Pak Yuriy, Kalyagina Nina, Yagudaev Daniel
CUC City Multidisciplinary Hospital No. 2, City Center of Urology, Nur-Sultan, Kazakhstan.
Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russia.
Curr Urol. 2024 Dec;18(4):268-272. doi: 10.1097/CU9.0000000000000149. Epub 2024 Dec 20.
There is limited published evidence regarding the incidence of intraoperative and postoperative events and the effect of percutaneous nephrolithotomy (PCNL) in supine and prone positions and laparoscopic pyelolithotomy on kidney function in patients with large and complex calculi.
We evaluated the surgical outcomes of 97 patients with large and complex kidney stones. The patients were divided into 3 groups: those who underwent PCNL in the prone position, PCNL in the supine position, and pyelolithotomy by laparoscopy and retroperitoneoscopy. General surgical outcomes, size of residual stones, stone-free rate, glomerular filtration rate (GFR), and split GFR obtained from Tc-99m renal dynamic scintigrams were analyzed.
Percutaneous nephrolithotomy in the prone position was correlated with improved function of the affected kidney. In the supine PCNL group, none of the analyzed indicators demonstrated a significant difference. Dynamic nephroscintigrams revealed negative changes in terms of accumulation and secretion of the affected kidney. A slight decrease in creatinine clearance was noted. However, positive dynamics in split GFR and secretory index were seen in this group. The laparoscopic group showed positive results in all analyzed parameters. However, full assessment of the function of the affected kidney in this group was limited due to restricted use of laparoscopic pyelolithotomy for complex stones.
Percutaneous nephrolithotomy in the prone position resulted in the most favorable renal functional outcomes for patients with high-grade renal calculi, whereas a laparoscopic approach may be preferred for patients with stones of lower grades. The most significant factors that adversely affected renal function were intraoperative bleeding volume, kidney stone size and density, and body mass index.
关于术中及术后事件的发生率以及仰卧位和俯卧位经皮肾镜取石术（PCNL）和腹腔镜肾盂切开取石术对大而复杂结石患者肾功能的影响，已发表的证据有限。
我们评估了97例大而复杂肾结石患者的手术结果。患者分为3组：接受俯卧位PCNL的患者、接受仰卧位PCNL的患者以及通过腹腔镜和后腹腔镜进行肾盂切开取石术的患者。分析了一般手术结果、残余结石大小、无石率、肾小球滤过率（GFR）以及从Tc-99m肾动态闪烁扫描获得的分肾功能GFR。
俯卧位经皮肾镜取石术与患肾功能改善相关。在仰卧位PCNL组中，所分析的指标均未显示出显著差异。动态肾闪烁扫描显示患肾在积聚和分泌方面有负面变化。肌酐清除率略有下降。然而，该组中分肾功能GFR和分泌指数有积极变化。腹腔镜组在所有分析参数中均显示出积极结果。然而，由于腹腔镜肾盂切开取石术在复杂结石中的应用受限，该组中对患肾功能的全面评估受到限制。
俯卧位经皮肾镜取石术对高级别肾结石患者产生了最有利的肾功能结果，而对于低级别结石患者，腹腔镜手术方法可能更受青睐。对肾功能产生不利影响的最显著因素是术中出血量、肾结石大小和密度以及体重指数。
