The comparison of laparoscopic pyelolithotomy and percutaneous nephrolithotomy in the treatment of solitary large renal pelvic stones

The aim of the study is to investigate whether laparoscopic pyelolithotomy (LPL) could find a place in the management of large renal pelvic stones which are generally considered as excellent indications for percutaneous nephrolithotomy (PNL). Between 2006 and 2009, 26 consecutive patients with large (>4?cm(2)) renal pelvic stones were treated by LPL and their charts were compared to 26 match-paired patients treated with PNL during the same period. The patients were matched for age, BMI, stone size and location as well as presence of congenital anomalies. Perioperative and postoperative findings were compared. The mean age, mean stone size, rate of congenital anomalies, history open renal surgery and shock wave lithotripsy were similar in both groups (p?>?0.05). The mean operation time was 138.40?±?51.19 (range 70-240)?min in LPL group as compared to 57.92?±?21.12 (range 40-110)?min in PNL group (p?相似文献   

后腹腔镜肾切开取石与经皮肾镜取石术治疗复杂性肾结石的临床疗效比较

目的 比较后腹腔镜肾切开取石与经皮肾镜取石术(PNL)治疗复杂性肾结石的临床疗效.方法 选取本院2010年1月至2014年12月收治的126例复杂性肾结石,其中行后腹腔镜肾切开取石术者54例(腹腔镜组),行PNL治疗72例(PNL组).比较两组患者的手术相关情况及疗效指标.结果 两组患者手术均顺利完成,无围手术期死亡病例.腹腔镜组的手术时间长于PNL组,但术中出血量小于PNL组,差异均有统计学意义(P＜0.05).两组患者的住院时间和中转开放率比较,差异无统计学意义(P＞0.05).腹腔镜组二期手术率高于PNL组,术中结石清除率低于PNL组,差异均有统计学意义(P＜0.05).但两组术后并发症发生发生率比较,差异无统计学意义(P＞0.05).经二期手术后,两组患者最终结石清除率均为100％.结论 后腹腔镜肾切开取石术和PNL治疗复杂性肾结石均安全有效,后腹腔镜肾切开取石术的手术时间较长,手术出血量较少,结石残留率较高.     

RLP与PCNL治疗肾盂单发结石的安全性及有效性的Meta分析

目的:系统评价后腹腔镜肾盂切开取石术(RLP)与经皮肾镜取石术(PCNL)治疗肾盂单发结石的安全性与有效性。方法:检索PubMed、EMBASE、Cochrane Library、Science Direct、中国生物医学文献数据库(CBM)、中文期刊全文数据库(CNKI)和万方数据库,纳入关于两种术式的所有对照性研究...     

腹膜后腹腔镜肾盂切开取石术治疗>3 cm肾盂单发结石的临床观察

目的观察腹膜后腹腔镜肾盂切开取石术治疗>3 cm肾盂单发结石的疗效。 方法选取2013年8月至2015年8月我院肾盂单发较大结石80例,对照组采用单通道经皮肾镜碎石取石术,实验组患者采用腹腔镜肾盂切开取石术。观察两组患者手术时间、出血量、肠道恢复时间、引流时间、住院时间、住院总费用。比较两组使用止痛药、结石清除率及并发症发生率。 结果实验组止痛药使用率5.00%少于对照组22.50%（P<0.05）。实验组结石清除率为100.00%高于对照组82.50%（P<0.05）。实验组患者手术时间、住院费用高于对照组（P<0.01）。实验组患者出血量、肠道恢复时间、引流时间、住院天数少于对照组（P<0.01）。实验组患者并发症发生情况优于对照组（P<0.01）。 结论腹膜后腹腔镜肾盂切开取石术治疗肾盂单发较大结石清除率高,具有出血量少、住院时间短、术后并发症少的特点。     

后腹腔镜肾盂切开取石术的临床应用

目的:分析后腹腔镜下肾窦内肾盂切开取石术的安全性及有效性。方法:回顾分析为42例患者行后腹腔镜肾盂切开取石术的临床资料。其中男30例,女10例1,8～74岁,平均47.8岁。结果:40例成功完成后腹腔肾盂切开取石术,2例中转开放手术。2例分别于术后第7天、第21天发生尿漏。结论:后腹腔镜下肾盂切开取石术安全可靠,患者损伤小,康复快。术者的手术经验和技术水平,以及适应证的正确选择是手术成功的关键。     

后腹腔镜与经皮肾镜治疗孤立肾合并输尿管上段结石的疗效比较

目的比较后腹腔镜切开取石术(RLU)与经皮肾镜碎石术(PCNL)治疗孤立肾合并输尿管上段结石的疗效。方法回顾性分析2015年5月至2018年5月武穴市第一人民医院收治的孤立肾合并输尿管上段结石患者60例,根据所行术式分为RLU组和PCNL组,比较2种术式的清石率,术中出血量、术后并发症发生率,住院天数及肾功能恢复率等方面。结果2组患者在清石率及住院时间上差异无统计学意义(P>0.05),而RLU组的术中出血量、术后总并发症的发生率均明显少于PCNL组,差异具有统计学意义(P<0.05)。结论RLU治疗孤立肾合并输尿管上段结石疗效确切,具有明显优势。     

后腹腔镜肾盂输尿管切开取石术的疗效观察

目的:探讨后腹腔镜肾盂输尿管切开取石术的技术与临床价值。方法:采用后腹腔镜技术行肾盂输尿管切开取石术24例,术前未行其他治疗。结果:24例均取石成功,其中1例5岁患儿改开放手术留置输尿管支架外引流管;手术时间55～210min,平均103min;术中出血量5～30ml,平均17.5ml。术后肠功能恢复时间12～24h,漏尿时间0～3d,日漏尿量0～50ml。术后4d拔除腹膜后引流管;术后住院5～7d;20例获随访2～12个月,患者肾功能均得到改善,无肾盂输尿管狭窄发生。结论:后腹腔镜肾盂输尿管切开取石术具有创伤小、患者康复快、疼痛轻等优点,是微创治疗上尿路结石可选择的方法,对于较大的肾外型肾盂、输尿管上段结石可作为首选的治疗方法。     

Retroperitoneoscopic pyelolithotomy via a posterior approach for large impacted renal pelvic stone

Retroperitoneal laparoscopic pyelolithotomy via a posterior approach was successful in a patient with a large impacted renal pelvic stone. This procedure is beneficial as an alternative to open surgery for stones that cannot be treated by SWL or intracorporeal lithotripsy. This procedure may also be the initial treatment in selected cases.     

Management of lower pole renal calculi: shock wave lithotripsy versus percutaneous nephrolithotomy versus flexible ureteroscopy

Current ureteroscopic intracorporeal lithotripsy devices and stone retrieval technology allow for the treatment of calculi located throughout the intra-renal collecting system. Difficulty accessing lower pole calculi, especially when the holmium laser fiber is utilized, is often encountered. Herein we review our experience where lower pole renal calculi were ureteroscopically managed by holmium laser fragmentation, either in situ, or by first displacing the stone into a less dependent position with the aid of a nitinol stone retrieval device. Lower pole stones less than 20 mm can be primarily treated by ureteroscopic means in patients: that are obese; have a bleeding diathesis; with stones resistant to shockwave lithotripsy (SWL); with complicated intra-renal anatomy; or as a salvage procedure after failed SWL. Lower pole calculi are fragmented with a 200 μm holmium laser fiber via a 7.5 F flexible ureteroscope. For those patients where the laser fiber reduced ureteroscopic deflection, precluding re-entry into the lower pole calyx, a 1.9 F nitinol basket is used to displace the lower pole calculus into a more favorable position, thus allowing for easier fragmentation. A nitinol device passed into the lower pole, through the ureteroscope, for stone displacement cause only a minimal loss of deflection and no significant impact on irrigation. Eighty-five percent of patients were stone free by IVP or CT scan performed at 3 months. Ureteroscopic management of lower pole calculi is a reasonable alternative to SWL or percutaneous nephrolithotomy (PNL) in patients with low volume stone disease. If the stone cannot be fragmented in situ, nitinol basket or grasper retrieval, through a fully deflected ureteroscope, allows for repositioning of the stone into a less dependant position, thus facilitating stone fragmentation.     

微创经皮肾镜取石术治疗孤立肾结石的疗效分析

目的 探讨微创经皮肾取石术(MPCNL)治疗孤立肾结石的临床疗效.方法 2000年8月至2010年8月,242例孤立肾结石患者接受MPCNL治疗.GFR 17～108 ml/min.SCr(108±20)μmol/L,高于正常者19例,平均(181±32)μmol/L.结石位于左侧116例,右侧126例,合并输尿管结石15例.结石大小1.1 cm× 1.8 cm～3.9 cm×5.8 cm. 结果平均手术时间68 min.一期结石清除率79.3%(192/242),残留结石≤4 mm者16例,残留结石5～19 mm者34例.二期MPCNL及ESWL术后1个月复查,结石总清除率88.0%(213/242).术后发热18例,输血21例,因术后严重出血行肾动脉造影及肾出血动脉超选择栓塞治疗10例,肾周血肿1例,气胸1例. 结论 MPCNL治疗孤立肾结石创伤小、并发症少、结石清除率高,应作为孤立肾结石患者的首选治疗方案之一.

Abstract：

Objective To report our experience with minimally invasive percutaneous nephrolithotomy (MPCNL) in treatment of renal calculi in solitary kidneys. Methods From August 2000 to August 2010, 242 patients with renal calculi in solitary kidneys were treated by MPCNL, the data were reviewed retrospectively. Results The mean operative time was 68 min, the clearance rates were 79.3% (192/242) after first session and 88. 0% (213/242) after second-look MPCNL and ESWL, respectively. Postoperative fever happened in 18 cases. Twenty-one cases required transfusion, 10 cases received angiography and embolization. One case experienced perirenal hematoma and 1 case had pneumatothorax. Conclusions MPCNL has the advantages of less bleeding, high clearance rate and short hospital stay. MPCNL is an effective and feasible treatment option for renal calculi in solitary kidneys and should be the first line choice.     

微创经皮肾取石术中肾盂内压测量

目的 探讨微创经皮肾取石术(MPCNL)中肾盂内压测量方法及其意义.方法 通过压力传感器连接逆行置入肾盂的5Fr输尿管导管与Mindray PM9000型监护仪有创压力测量通道,实施经皮肾取石术中肾盂内压测量,增加软件模块后的测压系统每秒采集1次数据,并将数据实时导入计算机数据库.结果 共对112例MPCNL术中肾盂内压进行测量,分析了MPCNL术中肾盂内压的影响因素以及肾盂内压与术后发热的关系.结论 MPCNL术中肾盂内压总趋势小于一般所认为的引起肾实质反流的极限[30 mm Hg(1 mm Hg=0.133 kPa)].任何引起灌注液流出受阻的因素,均可引起肾盂内压增高,术者应该在术中注意调整操作手法,降低肾盂内压.术后发热与MPCNL导致的肾盂内压短暂性增高无明显相关,但总手术时间过长,肾盂内高压状态(≥30 mmHg)累积到一定限度(50 s以上),总平均肾盂内压升高(20 mm Hg以上),将引起术后发热率增加.

Abstract：

Objective To introduce a new method to measure renal pelvic pressure in vivo during minimally invasive percutaneous nephrolithotomy (MPCNL), and investigate its clinical significance.Methods Renal pelvic pressure was measured by baroceptor which was connected to Mindray PM9000 monitor IBP channel and ureteric catheter positioned in renal pelvis during MPCNL, and a computer collected the renal pelvic pressure data each second. Results Renal pelvic pressure was measured in 112 cases during MPCNL, and the influence factors of renal pelvic pressure and its correlation with postoperative fever were analyzed. Conclusion Renal pelvic pressure generally remained lower than a level to back-flow [30 mm Hg(1 mm Hg=0.133 kPa)] during MPCNL. Any factors which brought about a bad drainage would result in a temporal elevated intrapelvic pressure greater than 30 mm Hg. It's necessary for the surgeons to adjust their manipulation to keep a low renal peivic pressure. A spurt high renal pelvic pressure greater than 30 mmHg wouldn't cause a postoperative fever, while a status of renal pelvic pressure greater than 30 mmHg(longer than 50 s) or a mean renal pelvic pressure greater than 20 mmHg all through the procedure may lead to an enough back-flow, resulting in a postoperative fever.     

开放性手术和PCNL在治疗鹿角形肾结石中的应用

目的探讨鹿角形肾结石的手术治疗方式，比较经皮肾穿刺碎石（Percutaneous nephrolithotomy，PCNL）与开放性手术的临床价值。方法回顾分析20例PCNL和15例肾切开取石及肾盏成形术的临床资料，比较两种术式在手术时间、术中出血量、结石清除情况、术后住院时间及并发症发生率等有无差异。结果术前两组对象在性别、年龄、结石大小、肾积水情况方面无明显差异（P〉0．05）；开放手术及PCNL组平均手术时间、平均出血量、术后住院时间分别为：（159.6±29．O）min和（321．9±112．4）min、（262．5±129．0）mL和（149．8±84．1）mL、（9．9±2．7）d和（14．1±3．8）d，差异均具有统计学意义（P〈0．01）；20例PCNL中一次取净结石5例，Ⅰ期结石取净率25％，二次取净结石11例，三次取净结石2例，四次取净结石2例。15例肾切开取石及肾盏成形术中全部一次取净结石，结石取净率100％，两组间有明显差异（P〈0．001）；术中并发症，PCNL组15％（3／20），开放手术组33．33％（5／15），无明显差异（P〉0．05）。结论鹿角形肾结石的手术方式应根据患者的病情及医院的实际情况慎重选择，对复杂性巨大鹿角肾结石较适合用开放性手术治疗。     

微创经皮肾穿刺取石术中肾盂内压变化的临床研究

目的探讨微创经皮肾穿刺取石(MPCNL)术中肾盂内压变化对术后并发症的影响。方法采用逆行置入肾盂5 F输尿管导管连接测压系统,平均灌注流量300 ml/min,平均灌注压191 mm Hg(1 mm Hg=0.1 33 kPa),监测76例不同口径通道下MPCNL术中肾盂内压变化,每秒钟采集一次数据,数据实时导入计算机并作统计学分析。结果14、1 6、18 F单通道以及16 F双通道下MPCNL术中平均肾盂内压分别为24.85、16.23、11.68及5.83 mm Hg,肾盂压力>30 mm Hg平均累积时间分别为283、96、44、10 s,14 F单通道MPCNL术中平均肾盂内压均高于16、18 F单通道(P<0.05)及16 F双通道(P<0.001)。结论不同口径通道下MPCNL术中肾盂内压均较低,小于引起肾实质返流的压力极限(30 mm Hg)。引起灌注液流出受阻因素均可引起肾盂内压明显增高。手术时间过长,肾盂内高压状态累积致使返流达到一定限度可能会引起菌血症。     

逆行肾内手术与经皮肾镜碎石术治疗直径小于1.5cm肾盂结石的疗效比较

目的探讨直径≤1.5 cm的肾盂结石最佳微创治疗方法。方法直径≤1.5 cm肾盂结石90例,其中47例行逆行途径的肾内手术(RIRS),采用输尿管硬镜联合软镜钬激光碎石,43例采用经皮肾镜碎石术(PCNL)。比较分析两种方法治疗结石的手术时间、碎石成功率、术后住院时间和并发症。结果 RIRS组和PCNL组结石平均直径分别为1.2 cm(1.0~1.5 cm)及1.3 cm(1.0~1.5 cm)。RIRS组手术均顺利完成,其中32例手术过程中换用输尿管软镜击碎冲入肾盏的结石。平均手术时间44 min(25~70 min),一期结石清除率达95.74%(45/47),术后发热2例,血红蛋白和红细胞压积轻度下降,血红蛋白平均下降(0.18±0.06)g/L,红细胞压积平均下降0.11%。所有患者均未发生并发症。PCNL组手术均顺利完成,平均手术时间70 min(45~90 min),一期结石清除率达95.35%(41/43),术后发热2例,血红蛋白平均下降(17.25±6.70)g/L,红细胞压积平均下降5.62%。PCNL2例出现明显术中、术后出血。结论对于直径≤1.5 cm的肾盂结石,RIRS组具有良好的清石率,其经自然腔道内镜手术的特点使其创伤小,主要并发症发生率明显低于PCNL,手术时间及住院时间均具有明显优势。对于直径≤1.5 cm的肾盂结石,应首选RIRS手术。     

Management of the staghorn calculus: multiple-tract versus single-tract percutaneous nephrolithotomy

PURPOSE OF REVIEW: Complete removal of stones is crucial for preventing recurrence and morbidity. Currently percutaneous nephrolithotomy is the preferred treatment modality. The debate continues over the use of single tract versus multiple tract percutaneous nephrolithotomy. We review papers on the topic published over the past 12-24 months. RECENT FINDINGS: Articles related to single and multiple tracts were reviewed. We discuss the morbidities, advantages and disadvantages of both the approaches. To decrease the number of tracts few authors have shown the efficacy of flexible ureteroscopy and nephroscopy as an adjuvant procedure. The authors state that this option effectively decreases the disadvantages of multiple tracts, namely blood loss complications, without compromising on stone free rates. SUMMARY: Several techniques have been described for percutaneous access and stone removal, all of them associated with inherent problems. Although feasible, access to all the calices will be difficult through one percutaneous tract because of the peculiarities of the renal collecting system, in which case, multiple-access percutaneous nephrolithotomy is the mainstay of the treatment. The crucial point to understand is that all cases should be dealt with on an individual basis.