The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Surg Innov. 2023 Aug;30(4):428-431. doi: 10.1177/15533506231165827. Epub 2023 Mar 27.
For complex branched renal calculi, the endoscopic combined intrarenal surgery (ECIRS) is worldwide prevalent. This study aimed to present a novel surgical technique of percutaneous nephrolithotomy combined with antegrade flexible ureteroscopy which is named 'Through-through' approach.
We retrospectively analyzed the data of 68 patients with complex renal calculi who underwent combined PNL and flexible ureteroscopy surgery using 'Through-through' approach at our center between August 2019 and December 2021. The 'Through-through' approach to surgery was indicated in residual calyceal calculi that neither rigid nephroscope nor retrograde flexible ureteroscope could reach. The brief procedure of this technique involved determining the direction of targeted calyces with the nephroscope first, followed by putting flexible ureteroscope into the targeted calyx through the nephroscope instrument channel and basketing or dusting residual calculi through the flexible ureteroscope instrument channel.
The mean maximum stone diameter was 4.0 ± 0.4 cm. The mean operative duration was 100.1 ± 18.0 minutes, and mean hemoglobin loss was 21.4 ± 5.1 g/L. In all 68 patients, calculi were cleared in 62 patients, and the stone free rate was 91.2%. Five patients underwent further surgery after 2 weeks because of significant residual calculi. One patient that had a 6 mm residual stone chose observational follow-up. Ten patients emerged with postoperative fever but did not progress to uroseptic shock. There were no Clavien grade ≥ III complications, and none of the patients required blood transfusion.
The 'Through-through' approach is safe, feasible and effective for complex renal calculi patients. It is a complementary solution to the failed endoscopic combined intrarenal surgery.
对于复杂的分支状肾结石，内镜下联合肾内手术（ECIRS）在全球范围内普遍应用。本研究旨在介绍一种新的经皮肾镜碎石术联合顺行软性输尿管镜手术的治疗方法，称为“贯穿”技术。
我们回顾性分析了 2019 年 8 月至 2021 年 12 月期间在我中心接受经皮肾镜碎石术联合软性输尿管镜手术（采用“贯穿”技术）治疗的 68 例复杂肾结石患者的数据。“贯穿”技术适用于无法通过硬性肾镜或逆行软性输尿管镜到达的残留肾盂结石。该技术的简要操作步骤包括：首先用肾镜确定目标肾盂的方向，然后通过肾镜器械通道将软性输尿管镜插入目标肾盂，并通过软性输尿管镜器械通道取石或碎石。
平均结石最大直径为 4.0 ± 0.4cm。平均手术时间为 100.1 ± 18.0 分钟，平均血红蛋白丢失量为 21.4 ± 5.1g/L。68 例患者中，62 例结石清除，结石清除率为 91.2%。5 例患者因残留结石较多在术后 2 周时再次手术，1 例患者有 6mm 残留结石，选择观察随访。10 例患者术后发热，但未进展为尿脓毒症休克。无 Clavien 分级≥Ⅲ级并发症，无患者需要输血。
“贯穿”技术对于复杂肾结石患者是安全、可行且有效的，是内镜下联合肾内手术失败的补充治疗方法。
