The safety and efficacy of ultrasound guided combined needle-perc and standard percutaneous nephrolithotomy in the treatment of staghorn stone
10.3760/cma.j.issn.1000-6702.2020.01.007
- VernacularTitle: 超声引导下针状肾镜联合标准通道PCNL治疗鹿角形结石的安全性和有效性
- Author:
Boxing SU
1
;
Bo XIAO
;
Weiguo HU
;
Chaoyue JI
;
Yuzhe TANG
;
Meng FU
;
Song CHEN
;
Jianxing LI
Author Information
1. Department of Urology, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing 102218, China
- Publication Type:Clinical Trail
- Keywords:
Kidney calculi;
Ultrasound guidance;
Staghorn stone;
Percutaneous nephrolithotomy;
Needle-perc
- From:
Chinese Journal of Urology
2020;41(1):37-40
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize our preliminary clinical experience of ultrasound-guided needle-perc combined with standard percutaneous nephrolithotomy (PCNL) in the treatment of staghorn stones, and to analyze its safety and efficacy.
Methods:The clinical data of 65 patients with staghorn stones treated by ultrasound-guided needle-perc combined with standard PCNL under general anesthesia with the patient in prone position from December 2017 to June 2019 were retrospectively reviewed. A total of 41 males and 24 females were included. The mean age was (53.5+ 8.9) years. The mean body mass index (BMI) was (25.1±2.9) kg/m2, and the mean stone diameter was (10.9±3.1) cm. Among them, there were 3 cases with bilateral staghorn stones, 38 cases with complete staghorn calculi, 36 cases with non- or mild preoperative hydronephrosis, 12 cases with previous ipsilateral renal surgery, and 9 cases with solitary kidneys. Ultrasound-guided renal access and tract dilation were used to establish F24 standard channel. Pneumatic combined with ultrasonic lithotripsy with suction system was used to treat staghorn stones under nephroscope. Needle-perc consists of F4.2 needle-like metal sheath connected with a three-way tube. A 0.6 mm diameter video fiber, 200 um holmium laser fiber and liquid perfusion device can be connected through the three-way tube respectively. The residual stone in the parallel calyx after standard PCNL were punctured by needle-perc under ultrasound guidance, and then the holmium laser fiber was used for lithotripsy.
Results:In this study, a total of 68 renal units were included. The median operative time was 79.8 minutes, ranging 45-129 minutes. The median decrease of hemoglobin on postoperative day 1 was 10.6 g/L, ranging 0-25.9 g/L. The median length of postoperative hospital stay was 5.5 days, ranging 4-7 days and the median time of tract establishment was 4.8 minutes, ranging 2.5-9.6 minutes. The median number of standard tract established was 1.5, ranging 1-3 and the median number of needle-perc punctured was 1.0, ranging 1-3. The total complication rate was 10.3% (7 cases), including 5 cases of Clavien grade Ⅰ, 2 cases of postoperative fever, 3 cases of analgesic use. There were 2 cases of Clavien grade Ⅱ. All of them were blood transfusion. The initial stone free rate was 79.4%(54/68). Of the 14 patients with residual stones, 9 patients underwent second-stage operation, 7 patients were stone free, and the final stone free rate was 89.7%(61/68).
Conclusions:Ultrasound-guided needle-perc combined with standard PCNL is safe and effective in the treatment of staghorn stone.
