The clinical study of percutaneous nephrolithotomy combined with retrograde flexible ureteroseopic lithotripsy in the prone split-leg position for treating renal staghorn calculi

doi:10.3877/cma.j.issn.1674-3253.2020.04.003

Abstract

Abstract:

Objective

Investigate the feasibility, efficacy and safety of percutaneous nephrolithotomy (PCNL) combined with retrograde intrarenal surgery (RIRS) in the treatment of renal staghorn calculi in split-leg prone position.

Methods

The clinical data of 93 patients with renal staghorn calculi in our hospital from August 2015 to August 2019 were retrospectively analyzed. 50 patients in the PCNL group received PCNL surgery only, and 43 patients in the PCNL+RIRS group received PCNL combined with RIRS surgery. The preoperative renal calculus was evaluated by the S.T.O.N.E scoring system. Both groups were inserted into the ureteral stents (getting rid of the head end) in the lithotomy position, then the PCNL group was changed to prone position for PCNL surgery, and the PCNL+RIRS group was changed to split-leg prone position. Operation time, postoperative hemoglobin decline, postoperative fever rate, reoperation rate, stone clearance rate, postoperative hospital stay and complications were compared between the two groups.

Results

There was no significant difference in preoperative basic data between the two groups. The procedure was successfully performed in all the patients, and the channels which were needed to be established in the PCNL+RIRS group were significantly less than that in the PCNL group. The PCNL+RIRS group have the advantage over the PCNL group in terms of decreased hemoglobin, stone clearance rate, reoperation rate and average hospital stay. Although there was no statistical difference in the operation time, postoperative fever rate and complications between the two groups, there was 1 patient in the PCNL group who needed embolization intervention because of bleeding. In addition, the ratio of postoperative fever in the PCNL group was higher than that in the PCNL+RIRS group, but no statistical difference was found. That may be attributed to the small number of cases in this study.

Conclusions

Percutaneous nephrolithotomy (PCNL) combined with retrograde intrarenal surgery (RIRS) in split-leg prone position is safe and effective for the treatment of renal staghorn calculi, which can reduce the channels and intraoperative bleeding, improve stone clearance rate and reduce reoperation rate.

Key words: Renal staghorn calculi, PCNL, RIRS, Split-leg prone position, PCNL combined RIRS

Guoping Lu, Kecheng Liao, Zhifu Zhang. The clinical study of percutaneous nephrolithotomy combined with retrograde flexible ureteroseopic lithotripsy in the prone split-leg position for treating renal staghorn calculi[J]. Chinese Journal of Endourology(Electronic Edition), 2020, 14(04): 249-253.

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References 15

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组别	例数	性别（例）		年龄（岁，±s）	BMI（kg/m²，±s）	侧别（例）		结石累及肾盏数量（个，±s）
组别	例数	男	女	年龄（岁，±s）	BMI（kg/m²，±s）	左侧	右侧	结石累及肾盏数量（个，±s）
PCNL组	50	27	23	55.3±11.4	24.1±2.8	29	21	2.6±0.6
PCNL+RIRS组	43	21	22	54.7±12.1	23.8±2.5	19	24	2.7±0.8
统计值	?	χ²=0.247		t=0.246	t=0.501	χ²=1.766		t=0.492
P值	?	0.619		0.806	0.618	0.184		0.624
?	S.T.O.N.E评分	结石最大横截面积（mm²）	糖尿病史[例（%）]	高血压史[例（%）]	手术史[例（%）]
PCNL组	9.6±1.2	857±135	5（10.0）	8（16.0）	3（6.0）
PCNL+RIRS组	9.4±1.5	891±170	5（11.6）	6（14.0）	4（9.3）
统计值	t=0.795	t=1.091	χ²=0.000	χ²=0.076	-
P值	0.434	0.278	1.000	0.783	0.700^a

组别	例数	性别（例）		年龄（岁，±s）	BMI（kg/m²，±s）	侧别（例）		结石累及肾盏数量（个，±s）
组别	例数	男	女	年龄（岁，±s）	BMI（kg/m²，±s）	左侧	右侧	结石累及肾盏数量（个，±s）
PCNL组	50	27	23	55.3±11.4	24.1±2.8	29	21	2.6±0.6
PCNL+RIRS组	43	21	22	54.7±12.1	23.8±2.5	19	24	2.7±0.8
统计值	?	χ²=0.247		t=0.246	t=0.501	χ²=1.766		t=0.492
P值	?	0.619		0.806	0.618	0.184		0.624
?	S.T.O.N.E评分	结石最大横截面积（mm²）	糖尿病史[例（%）]	高血压史[例（%）]	手术史[例（%）]
PCNL组	9.6±1.2	857±135	5（10.0）	8（16.0）	3（6.0）
PCNL+RIRS组	9.4±1.5	891±170	5（11.6）	6（14.0）	4（9.3）
统计值	t=0.795	t=1.091	χ²=0.000	χ²=0.076	-
P值	0.434	0.278	1.000	0.783	0.700^a

组别	例数	通道数量（例）			手术时间（min，±s）	血红蛋白下降值（g/L，±s）	结石清除率[例（%）]	再次手术率[例（%）]
组别	例数	3个	2个	1个	手术时间（min，±s）	血红蛋白下降值（g/L，±s）	结石清除率[例（%）]	再次手术率[例（%）]
PCNL组	50	7	40	3	97±26	24.6±3.1	34（68.0）	11（22.0）
PCNL+RIRS组	43	0	6	37	105±24	13.1±2.0	38（88.4）	3（7.0）
统计值	?	χ²=-7.599			t=1.428	t=20.868	χ²=5.488	χ²=4.080
P值	?	<0.001			0.156	<0.001	0.019	0.043
组别	例数	术后发热[例（%）]	术后平均住院天数（d，±s）	Clavien-Dindo分级[例（%）]
组别	例数	术后发热[例（%）]	术后平均住院天数（d，±s）	无并发症^b	Ⅰ级	Ⅱ级	Ⅲ级
PCNL组	50	7（14.0）	7.2±2.3	40（80.0）	7（14.0）	2（4.0）	1（2.0）
PCNL+RIRS组	43	2（4.7）	6.1±1.5	39（90.7）	3（7.0）	1（2.3）	0
统计值	?	-	t=2.680	Z=-1.445
P值	?	0.170^a	0.009	0.148

组别	例数	通道数量（例）			手术时间（min，±s）	血红蛋白下降值（g/L，±s）	结石清除率[例（%）]	再次手术率[例（%）]
组别	例数	3个	2个	1个	手术时间（min，±s）	血红蛋白下降值（g/L，±s）	结石清除率[例（%）]	再次手术率[例（%）]
PCNL组	50	7	40	3	97±26	24.6±3.1	34（68.0）	11（22.0）
PCNL+RIRS组	43	0	6	37	105±24	13.1±2.0	38（88.4）	3（7.0）
统计值	?	χ²=-7.599			t=1.428	t=20.868	χ²=5.488	χ²=4.080
P值	?	<0.001			0.156	<0.001	0.019	0.043
组别	例数	术后发热[例（%）]	术后平均住院天数（d，±s）	Clavien-Dindo分级[例（%）]
组别	例数	术后发热[例（%）]	术后平均住院天数（d，±s）	无并发症^b	Ⅰ级	Ⅱ级	Ⅲ级
PCNL组	50	7（14.0）	7.2±2.3	40（80.0）	7（14.0）	2（4.0）	1（2.0）
PCNL+RIRS组	43	2（4.7）	6.1±1.5	39（90.7）	3（7.0）	1（2.3）	0
统计值	?	-	t=2.680	Z=-1.445
P值	?	0.170^a	0.009	0.148

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