An L Z, Xiong L L, Chen L, Wang H R, Chen W N, Huang X B
Urology and Lithotripsy Center, Peking University People' s Hospital, Peking University Applied Lithotripsy Institute, Beijing 100034, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2022 Aug 18;54(4):746-750. doi: 10.19723/j.issn.1671-167X.2022.04.026.
To investigate the efficacy and safety of laparoscopic pyeloplasty combined with ultrasonic lithotripsy via nephroscope in the treatment of ureteropelvic junction obstruction (UPJO) with renal calculi.
From June 2016 to January 2022, eight patients including five males and three females underwent laparoscopic pyeloplasty combined with ultrasonic lithotripsy via 19.5F(1F≈0.33 mm) nephroscope in Peking University People' s Hospital. The age ranged from 23-51 years (mean: 40.5 years) and the body mass index (BMI) ranged from 18.8-32.4 kg/m (mean 27.0 kg/m). The lesion located on the left side in all of the eight patients. Two patients had solitary kidney and one patient had horseshoe kidney. Solitary stone was seen in one patient and the other seven patients suffered multiple stones, with two patients had staghorn stones. The largest diameter of stones ranged from 0.6-2.5 cm (mean: 1.5 cm). CT or ultrasound showed that moderate nephrosis was seen in five patients and severe nephrosis was seen in three patients. During surgery, after exposure of renal pelvis and proximal ureter, a small incision of 1.5 cm was performed in the anterior wall of the renal pelvis, and a 19.5F nephroscope was introduced into renal pelvis through laparoscopic trocar and renal pelvis incision. Stones were fragmented and sucked out by 3.3 mm ultrasonic probe placed through nephroscope. After stones were removed, modified laparoscopic pyeloplasty was performed.
Surgery was successfully completed in all of the eight patients without conversion to open surgery. The operation time ranged from 160-254 min (mean 213 min) and the time of nephroscopic management time was 25-40 min (mean: 33 min). The hemoglobin was decreased by 3-21 g/L (mean: 10.3 g/L). The stone-free rate was 75% (6/8 cases), stones were incompletely removed in two patients due to abnormal intrarenal structure. The modified Clavien classification system (MCCS) grade ⅢA complication occurred in one patient postoperatively, which was nephrosis due to intrarenal bleeding, and nephrostomy was performed. With the mean follow-up of 30 months (ranged from 2-68 months), there was no evidence of obstruction in all the patients, and one patient underwent percutaneous nephrolithotomy to treat residual calculi.
Laparoscopic pyeloplasty combined with ultrasonic lithotripsy via 19.5F nephroscope is feasible and safe, and could be a complementary method to treat UPJO and renal calculi.
探讨腹腔镜肾盂成形术联合经肾镜超声碎石术治疗输尿管肾盂连接部梗阻（UPJO）合并肾结石的疗效及安全性。
2016年6月至2022年1月，北京大学人民医院8例患者（男5例，女3例）接受了19.5F（1F≈0.33mm）肾镜下腹腔镜肾盂成形术联合超声碎石术。年龄23 - 51岁（平均40.5岁），体重指数（BMI）18.8 - 32.4kg/m²（平均27.0kg/m²）。8例患者病变均位于左侧。2例为孤立肾，1例为马蹄肾。1例患者为单发结石，其余7例为多发结石，其中2例为鹿角形结石。结石最大直径0.6 - 2.5cm（平均1.5cm）。CT或超声检查显示，5例患者为中度肾积水，3例为重度肾积水。手术中，暴露肾盂和近端输尿管后，在肾盂前壁做一个1.5cm的小切口，通过腹腔镜套管针和肾盂切口将19.5F肾镜置入肾盂。通过肾镜放置3.3mm超声探头将结石击碎并吸出。结石清除后，进行改良腹腔镜肾盂成形术。
8例患者均成功完成手术，未转为开放手术。手术时间160 - 254分钟（平均213分钟），肾镜操作时间25 - 40分钟（平均33分钟）。血红蛋白下降3 - 21g/L（平均10.3g/L）。结石清除率为75%（6/8例），2例患者因肾内结构异常结石清除不完全。1例患者术后发生改良Clavien分类系统（MCCS）ⅢA级并发症，即肾内出血导致肾积水，行肾造瘘术。平均随访30个月（2 - 68个月），所有患者均无梗阻迹象，1例患者接受经皮肾镜取石术治疗残留结石。
19.5F肾镜下腹腔镜肾盂成形术联合超声碎石术可行且安全，可作为治疗UPJO合并肾结石的补充方法。
