开放手术或体外冲击波碎石术失败的患者再次行经皮肾镜取石术的手术效果

Percutaneous nephrolithotomy success rate and complications in patients with previous open stone surgery and unsuccessful extracorporeal shockwave lithotripsy

目的探讨既往行肾开放手术或体外冲击波碎石术(ESWL)失败的患者同侧再次行经皮肾镜取石术(PCNL)的手术效果。方法回顾性分析2005年-2014年1 201例曾在该科行PCNL术患者的临床资料。1 201例患者中,既往无ESWL也无肾开放手术史的683例(56.9%)患者为第1组。同侧行ESWL失败的302例患者(25.1%)为第2组,216例(18.0%)同侧曾行肾脏开放手术的患者为第3组。比较3组间患者的一般资料、手术持续时间、结石清石率(SFR),建立进入集合系统通道的个数,术中和术后并发症间是否存在差异。结果 3组间在性别、体质指数(BMI)、结石大小和位置间差异无统计学意义。第1组手术时间明显缩短(P=0.000),第2和第3组间手术持续时间差异无统计学意义(P>0.05)。建立进入集合系统通道个数方面,第1组明显少于其他两组(P=0.000)。3组间在住院时间、SFR和术中和术后并发症之间差异无统计学意义。结论研究表明对于曾经行肾开放取石或ESWL碎石失败的肾结石患者再次行PCNL是安全有效的,其手术成功率和未行开放手术和体外碎石的患者相近。

Objective To evaluated the effects of percutaneous nephrolithotomy （PCNL） in treatment of patients once received open renal surgery or failed to taken extracorporeal shockwave lithotripsy （ESWL）. Methods Clinical data of 1201 patients who had been underwent PCNL from 2005 to 2014 by the same surgeon. 683 patients （56.9%） of them without a history of ESWL or open renal surgery as group Ⅰ ; 302 patients （25.1 %） with a history of failed ESWL on the same side were categorized as group Ⅱ , the remaining 216 （18.0 %） who had once received open renal surgery on the same kidney were categorized as group Ⅲ. Then compare the operation duration, stone free rate （SFR）, number of attempts to access the collecting system and intraoperative and postoperative complications among the three groups. Results There were no differences in sex, body mass index, stone burden and laterality among the three groups. Operation time was signifcantly shorter in the frst group （P = 0.000） while there was no statistically differences in operation duration between the second and the third group （P 〉 0.05）. The number of attempts to enter the collecting system was signifcantly lower in the frst group compared to the other two groups （P = 0.000）. There has no signifcant differences among the three groups in hospital stay, SFR, intraoperative and postoperative complications. Conclusion The study clearly demonstrates that PCNL with standard technique can be performed safely in patients with a history of open nephrolithotomy or ESWL without a higher risk of complications and with a success rate similar to that of PCNL in patients with no previous intervention.