Singh Udham, Singh Vivek K, Singh Vishwajeet, Singh Alka, Singh Jigardeep
Urology, King George's Medical University, Lucknow, IND.
Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, IND.
Cureus. 2024 Sep 10;16(9):e69096. doi: 10.7759/cureus.69096. eCollection 2024 Sep.
Introduction Renal stones are mineral concretions in the pelvicalyceal system. Their prevalence and recurrence are increasing globally. Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure for the removal of kidney stones. It is a safer technique offering the highest stone-free rates. However, a few complications may still occur. We aimed to evaluate our experiences of PCNL and classify the complications as intraoperative, early postoperative, and late postoperative events. We also aimed to find the predictors of complications in PCNL. Methods A single-center prospective observational study was conducted from June 2021 to October 2022 where all patients who were >18 years old with radiopaque calculus in the kidney and underwent PCNL were included. Statistical analysis was performed using the IBM Statistical Package for Social Sciences (SPSS) software (IBM SPSS Statistics, Armonk, NY). A p-value of <0.05 was considered significant. Results Two hundred one patients including 137 males and 64 females participated in the study. The overall rate of complications was 21.9%. Most of the patients (16.4%) experienced minor complications of Clavien grades 1 and 2. A Clavien grade of >3 included major complications and was noted in 5.5% of patients. No mortality was seen in the postoperative period. Female patients (p = 0.028), a stone burden of >3 cm (p = 0.003), stones in multiple calyces (p = 0.001), hydronephrosis (p = 0.001), history of recently treated urinary tract infection (UTI) (p < 0.001), longer operative time (>91 minutes) (p < 0.001), Guy's stone scores (GSS) III and IV (p < 0.001), complex renal calculi (staghorn) (p = 0.002), and multiple punctures (p = 0.001) were associated with higher complication rates after PCNL. Conclusion Most PCNL-related complications are minor and resolve with conservative or minimally invasive management. However, there are certain complications that can limit the surgical outcome. The overall complication rate in the current study is similar to that reported in the literature. Bleeding was the most common intraoperative complication, whereas hematuria was the most common early postoperative complication. A stone burden of >3 cm, hydronephrosis, longer operative time, higher GSS, and multiple punctures can all affect the rate of complications.
引言 肾结石是肾盂肾盏系统中的矿物质凝结物。其全球患病率和复发率正在上升。经皮肾镜取石术（PCNL）是一种用于去除肾结石的微创手术。它是一种更安全的技术，结石清除率最高。然而，仍可能发生一些并发症。我们旨在评估我们的PCNL经验，并将并发症分类为术中、术后早期和术后晚期事件。我们还旨在找出PCNL并发症的预测因素。
方法 2021年6月至2022年10月进行了一项单中心前瞻性观察性研究，纳入所有年龄大于18岁、肾脏有不透X线结石且接受PCNL的患者。使用IBM社会科学统计软件包（SPSS）软件（IBM SPSS Statistics，纽约州阿蒙克）进行统计分析。p值<0.05被认为具有统计学意义。
结果 201名患者参与了研究，其中男性137名，女性64名。总体并发症发生率为21.9%。大多数患者（16.4%）经历了Clavien 1级和2级的轻微并发症。Clavien分级>3级包括严重并发症，在5.5%的患者中出现。术后期间未观察到死亡病例。女性患者（p = 0.028）、结石负荷>3 cm（p = 0.003）、多个肾盏有结石（p = 0.001）、肾积水（p = 0.001）、近期有尿路感染（UTI）治疗史（p < 0.001）、手术时间较长（>91分钟）（p < 0.001）、盖氏结石评分（GSS）III级和IV级（p < 0.001）、复杂性肾结石（鹿角形结石）（p = 0.002）以及多次穿刺（p = 0.001）与PCNL术后较高的并发症发生率相关。
结论 大多数与PCNL相关的并发症是轻微的，通过保守或微创治疗可缓解。然而，某些并发症可能会限制手术效果。本研究中的总体并发症发生率与文献报道相似。出血是最常见的术中并发症，而血尿是最常见的术后早期并发症。结石负荷>3 cm、肾积水、手术时间较长、GSS较高以及多次穿刺均会影响并发症发生率。
