Perioperative and long-term results of ultrasonography-guided single-and multiple-tract percutaneous nephrolithotomy for staghorn calculi

BACKGROUND It is possible that this condition will lead to urosepsis and progressive deterioration of renal function in the absence of surgical intervention.Several recent clinical studies have shown that multi-tract percutaneous nephrolithotomy(MPCNL)has a similar stone free rate(SFR)as standard percutaneous nephrolithotomy(S-PCNL).As a result,M-PCNL was also recommended as a treatment option for staghorn calculi.AIM To examine the perioperative and long-term results of ultrasonography-guided single-and M-PCNL.METHODS This was a retrospective cohort study.Between March 2021 and January 2022,the urology department of our hospital selected patients for the treatment of staghorn calculi using percutaneous nephrolithotomy.The primary outcomes were com plication rate and SFR,and the characteristics of patients,operative parameters,laboratory measurements were also collected.RESULTS In total,345 patients were enrolled in the study(186 in the S-PCNL group and 159 in the M-PCNL group).The SFR in the M-PCNL group was significantly higher than that in the S-PCNL group(P=0.033).Moreover,the incidence rates of hydrothorax(P=0.03)and postoperative infection(P=0.012)were higher in the M-PCNL group than in the S-PCNL group.Logistic regression analysis demonstrated that post-operative white blood cell count(OR=2.57,95%CI:1.90-3.47,P<0.001)and stone size(OR=1.59,95%CI:1.27-2.00,P<0.001)were associated with a higher overall complication rate in the S-PCNL group.Body mass index(OR=1.22,95%CI:1.06-1.40,P=0.004)and stone size(OR=1.70,95%CI:1.35-2.15,P<0.001)were associated with increased overall complications in the M-PCNL group.CONCLUSION Multiple access tracts can facilitate higher SFR while slightly increasing the incidence of acceptable complications.

The global,prevalence,and risk factors of postoperative fever after percutaneous nephrolithotomy:A systematic review and meta-analysis

Objective:This study aimed to explore the global,prevalence,and risk factors of fever after percutaneous nephrolithotomy(PCNL)by conducting a systematic review and meta-analysis.Methods:The high-sensitivity searching was conducted without time limitation until December 30,2020 in Web of Sciences,Scopus,and PubMed based on inclusion and exclusion criteria.Results:The prevalence rates of fever and sepsis among patient undergoing PCNL were estimated 9.5%(95%confidence interval[CI]:9.3%-9.7%),and 4.5%(95%CI:4.2%-4.8%),respectively.Nephrostomy tube was used in 9.96%(95%CI:9.94%-9.97%)of patients.The mean preoperative white blood cells of patients were 6.401×109/L;18.3%and 4.55%of patients were considered as the positive urinary culture and pyuria,respectively.About 20.4%of patients suffered from residual stones.The odds ratios(ORs)of fever in patients who suffering from diabetes mellitus,hydronephrosis,staghorn stones,and blood transfusion were 4.62(95%CI:2.95-7.26),1.04(95%CI:0.81-1.34),2.57(95%CI:0.93-7.11),and 2.65(95%CI:1.62-4.35),respectively.Patients who underwent PCNL in prone position were more likely to develop fever(OR:1.23;95%CI:0.75-2.00)than patients in supine position.Conclusion:The current study showed that patients who suffer from diabetes mellitus,hydronephrosis,staghorn stones,nephrostomy tube or double-J stent,blood transfusion,and also patients who underwent PCNL in prone position surgery are more likely to develop a postoperative fever after PCNL.

Metabolic syndrome and the urinary microbiome of patients undergoing percutaneous nephrolithotomy

Objective:To identify possible stone-promoting microbes,we compared the profiles of microbes grown from stones of patients with and without metabolic syndrome(MetS).The association between MetS and urinary stone disease is well established,but the exact pathophysiologic relationship remains unknown.Recent evidence suggests urinary tract dysbiosis may lead to increased nephrolithiasis risk.Methods:At the time of percutaneous nephrolithotomy,bladder urine and stone fragments were collected from patients with and without MetS.Both sample types were subjected to expanded quantitative urine culture(EQUC)and 16 S ribosomal RNA gene sequencing.Results:Fifty-seven patients included 12 controls(21.1%)and 45 MetS patients(78.9%).Both cohorts were similar with respect to demographics and non-MetS comorbidities.No controls had uric acid stone composition.By EQUC,bacteria were detected more frequently in MetS stones(42.2%)compared to controls(8.3%)(p=0.041).Bacteria also were more abundant in stones of MetS patients compared to controls.To validate our EQUC results,we performed 16 S ribosomal RNA gene sequencing.In 12/16(75.0%)sequence-positive stones,EQUC reliably isolated at least one species of the sequenced genera.Bacteria were detected in both“infectious”and“non-infectious”stone compositions.Conclusion:Bacteria are more common and more abundant in MetS stones than control stones.Our findings support a role for bacteria in urinary stone disease for patients with MetS regardless of stone composition.

Predictive factors for percutaneous nephrolithotomy bleeding risks

Objective:This study aimed to identify predictive factors for percutaneous nephrolithotomy(PCNL)bleeding risks.With better risk stratification,bleeding in high-risk patient can be anticipated and facilitates early identification.Methods:A prospective observational study of PCNL performed at our institution was done.All adults with radio-opaque renal stones planned for PCNL were included except those with coagulopathy,planned for additional procedures.Factors including gender,co-morbidities,body mass index,stone burden,puncture site,tract dilatation size,operative position,surgeon's seniority,and operative duration were studied using stepwise multivariate regression analysis to identify the predictive factors associated with higher estimated hemoglobin(Hb)deficiency.Results:Overall,4.86%patients(n=7)received packed cells transfusion.The mean estimated Hb deficiency was 1.3(range 0-6.5)g/dL and the median was 1.0 g/dL.Stepwise multivariate regression analysis revealed that absence of hypertension(p=0.024),puncture site(p=0.027),and operative duration(p=0.023)were significantly associated with higher estimated Hb deficiency.However,the effect sizes are rather small with partial eta-squared of 0.037,0.066,and 0.038,respectively.Observed power obtained was 0.621,0.722,and 0.625,respectively.Other factors studied did not correlate with Hb difference.Conclusion:Hypertension,puncture site,and operative duration have significant impact on estimated Hb deficiency during PCNL.However,the effect size is rather small despite adequate study power obtained.Nonetheless,operative position(supine or prone),puncture number,or tract dilatation size did not correlate with Hb difference.The mainstay of reducing bleeding in PCNL is still meticulous operative technique.Our study findings also suggest that PCNL can be safely done by urology trainees under supervision in suitably selected patient,without increasing risk of bleeding.

Clinical efficacy and safety of flexible ureteroscopy and percutaneous nephrolithotomy for large kidney stones:A retrospective comparative study

BACKGROUND Renal stones ranging 20–40 mm are very common in China.Although no largesample clinical studies have confirmed the clinical efficacy and safety of this method,there is also a lack of comparative data with traditional treatment.AIM To investigate the clinical efficacy of flexible ureteroscopy(FURS)and percutaneous nephrolithotomy(PCNL)by postoperative stone clearance and changes in soluble vascular cell adhesion molecule 1(sVCAM-1)and kidney injury molecule 1(KIM-1)levels in patients with large kidney stones(>2 cm in diameter).METHODS This single-center observational study was performed at a Chinese hospital between January 1,2021,and October 30,2023.All 250 enrolled patients were diagnosed with large kidney stones(>2 cm)and divided into a FURS group(n=145)and a PCNL group(n=105)by the surgical method.The FURS group was treated with flexible ureteroscopy and the PCNL group was treated with percutaneous nephrolithotomy.The operation time,time to palinesthesia,intraoperative blood loss,drop in hemoglobin,length of hospital stay,stone clearance rate,and complications were recorded in the two groups.Preoperative and postoperative serum sVCAM-1 levels,erythrocyte sedimentation rate(ESR),urine KIM-1 levels,preoperative and postoperative pain visual analog scale(VAS)and Wisconsin Stone Quality of Life Questionnaire(WISQOL)scores were also documented.RESULTS All 250 eligible patients completed the follow-up.There were no significant differences in baseline characteristics between the two groups(P>0.05).The operation time in the FURS group was significantly greater than that in the PCNL group.The time to ambulation,intraoperative blood loss,decrease in hemoglobin,and length of hospital stay were significantly lower in the FURS group than in the PCNL group.The FURS group also had a significantly higher stone clearance rate and a lower incidence of postoperative complications.There was no significant difference in antibiotic use between the groups.Postoperative serum sVCAM-1 levels,urine KIM-1 levels,and VAS scores were lower in the FURS group than in the PCNL group,but postoperative ESR and WISQOL scores were greater in the FURS group than in the PCNL group.CONCLUSION FURS demonstrated superior clinical efficacy in treating large kidney stones(>2 cm in diameter)compared PCNL.It not only improved the postoperative stone clearance rate and reduced complications and recovery time but also positively affected serum SCM-1,ESR,and urine KIM-1 levels,subsequent improvement of patient quality of life.

Clinical Application Study of Super-Mini Percutaneous Nephrolithotomy in the Treatment of Kidney Stones

Objective:To observe the clinical efficacy and complication rates of different stone fragmentation techniques in the treatment of kidney stones.Methods:This study selected 100 patients with urinary stones treated at the Third Division General Hospital from 2021 to November 2023 as subjects.The control group(n=50)received conventional percutaneous nephrolithotomy(PCNL)for stone fragmentation,while the research group(n=50)received super-mini percutaneous nephrolithotomy(SMP)treatment.Surgical parameters,stone clearance rates,recurrence rates,and complication rates were compared between the two groups.Results:After treatment,the surgical parameters in the research group were significantly better than those in the control group.The research group had a higher stone clearance rate and lower rates of stone recurrence and complications(P<0.05).Conclusion:Compared with conventional PCNL,SMP shows better clinical outcomes for patients with kidney stones.It improves surgical parameters,increases stone clearance rates,and reduces both stone recurrence and complication rates,making it a valuable technique for clinical reference.

Miniaturization in percutaneous nephrolithotomy:What is new?

Objective:To summarize recent advancements in mini-percutaneous nephrolithotomy(mini-PCNL)in surgical technique,stone removal strategy,lithotripsy,and surgical model from the current literature.Methods:We conducted a narrative review of relevant English-language articles up to October 2022 using the PubMed and Web of Science databases.The following keywords were used in the search:“percutaneous nephrolithotomy”,“minimally invasive percutaneous nephrolithotomy”,“mini-PCNL”,“mini-perc”,“mPCNL”,and“miniaturization”.Results:A series of new progress has been made in many aspects of mini-PCNL,such as further reduction of tract sizedneedle perc and further improvement of robotic-assisted PCNLdartificial intelligence-powered robotic devices.Conclusion:Many studies and trials have been conducted to reduce morbidity and increase the safety and effectiveness of mini-PCNL.It is crucial to realize that miniaturization of PCNL requires not only a smaller percutaneous tract size,but also an adjustment strategically in renal access,stone removal,lithotripsy,and surgical model in general.More large-scale prospective research needs to be carried out to further validate and optimize the safety and effectiveness of mini-PCNL.

Mini versus ultra-mini percutaneous nephrolithotomy in a paediatric population

Objective:To evaluate whether there would be a difference in outcome when the smaller ultra-mini 12 Fr sheath was used instead of the mini 16 Fr sheath for percutaneous nephrolithotomy(PCNL)in paediatric patients for stones less than 25 mm.Methods:This was a prospective cohort study of patients who underwent PCNL in our hospital in a 2-year period from July 2016 to June 2018 by a single surgeon.PCNL was performed in a prone position and tract was dilated to the respective size using single step dilatation.Laser was used to fragment the stone.Stone-free outcome was defined as absence of stone fragment at 3 months on kidney,ureter,and bladder X-ray.Results:There were 40 patients in each group.Mean stone size was comparable between the two groups(14.5 mm vs.15.0 mm).The procedure was completed faster in the 16 Fr group compared to 12 Fr group(24.5 min vs.34.6 min).Stone clearance was highly successful in both groups(97.5%vs.95.0%).There was no difference in complications between the two groups.The decrease in hemoglobin was minimal in both groups(0.2 g/dL vs.0.3 g/dL).Conclusion:We found that the success rates were similar in both mini PCNL and the smaller ultra-mini PCNL groups.No significant difference in bleeding was noted in our pilot study,however,operative time was longer in the ultra-mini group as compared to the mini sheath group.

Reliability of nephrolithometric nomograms in patients treated with minimally invasive percutaneous nephrolithotomy: A precision study

Objectives:The study aimed to evaluate quality of nephrolithometric nomograms to predict stone-free rates(SFRs)and complication rates(CRs)in case of minimally invasive percutaneous nephrolithotomy(PNL).In the last decade,nomograms have been introduced to estimate the SFRs and CRs of PNL.However,no data are available regarding their reliability in case of utilization of miniaturized devices.Herein we present a prospective multicentric study to evaluate reliability of Guy’s stone score(GSS),the stone size,tract length,obstruction,number of involved calyces,and essence of stone(S.T.O.N.E.)nephrolithometry score and Clinical Research Office of the Endourological Society(CROES)score in patients treated with minimally invasive PNL.Methods:We evaluated SFRs and CRs of 222 adult patients treated with miniaturized PNL.Patients were considered stone-free if no residual fragments of any size at post-operative unenhanced computed tomography scan.Patients demographics,SFRs,and CRs were reported and analyzed.Performances of nomograms were evaluated with the area under the curve(AUC).Results:We included 222 patients,the AUCs of GSS,CROES score,and S.T.O.N.E.nephrolithometry score were 0.69(95%confidence interval[CI]0.61-0.78),0.64(95%CI 0.56-0.73),and 0.62(95%CI 0.52-0.71),respectively.Regarding SFRs,at multivariate binomial logistic regression,only the GSS had significance with an odds ratio of 0.53(95%CI 0.31e0.95,p=0.04).We did not find significant correlation with complications,with only a trend for GSS.Conclusion:This is the first study evaluating nomograms in miniaturized PNL.They still show good reliability;however,our data showed lower performances compared to standard PNL.We emphasize the need of further studies to confirm this trend.A dedicated nomogram for minimally invasive PNL may be necessary.

Stone-scoring systems for predicting complications in percutaneous nephrolithotomy:A systematic review of the literature

Objective:Percutaneous nephrolithotomy is a treatment of choice for larger stones of the upper urinary tract.Currently,several nephrolithometric nomograms for prediction of post-operative surgical outcomes have been proposed,although uncertainties still exist regarding their roles in the estimation of complications.Methods:We conducted a systematic review on PubMed and Web of Sciences databases including English studies with at least 100 cases and published between January 2010 and December 2021.We identified original articles evaluating correlations between the Guy’s stone score,the stone size(S),tract length(T),obstruction(O),number of involved calices(N),and essence or stone density(E)(S.T.O.N.E.),Clinical Research Office of the Endourological Society(CROES),and Seoul National University Renal Stone Complexity(S-ReSC)scores and post-operative complications in adult patients.We also included newly designed nomograms for prediction of specific complications.Results:After an initial search of 549 abstracts,we finally included a total of 18 papers.Of them,11 investigated traditional nephrolithometric nomograms,while seven newly designed nomograms were used to predict specific complications.Overall,7316 patients have been involved.In total,14 out of 18 papers are derived from retrospective single-center studies.Guy’s stone score obtained correlation with complications in five,S.T.O.N.E.nephrolithometry score in four,while CROES score and S-ReSC score in three and two,respectively.None of the studies investigated minimally invasive percutaneous nephrolithotomy(PCNL)and all cases have been conducted in prone position.Considering newly designed nomograms,none of them is currently externally validated;five of them predict post-operative infections;the remaining two have been designed for thromboembolic events and urinary leakage.Conclusion:This review presents all nomograms currently available in the PCNL field and highlights a certain number of concerns.Published data have appeared contradictory;more recent tools for prediction of post-operative complications are frequently based on small retrospective cohorts and lack external validations.Heterogeneity among studies has also been noticed.More rigorous validations are advisable in the future,involving larger prospective patients’series and with the comparison of different tools.

A pilot clinical study of developing an External Assist Targeting Device for rapid and precise renal calyx access during percutaneous nephrolithotomy

Objective:To design a device to increase the accuracy of the targeting process and reduce the radiation exposure to both the patients and the medical staff.Methods:We analyzed the inherent problem and designed the External Assist Targeting Device(EATD)to assist in the alignment of needle targeting on the desired renal calyx under fluoroscopic guidance.The EATD was designed to allow rapid and precise access to calyces at all angles,with a simple two-step puncture protocol developed for puncturing a target renal calyx.We then tested the device in a pilot human trial with four patients.Results:In experiments with phantom models,the time for successful targeting was reduced by 31%using the device.The mean fluoroscopic time was reduced by 40%.In initial human trial,the puncture time was shortened by 66%and the radiation dose was decreased by 65%compared to free-hand technique.No complication was observed during the trial.Conclusion:The EATD was found to be cost effective,portable,simple to set up,and safe to operate for assisting in the percutaneous nephrolithotomy procedures.Our preliminary tests showed high degree of accuracy in gaining precise access to a targeted renal calyx with much shorter time and lesser radiation dose.The EATD also has the potential to be used to access other organs with precision under fluoroscopic guidance.

采用自制一体式输尿管肾导管与常规方式行PCNL治疗肾结石的疗效、安全性及患者满意度对比

目的 比较常规经皮肾镜碎石取石术(PCNL)与应用一体式输尿管肾导管的PCNL在治疗肾结石方面的安全性、疗效及患者满意度,为肾结石患者的临床治疗提供参考。方法 回顾性分析2022年4月—2023年5月新疆和田地区人民医院收治的154例肾结石(结石最大径为1.5~3.5 cm)患者资料。根据术中碎石结束后双J管和肾造瘘管的置入方式分为一体式组(应用一体式输尿管肾导管,n=77)和标准组(常规PCNL术式,n=77),比较两组患者的一般特征及术前、术后及随访资料。结果 一体式组和标准组术后住院时间[(5.78±2.50)d vs.(5.29±2.18)d,P=0.193]、术后疼痛评分[(2.22±0.42)分vs.(2.30±0.46)分,P=0.273]、术前及术后血红蛋白的变化值[(-4.13±10.11)g/L vs.(-2.96±9.39)g/L,P=0.459]、住院费用[(17 088.14±2 876.94)元vs.(16 389.74±2 427.37)元,P=0.105]、结石清除率[65(84.4%)vs.66(85.7%),P=0.821]等数据差异均无统计学意义(P>0.05)。术后随访发现一体式组较标准组的不适症状发生率较低[36.4%(28/77)vs.90.9%(70/77),P=0.001],满意度更高(一体式组77例全部满意,标准组中64例满意、13例基本满意)。所有患者均未出现术后脓毒血症及感染性休克,未发生转入重症监护室等情况。结论 一体式输尿管肾导管PCNL和常规PCNL安全性和疗效相当,但一体式组满意度更高,值得临床在把握适应证的情况下选择使用。

Miniaturised percutaneous nephrolithotomy:Its role in the treatment of urolithiasis and our experience

Miniaturized percutaneous nephrolithotomy(PCNL)procedures have gained increased popularity in recent years.They aim to reduce percutaneous tract size in order to lower complication rates,while maintaining high stone-free rates.Recently,miniaturized PCNL techniques have further expanded,and can currently be classified into mini-PCNL,minimally invasive PCNL(MIP),Chinese mini-PCNL(MPCNL),ultra-mini-PCNL(UMP),micro-PCNL,mini-micro-PCNL,and super-mini-PCNL(SMP).However,despite its minimally-invasive nature,its potential superiority in terms of safety and efficacy when compared to conventional PCNL is still under debate.The aim of this review is to summarise different available modalities of miniaturized PCNL,details of instruments involved,and their corresponding safety and efficacy.In particular,this article highlights the role of the SMP and our experience with this novel technique in management of urolithiasis.Overall,miniaturized PCNL techniques appear to be safe and effective alternatives to conventional PCNL for both adult and pediatric patients.Well-designed,randomized studies are required to further investigate and identify specific roles of miniaturized PCNL techniques before considering them as standard rather than alternative procedures to conventional PCNL.

mPCNL与FURL联合治疗完全性铸型肾结石的效果及其对患者机体应激、炎症反应的影响

目的探讨微通道经皮肾镜取石术(mPCNL)与输尿管软镜钬激光碎石术(FURL)联合治疗完全性铸型肾结石的效果及其对患者机体应激、炎症反应的影响。方法将104例完全性铸型肾结石患者随机分为对照组与研究组,每组52例。对照组行mPCNL治疗,研究组行mPCNL与FURL联合治疗。比较2组患者手术一般情况、结石清除率及并发症发生情况;观察2组术前术后肾功能[尿素氮(BUN)、肌酐(SCr)]、氧化应激[皮质醇(Cor)、丙二醛(MDA)、谷胱过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)]、炎症因子[白介素(IL)-6、C反应蛋白(CRP)、降钙素原(PCT)]指标的变化情况。结果与对照组相比,研究组手术时间、住院时间及结石清除率显著增加(P<0.05)。2组术前术后BUN、Scr水平比较差异无统计学意义(P>0.05)。与术前相比,2组术后24、48 h Cor、MDA水平显著升高(P<0.05),GSH-Px、SOD水平显著降低(P<0.05);与对照组术后各时点比较,研究组Cor、MDA水平显著降低(P<0.05),GSH-Px、SOD水平显著升高(P<0.05)。2组术后2 h IL-6水平均较术前显著升高(P<0.05),术后12 h IL-6水平与术前比较差异无统计学意义(P>0.05);研究组术后2 h IL-6水平显著低于对照组(P<0.05)。与术前相比,2组术后2、12 h PCT水平均显著升高(P<0.05);但研究组术后各时点PCT水平显著低于对照组(P<0.05)。与术前相比,2组术后24、48 h CRP水平显著升高;但研究组术后各时点CRP水平显著低于对照组(P<0.05)。结论mPCNL联合FURL治疗完全性铸型肾结石疗效确切,虽然延长了手术时间,但结石清除率显著增加,且不增加患者肾功能及机体应激与炎症反应程度,有利于术后恢复。

Clinical study on the minimally invasive percutaneous nephrolithotomy treatment of upper urinary calculi

BACKGROUND Upper urinary tract stones are very common in my country,with an incidence of 1%to 5%in the North and an even higher incidence of 5%to 10%in the south.The incidence rate in the south is higher than that in the north,mainly due to the water quality,climate and eating habits of the region.From the perspective of sex,incidence is more likely in males than females.In the high-incidence population,young adults are most prone to stones.Men in the age range of 25 to 40 years are more likely to have stones.AIM To observe the therapeutic effect of minimally invasive percutaneous nephrolithotomy(mPCNL)on upper urinary tract stones and its influence on the renal function of patients.METHODS Patients with upper urinary tract stones who were treated in our hospital from February 2017 to March 2018 were selected as research subjects and were divided into the PCNL group and the mPCNL group according to the random number table method.The general conditions of the two groups of patients were observed during the perioperative period,and the differences in stone clearance,pain,renal function indicators and complication rates were compared between the two groups to determine which were statistically significant(P<0.05).RESULTS The operation time of the mPCNL group was longer than that of the PCNL group(t=-34.392,P<0.001),and the intraoperative blood loss of the mPCNL group was more than that of the PCNL group(t=34.090,P<0.001).There was no difference in renal function indices between the two groups of patients before treatment,and there was no difference in the levels of serum creatinine,β2 microglobulin or retinol binding protein in the mPCNL group after treatment.The visual analog scale score of patients in the mPCNL group was lower than that of the PCNL group(t=12.191,P<0.001),and there was no significant difference in the stone clearance rate between the two groups(χ2 value=1.013,P=0.314).There was no significant difference in the incidence of urine extravasation,dyspnea and peripheral organ damage between the two groups(χ2 value=1.053,P=0.305).At 1 mo after treatment and 3 mo after treatment,the quality of life of the mPCNL group was lower than that of the PCNL group,and the Qmax level of the mPCNL group was higher than that of the PCNL group.CONCLUSION mPCNL has a good therapeutic effect on upper urinary tract stones,with a high stone clearance rate without causing kidney damage or increasing the incidence of complications,and thus has good application value.

mPNL、SPCNL及FURL治疗2~3 cm肾结石临床效果比较及对免疫功能与应激反应的影响

目的探讨应用微通道经皮肾镜取石术(Micro-channel Percutaneous Nephrolithotomy,mPNL)、标准通道经皮肾镜取石术(Standard Channel Percutaneous Nephrolithotomy,SPCNL)、输尿管软镜碎石取石术(Flexible Ureteral Lithotripsy,FURL)3种不同方式治疗2~3 cm肾结石效果及对免疫功能、应激反应影响。方法选择2022年9月—2023年9月南京市江宁医院收治的120例肾结石者为研究对象,根据手术方式分成甲组(mPNL)、乙组(SPCNL)、丙组(FURL),各40例。比较3组患者一期结石清除率、手术前后免疫功能、应激反应及术后并发症发生情况。结果3组患者一期结石清除率比较,差异无统计学意义(P>0.05)。术后3 d各组患者CD4+、CD4+/CD8+比值较术前降低,且丙组均高于甲、乙两组;术后3 d各组患者CD8+较术前升高,且丙组低于甲、乙两组,差异有统计学意义(P均<0.05)。术中3组的血管紧张素I、去甲肾上腺素水平较术前升高,术后较术中下降;而丙组术中、术后的血管紧张素I、去甲肾上腺素水平均低于甲、乙两组,差异有统计学意义(P均<0.05)。丙组并发症总发生率最低,但3组对比差异无统计学意义(P>0.05)。结论相对比mPNL、SPCNL,采取FURL治疗肾结石效果更好,可减轻对机体免疫功能及应激反应影响,术后并发症较少。

PCNL对复杂型肾结石患者结石清除情况、手术相关指标及并发症的影响分析

目的:分析经皮肾镜取石术(PCNL)对复杂型肾结石患者结石清除情况、手术相关指标及并发症的影响。方法:选取2023年1—12月咸宁市第一人民医院收治的80例复杂型肾结石患者作为研究对象,按数字随机分组法分为试验组和对照组,每组各40例。对照组患者采用输尿管软镜下钬激光碎石术治疗,试验组患者采用PCNL治疗。对比两组患者手术相关指标[碎石时间、血红蛋白(HB)水平下降值、术中出血量、住院时间]、并发症(血尿、尿瘘、发热、尿路感染、肾周损伤)发生率、一期结石清除率、二期手术率以及炎症水平、肾功能水平改善情况。结果:两组患者碎石时间比较,差异无统计学意义(P>0.05)。试验组患者住院时间短于对照组,差异有统计学意义(P<0.05)。试验组患者Hb水平下降值、术中出血量低于对照组,差异有统计学意义(P<0.05)。手术后,试验组患者各项炎症指标、肾功能水平均低于对照组,差异有统计学意义(P<0.05)。试验组患者术后血尿、尿瘘、发热、尿路感染、肾周损伤等并发症发生率均低于对照组,差异有统计学意义(P<0.05)。试验组一期结石清除率高于对照组,二期手术率低于对照组,差异有统计学意义(P<0.05)。结论:PCNL能有效提高复杂型肾结石患者结石清除率,有利于降低术中出血量和并发症发生率,缩短患者住院时间,促进患者炎症水平和肾功能水平改善。

多通道统一穿刺PCNL和多通道先后穿刺PCNL治疗复杂性多发肾结石的效果

目的:观察多通道统一穿刺经皮肾镜取石术(PCNL)和多通道先后穿刺PCNL治疗复杂性多发肾结石的效果。方法:选取2019年11月—2022年11月庆阳市人民医院泌尿外科收治的80例复杂性多发肾结石患者作为研究对象。根据红蓝双色球法随机将其分为常规组(n=40)和观察组(n=40)。常规组给予多通道先后穿刺PCNL,观察组给予多通道统一穿刺PCNL。比较两组结石清除率,围手术期指标及疼痛程度,并发症。结果:观察组结石清除率为90.00%,高于常规组的70.00%,差异有统计学意义(P<0.05)。两组术中出血量、手术时间、术后12 h视觉模拟评分法(VAS)评分、住院时间比较,差异无统计学意义(P>0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:多通道统一穿刺PCNL治疗能够显著提高结石清除效果,避免结石残留。

PCNL术后发生SIRS的危险因素分析

目的:探讨经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)术后发生全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)的危险因素,为制订防治SIRS发生的方案提供参考。方法:回顾性分析2019年1月—2020年12月于南通大学附属常熟医院行PCNL 97例患者的临床资料。根据术后是否出现SIRS,分为SIRS组和非SIRS组。比较两组患者性别、年龄、BMI、高血压病、糖尿病、术前尿WBC、肾周脂肪条索影(perirenal fat stranding,PFS)、结石长径、手术通道、手术时间的差异。使用多因素Logistic回归分析SIRS发生的危险因素。结果:两组患者性别、年龄、BMI、高血压病、糖尿病、结石长径、手术通道、手术时间差异均无统计学意义(均P>0.05);术前尿WBC、PFS差异有统计学意义(P<0.05)。纳入BMI、糖尿病、术前尿WBC、PFS、手术通道和手术时间行多因素Logistic回归分析显示,术前尿WBC阳性、存在PFS是SIRS发生的独立危险因素(P<0.05)。结论:PCNL术后发生SIRS和术前尿WBC阳性、存在PFS相关,关注术前尿WBC和PFS,必要时给予充分的抗感染治疗可能是减少SIRS发生的重要措施。

贵州基层医院泌尿外科医生接受PCNL手把手培训后工作开展情况及影响因素的分析

目的调查贵州基层医院泌尿外科医生接受经皮肾镜碎石取石术(PCNL)手把手培训后的开展情况,并分析其相关影响因素。方法选取接受贵州省人民医院泌尿外科PCNL培训的76名医生进行问卷调查,受训医生来自30所贵州基层医院,观察21所医疗机构开展PCNL的工作情况。比较分析受训时间、受训期间PCNL例数、所在医疗机构级别和科室床位数等因素对受训医生后续PCNL工作开展情况的影响。结果共回收有效问卷73份(96.1%),73人中每月开展PCNL例数<4例的医生49人,例数≥4例的医生24人。与开展PCNL例数<4例/月的医生相比,开展PCNL≥4例/月的医生所在科室能够完成PCNL的医生人数更多,受训医生评估肾穿刺成功率≥90%的比例和掌握经尿道输尿管镜碎石术的比例均显著提高(P<0.05)。此外,已独立成立泌尿外科且床位数较多,以及县城人口数基数较大是开展PCNL的促进因素。结论影响受训基层泌尿外科医生开展PCNL的主要因素是个人操作能力、PCNL病例数量、医院和科室的支持,促进因素是所在县城的经济GDP、县城人口数和科室床位数。