Department of Urology, Beijing Chuiyangliu Hospital, Tsinghua University, 100022 Beijing, China.
Arch Esp Urol. 2023 Feb;76(1):84-89. doi: 10.56434/j.arch.esp.urol.20237601.8.
Percutaneous nephrolithotomy (PCNL) has been widely used in the clinical practice of urinary calculi. The prone positioning for PCNL is generally adopted, while it is associated with a certain risk when repositioning the patient into the prone position after anesthesia. This approach is more difficult for obese or elderly patients with respiratory diseases. The application of PCNL combined with B-mode ultrasound-guided renal access in the lateral decubitus flank position for complex renal calculi has been poorly investigated. This study aimed to evaluate the efficacy and safety of PCNL combined with B-mode ultrasound-guided renal access in the lateral decubitus flank position for complex renal calculi.
From June 2012 to August 2020, 660 patients with renal stones (>20 mm) were enrolled. All patients were diagnosed by ultrasonography, kidney-ureter-bladder (KUB) plain X-ray imaging, intravenous urography (IVU), or computed tomographic urography (CTU). All the enrolled subjects underwent PCNL combined with B-mode ultrasound-guided renal access in the lateral decubitus flank position.
Successful access was achieved in 660 patients (100%). Micro-channel PCNL and PCNL were performed on 503 and 157 patients, respectively. The stone-free rate was 85.30% (563/660). A dual-channel access was required for phase I PCNL in 92 cases, and reconstruction of channel was required for 33 cases for phase II PCNL. The stone-free rate of phase I PCNL was 85.30% (563/660). Totally, 45 patients had stones that were cleared during phase II PCNL, while 5 patients became stone-free after phase III PCNL. Besides, 12 cases became stone-free after undergoing PCNL combined with extracorporeal shock wave lithotripsy. The mean operation time was 66 (range, 38 to 155) min, and the mean length of hospital stay was 16 (range, 8 to 33) days. One case developed heavy bleeding 6 days after the removal of kidney fistula, and one case developed acute left epididymitis during urethral catheter retention. No visceral injuries and other complications occurred.
PCNL combined with B-mode ultrasound-guided renal access in the lateral decubitus flank position is safe and convenient, preventing the surgical team and patients from exposure to harmful radiations.
经皮肾镜碎石术（PCNL）已广泛应用于尿路结石的临床实践中。PCNL 通常采用俯卧位，但在麻醉后重新将患者置于俯卧位时存在一定风险。对于肥胖或患有呼吸系统疾病的老年患者，这种方法更为困难。B 型超声引导下侧卧位肾穿刺在复杂肾结石中的应用研究较少。本研究旨在评价 B 型超声引导下侧卧位 PCNL 治疗复杂肾结石的疗效和安全性。
2012 年 6 月至 2020 年 8 月，共纳入 660 例肾结石（>20mm）患者。所有患者均经超声、肾输尿管膀胱（KUB）平片、静脉尿路造影（IVU）或 CT 尿路造影（CTU）诊断。所有患者均接受 B 型超声引导下侧卧位 PCNL。
660 例患者（100%）均成功建立通道。其中，503 例行微通道 PCNL，157 例行 PCNL。结石清除率为 85.30%（563/660）。92 例一期 PCNL 需要双通道建立通道，33 例二期 PCNL 需要重建通道。一期 PCNL 结石清除率为 85.30%（563/660）。二期 PCNL 中 45 例结石清除，3 例三期 PCNL 后结石清除，12 例联合体外冲击波碎石后结石清除。手术时间平均 66（38～155）min，住院时间平均 16（8～33）d。1 例术后 6d 肾造瘘管拔出后出现大出血，1 例留置导尿管期间出现急性左侧附睾炎。无内脏损伤等其他并发症发生。
B 型超声引导下侧卧位 PCNL 安全、方便，可避免手术团队和患者受到有害射线的照射。
