous nephrolithotomy (PCNL).

METHODS

Data of patients who underwent PCNL from June 2004 to August 2014 at the Kidney Centre Karachi, Pakistan were reviewed. Patients above 14 years of age with Supracostal Access were included in study. PCNL was performed in prone position with 'Bull's Eye Technique'. Nephrostomy was placed after completion of the procedure in most cases. Data on demographic details, stone burden, stone clearance with primary PCNL and combination and complications rate was assessed using Modified Clavien Grades 1 through 5.

RESULTS

Total 426 patients underwent PCNL. Seventy (70) out of 426 underwent PCNL through Supracostal Approach. Fifty (71.4 %) patients were Stone Free after PCNL and 64 (91.4%) patients were stone free after auxiliary procedures (ESWL, SECONDARY PCNL). The overall complication rate was 4.7% with 3 (4.3%) patients requiring Tube Thoracostomy and 1 (1.4%) each for angioembolisation, pulmonary oedema/ Ventilation and ICU admission due to urosepsis and renal dysfunction.

CONCLUSIONS

Supracostal PCNL is a safe and effective approach for multiple stones in pelvicalyceal system. Due anatomic consideration can decrease the complication rate. In complex stones with huge burden, an elaborate and thorough counseling regarding delayed clearance and need for auxiliary procedures including secondary PCNL is mandatory.

摘要

目的

通过解剖入路强调经皮肾镜碎石取石术（PCNL）中的安全原则。

方法

回顾 2004 年 6 月至 2014 年 8 月在巴基斯坦卡拉奇肾脏中心接受 PCNL 的患者数据。纳入研究的患者为年龄在 14 岁以上、采用肋上入路的患者。PCNL 在俯卧位下采用“牛眼技术”进行。大多数情况下，在手术完成后放置肾造瘘管。使用改良的 Clavien 分级 1 至 5 评估人口统计学细节、结石负担、初次 PCNL 及联合治疗后的结石清除率和并发症发生率。

结果

共有 426 例患者接受了 PCNL。426 例患者中有 70 例（70%）通过肋上入路接受了 PCNL。50 例（71.4%）患者在 PCNL 后结石清除，64 例（91.4%）患者在辅助治疗（ESWL、二次 PCNL）后结石清除。总体并发症发生率为 4.7%，3 例（4.3%）患者需要行胸腔引流管，1 例（1.4%）患者因败血症和肾功能障碍行血管栓塞术、肺水肿/通气和 ICU 入院。