Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China.
Urol Int. 2023;107(6):550-556. doi: 10.1159/000528677. Epub 2023 Feb 8.
The aim of the study was to assess the safety and efficacy of ultrasound (US)-guided percutaneous nephrolithotomy (PCNL) for complex renal stones when performed in a modified supine position.
We retrospectively reviewed the charts of patients who underwent PCNL for complex renal stones at our institution between August 2018 and December 2021. During this time, 188 consecutive patients underwent US-guided PCNL in the prone position (P group, n = 129) or in the flank-free modified supine position (S group, n = 59). Patient demographics and intraoperative and postoperative data were analyzed.
Successful renal access was achieved in all patients. The baseline demographics were comparable between the two groups. The numbers of renal access were significantly higher (2.1 ± 0.4 vs. 1.2 ± 0.2, p = 0.002), and the operation time was comparable (79.1 ± 14.6 min vs. 96.2 ± 19.6 min, p = 0.06) between the two groups. The postoperative hospital stay was also shorter in the P group (6.2 ± 1.5 d vs. 10.2 ± 1.7 d, p = 0.008). The postoperative hemoglobin loss was similar between the P and S groups (1.7 ± 0.4 g/dL vs. 1.8 ± 0.3 g/dL, p = 0.12). The stone-free rate was significantly lower in the S group (57.5% vs. 82.7%, p < 0.001). There were no embolization or septic complications. Twelve patients (20.3%) in the S group underwent simultaneous or staged retrograde flexible ureteroscopy to remove residual stones.
US-guided PCNL in the modified supine position was a safe treatment for complex renal stones. However, the single-session stone clearance rate was not ideal. The supine flank-free position may be unsuitable for US-guided PCNL in patients with complex renal stones according to our preliminary findings.
本研究旨在评估改良仰卧位下超声引导经皮肾镜取石术（PCNL）治疗复杂性肾结石的安全性和疗效。
我们回顾性分析了 2018 年 8 月至 2021 年 12 月在我院接受 PCNL 治疗复杂性肾结石的患者病历。在此期间，188 例连续患者接受了超声引导下俯卧位（P 组，n=129）或改良仰卧位（S 组，n=59）PCNL。分析患者的人口统计学资料及术中、术后资料。
所有患者均成功建立肾通道。两组患者的基线资料相似。S 组的肾通道数量明显多于 P 组（2.1±0.4 比 1.2±0.2，p=0.002），手术时间相似（79.1±14.6min 比 96.2±19.6min，p=0.06）。S 组术后住院时间更短（6.2±1.5d 比 10.2±1.7d，p=0.008）。两组术后血红蛋白丢失量相似（1.7±0.4g/dL 比 1.8±0.3g/dL，p=0.12）。S 组的结石清除率明显较低（57.5%比 82.7%，p<0.001）。无栓塞或感染并发症。S 组 12 例（20.3%）患者行同期或分期逆行软性输尿管镜碎石术以清除残余结石。
改良仰卧位下超声引导 PCNL 治疗复杂性肾结石是一种安全的治疗方法。然而，单次结石清除率不理想。根据我们的初步研究结果，仰卧位下无侧卧位可能不适合超声引导下 PCNL 治疗复杂性肾结石。
