ABSTRACT
Objective To analyze the clinical indications,efficacy and safety of Chinese minimally invasive percutaneous nephrolithotomy (MPCNL) in treating upper urinary calculi based on our experience.Methods From June 1992 to September 2010,a total of 10,452 patients (6060 males and 4392 females)with a mean age of (47.6 ± 13.7) years (7 months-93 years) received MPCNL in our center.The mean stone burden was (777.4 ± 740.3) mm2 (20 - 4 080 mm2 ).The data of stone burden,operative techniques,operating time,stone-free rate,major complication,hospital stay and stone composition were investigated. Results Of the 10 452 cases,11 801 procedures were performed on 10 876 (5493 left and 5383right) renal units,including 10 102 first stage procedures,1604 secondary procedures,86 third procedures and 9 fourth procedures.There were 11 830 tracts established,including 373 (3.15％ ) tracts of 14 F,7867 (66.50％) tracts of 16 F and 3590 (30.35％) tracts of 18 F.There were 1207 (10.20％),9174(77.55％) and 1449 (12.25％) punctures located in upper,middle and lower pole,respectively.956(8.79％) renal units were managed with multiple tracts,which including 2 tracts in 846 (7.78％) units,3tracts in 85 (0.78％) units,4 tracts in 18 (0.17％) units and 5 tracts in 7 (0.06％) units.Pneumatic lithotripsy was used in 8563 (72.56％) procedures,Holmium:YAG laser lithotripsy was used in 2981(25.26％) procedures and Pneumatic lithotripsy + Holmium: YAG laser lithotripsy was used in 257(2.18％) procedures.762 (7.29％) cases needed ESWL to clean the stone after MPCNL.The average operating time was ( 101.3 ± 44.2) min ( 10 -240 min).The stone-free rate of MPCNL was 89.9％,which increased to 93％ by adjunctive ESWL.And the mean hospital stay was ( 13.2 ± 6.4) days (2 - 72 days).The major complications happened on 321 (3.07％) cases,including 294 (2.81％ ) cases of blood transfusion,12 (0.11％ ) cases of sepsis,2 (0.02％) cases of renal abscess,9 (0.09％) cases of pleura injury,2 (0.02％) cases of colon injury and 2 (0.02％) cases of death.53 (0.51％) cases needed selective renal arterial embolization to achieve hemostasis.The main stone compositions were analyzed in 4345 cases.Calcium oxalate,calcium phosphate,magnesium ammonium phosphate,uric acid,ammonium urate,carbapatite and cystin were 91.74％,90.33％,14.91％,17.77％,4.83％,8.47％ and 0.51％,respectively. Conclusions MPCNL is an effective and safe treatment option for all kinds of upper urinary calculi in patients at all ages with a high stone free rate and low major complication rate.
ABSTRACT
Objective To investigate the treatment of hemorrhage after mini-percutaneous nephrolithotomy. Method From February 2001 to May 2006, 20 clinical data of severe bleeding were retrospectively analysed in 3910 cases of mini-percutaneous nephrolithotomy in treatment of upper urinary calculi. Results In 20 cases, 19 were successfully treated, in which 2 patients can be treated with expectant treatment (transfusion and catheter compression), 16 cases were rendered with super-selective arterial embolization;1 case with nephrectomy;1 case wsa suffered from DIC and died. Conclusions The most familiar complication of mini-percutaneous nephrolithotomy is bleeding. If only be more carefully and try the right way in time, the safety of the operation must be increased.
ABSTRACT
Objective To assess the safety and feasibility of minimally invasive percutaneous nephrolithotomy(mPCNL) in the treatment of solitary kidney calculi.Method Thirty-eight patients with solitary kidney calculi,treated with mPCNL from Jan 1998 to May 2004,were retrospectively investigated.Results Of 38 cases,there was 6 cases with pyonephrosis and 32 cases with the treatment of one stage percutaneous nephrolithotomy.With the treatment of 1 to 3 tract was used for calculus removed in all cases,a total of 86% stone-free rate was achieved.Only one case with pyonephrosis suffered from postoperative infection shock while one stage minimally invasive percutaneous nephrolithotomy was performed.Another one patient with diabetes suffered from postoperative ketoacidosis and no major complications were noted in other patients.Conclusion Minimally invasive percutaneous nephrolithotomy is safe and effective in the treatment of solitary kidney calculi.