Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, Canada.
Department of Urology, University of California, San Francisco, San Francisco, California, USA.
J Endourol. 2023 Jun;37(6):634-641. doi: 10.1089/end.2022.0761. Epub 2023 May 9.
Outcomes after ultrasound-only percutaneous nephrolithotomy (PCNL), in which no fluoroscopy is used, are not well known. The goal of this study was to compare outcomes of ultrasound-only and fluoroscopy-directed PCNL. Prospectively collected data from the Registry for Stones of the Kidney and Ureter database were reviewed for all patients who underwent PCNL at one academic center from 2015 to 2021. Primary outcomes were complications and stone-free rates (no residual fragments ≥3 mm). Of the 141 patients who underwent ultrasound-only PCNL and 147 who underwent fluoroscopy-directed PCNL, there was no difference in complication rates (15% 16%, = 0.87) or stone-free status (71% 65%, = 0.72), respectively. After adjusting for body mass index, American Society of Anesthesiologists (ASA), stone size, and stone complexity by Guy score, ultrasound-only PCNL was not associated with any increased odds of complications (odds ratio [OR] 0.7, 95% confidence interval [CI] 0.3-1.6, = 0.41) or residual stone fragments ≥3 mm (OR 1.0, 95% CI 0.5-1.9, = 0.972) compared with fluoroscopy-directed PCNL. Ultrasound-only PCNL was associated with shorter operative time (median 99.5 126 minutes, < 0.001), and the use of ultrasound remained a significant predictor of short operative time (<100 minutes) after controlling for supine positioning, stone size, and stone complexity by Guy score (OR 2.31, 95% CI 1.01-5.29, = 0.048). Patients in the ultrasound-only group were spared a mean radiation exposure dose of 10 mGy per procedure. Ultrasound-only PCNL is safe and achieves similar stone-free rates compared with fluoroscopy-directed PCNL with the added benefit of avoidance of radiation.
单纯超声引导经皮肾镜取石术（PCNL），即不使用透视的手术结果尚不明确。本研究旨在比较单纯超声引导与透视引导 PCNL 的结果。回顾了 2015 年至 2021 年期间在一家学术中心接受 PCNL 的患者的登记库数据库中的前瞻性收集数据。主要结局为并发症和结石清除率（无残留结石≥3mm）。在 141 例行单纯超声引导 PCNL 和 147 例行透视引导 PCNL 的患者中，并发症发生率（15%比 16%， = 0.87）或结石清除状态（71%比 65%， = 0.72）无差异。通过调整体质量指数、美国麻醉医师协会（ASA）、结石大小和 Guy 评分的结石复杂性，单纯超声引导 PCNL 与并发症（比值比 [OR] 0.7，95%置信区间 [CI] 0.3-1.6， = 0.41）或残留结石≥3mm（OR 1.0，95% CI 0.5-1.9， = 0.972）无关。与透视引导 PCNL 相比，单纯超声引导 PCNL 具有较短的手术时间（中位数 99.5 比 126 分钟， < 0.001），并且在控制仰卧位、结石大小和 Guy 评分的结石复杂性后，超声的使用仍然是手术时间短于 100 分钟的显著预测因素（OR 2.31，95% CI 1.01-5.29， = 0.048）。单纯超声组患者平均每次手术可避免 10mGy 的辐射剂量。单纯超声引导 PCNL 安全有效，与透视引导 PCNL 相比结石清除率相似，并且具有避免辐射的额外益处。
