经皮肾镜取石术的预后及并发症

来源 ：公众号柳叶新潮

Outcome and Clinical Complications of Percutaneous Nephrolithotomy

作者：Amador Robayna A., Falcón Barroso J., Fumero Arteaga S., Carrión Valencia A., Orribo Morales N., Ballesta Martínez B., Monllor Gisbert J.

原载：European Urology Supplement 2017.11

INTRODUCTION & OBJECTIVES:  

Percutaneous nephrolithotomy (PCNL) is considered the first-line treatment for large and complex renal stones, it is considered a minimally invasive technique by the hand of the improvements in the instruments and the minitualization of the same, anyway produces an aggression on the renal parenchyma. Analyze the clinical repercussion to percutaneous nephrolithotomy in our early learning curve. Evaluate the composition of renal lithiasis in our environment.

简介与目的：  

经皮肾镜取石术（PCNL）被认为是大型及复杂型肾结石的一线疗法，借助于器械与微创技术的发展，PCNL被认为是一项微创术式，尽管它仍旧会侵及肾实质。本文旨在分析早期学习曲线中的PCNL的临床响应。并在此环境下对肾结石的成分进行了评估。

MATERIAL & METHODS:  

We conducted a prospective observational study since the beginning of percutaneous nephrolithotomy in our center from August 2014 to November 2016. We studied demographic variables, comorbidities and analytical data. We analyzed the data with non-parametric tests using SPSS program.

材料与方法：  

本中心于2014年8月引入PCNL技术，本次前瞻性观察研究截止于2016年11月。我们对人口统计学参数、共患病及分析数据进行了研究。借助于SPSS程序，我们采用非参数检验法对数据进行了分析。

RESULTS:  

In this period 20 PCNL were performed in our center, all in a supine position. The distribution by sex was 55% male (N = 11) and 45% female (N = 9) with a mean age of 50 years (SD 9.7). In the co-morbidities we observed a mean BMI of 29 (SD 4), an anesthetic risk (ASA) of 2 in 65% of the sample (range 1-3) and a mean Charlson comorbidity index of 2 (range 0-5). Fifty-five percent of patients received at least one ESWL session before or after perform PNL. Analysis of renal function using the Wilcoxon test shows no variation in creatinemia after PCNL (p = 0.791). In the analysis of bleeding, the Friedman two-dimensional test was applied, which showed that the bleeding of the patients treated with PNL had repercussions on the blood count (p <0.05), however there was no hemodynamic impact of the same and only one patient (5%) required a blood transfusion. 95% (n = 19) of the patients left the operating room with the urinary diversion through nephrostomy and ureteral catheter and only one patient left without ureteral drainage. The composition of the stones was calcium oxalate in 55% (n = 11, 30% of mixtures with calcium phosphate), uric acid in 20% (n = 4), ammonium magnesium phosphate in 20% (n = 4) and 5% to calcium phospate (n = 1).

结果：  

在此期间，本中心行PCNL共计20例，均采取仰卧位。分布情况为男性占比55%（11例），女性占比45%（9例），平均年龄为50岁（SD 9.7）。在共患病方面，平均BMI为29（SD 4），65%的患者的麻醉风险（ASA）等级为2（范围为1-3），平均查尔森合并症指数为2（范围为0-5）。55%的患者策在PNL前后接受过至少一次ESWL。对肾功能进行Wilcoxon检验后发现肌酸酐在PCNL前后并未发生变化（p=0.791）。采用Friedman二维检验法进行出血分析后发现，接受PNL患者的出血量会对血细胞计数产生响应（p＜0.05），但未对血代动力学造成影响，仅1例患者（5%）需要接受数学。95%（n=19）的患者在离开手术室前通过肾造瘘术接受了尿流改道（肾造瘘术）或被植入输尿管导管，仅1例患者无需接受输尿管引流。在结石成分方面，草酸钙占比55%（n=11，其中30%还混杂有磷酸钙），尿酸占比20%（n=4），磷酸镁铵占比20%（n=4），磷酸钙占比5%（n=1）。

CONCLUSIONS:  

In our short serie, we observed that PCNL does not affect the renal function of the patients, we confirm it is procedure with a statistically significant variation in the numbers of the red blood cell series, but only 5% of the cases have a hemodynamic repercussion.

结论：  

在此次简短的病例分析中，我们发现，PCNL未对患者的肾功能产生影响，并证实该术式引发红细胞数量的显著变化，但仅有5%的患者表现出了血代动力学响应。

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