Lin Fangyou, Li Bojun, Rao Ting, Ruan Yuan, Yu Weimin, Cheng Fan, Larré Stéphane
Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China.
Department of Urology, Robert Debré Teaching Hospital, University of Reims, Reims, France.
Front Surg. 2022 Jun 21;9:942147. doi: 10.3389/fsurg.2022.942147. eCollection 2022.
Fused renal pyramid (FRP) is a kidney anatomical structure which was first identified by us. The vascular anatomy of FRP exhibits different from that of the normal renal pyramid (NRP), manifested by the distribution of the ectopic interlobar arteries in FRP. In this study, we analyzed the effect of FRPs on bleeding when using calyx access in mini-percutaneous nephrolithotomy (PCNL).
Overall, 633 patients who underwent ultrasound-guided single-tract mini-PCNL were divided into two groups according to the puncture method used: in group A, puncture was performed through the axial direction of the renal calyx, the line from the apex of the fornix to the center of the neck plane under B-mode ultrasound guidance; and in group B, Doppler ultrasound-guided axillary puncture through calyces corresponding to NRPs when the plane of renal column blood vessels on both sides was selected or calyx puncture through the hypovascular area of the FRPs. Relevant demographic and clinical data were retrospectively analyzed.
The two groups exhibited similar baseline characteristics. No significant differences were found in hemoglobin reduction, puncture site, tract size, postoperative creatinine level, or stone-free rate between the two groups ( > 0.05). Blood transfusion and embolization rates in group B were significantly lower than those in group A ( = 0.03 and 0.045, respectively). No differences were found between the two groups in terms of persistent pain, hydrothorax, fever, subcapsular hematoma, and urosepsis ( > 0.05). The overall complication rate was not significantly different between the two groups ( = 0.505).
FRP is a non-negligible anatomical structure that may cause hemorrhage when using calyx access. Doppler ultrasound can identify ectopic blood vessels in FRPs to reduce bleeding during calyx access in mini-PCNL procedures.
融合肾锥体（FRP）是我们首次发现的一种肾脏解剖结构。FRP的血管解剖结构与正常肾锥体（NRP）不同，表现为FRP中异位叶间动脉的分布。在本研究中，我们分析了在微创经皮肾镜取石术（PCNL）中使用肾盏入路时FRP对出血的影响。
总体而言，633例行超声引导下单通道微创PCNL的患者根据所采用的穿刺方法分为两组：A组在B超引导下沿肾盏轴向穿刺，即从穹窿顶至颈部平面中心连线方向穿刺；B组在选择双侧肾柱血管平面时，采用多普勒超声引导经对应NRP的肾盏进行腋部穿刺，或经FRP的低血管区进行肾盏穿刺。对相关人口统计学和临床数据进行回顾性分析。
两组患者基线特征相似。两组间血红蛋白降低程度、穿刺部位、通道大小、术后肌酐水平或结石清除率比较，差异均无统计学意义（均>0.05）。B组输血率和栓塞率显著低于A组（分别为=0.03和0.045）。两组在持续性疼痛、胸腔积液、发热、肾包膜下血肿和尿脓毒症方面比较，差异无统计学意义（均>0.05）。两组总体并发症发生率比较，差异无统计学意义（=0.505）。
FRP是一个不可忽视的解剖结构，在使用肾盏入路时可能导致出血。多普勒超声可识别FRP中的异位血管，以减少微创PCNL手术中肾盏入路时的出血。
