Percutaneous Nephrolithotomy for Staghorn Stones in Patients with Solitary Kidney in Prone Position or in completely Supine Position: a Single-center Experience

PurposeTo evaluate the effectivity and safety of percutaneous nephrolithotomy (PCNL) in the treatment of solitary kidney with staghorn stones in prone position or in completely supine position.Materials and methodsWe retrospectively reviewed the records of 18 patients with staghorn stones in a solitary kidney treated with PCNL. 12 patients underwent PCNL in prone position (group A). 6 patients underwent PCNL in completely supine position (group B). Demographic data, number of accesses, operating time, stone free rate, hemoglobin values, hospital stay and complications were studied. Serum creatinine, systolic and diastolic blood pressure, and new onset hypertension were determined preoperatively and postoperatively at 3 months.ResultsNo blood transfusions were required and no abdominal or thoracic organ injuries were reported in both groups. The mean operative time was 104 minutes (range:72-145 minutes) and 128 minutes (range:80-170 minutes), respectively. The I stage stone free rate was 91.7% and 83.3%, respectively. There was no new onset hypertension by the end of follow-up in both groups. Both groups showed a similar fall in serum creatinine at 3 month follow-up period (p = 0.004 and 0.029, respectively). Systolic blood pressure showed a statistically significant improvement in group B (p = 0.034).ConclusionPCNL is safe and has an acceptably high stone free rate in patients with solitary kidneys in both prone and completely supine position. At short-term follow-up, systolic blood pressure had improved in PCNL in supine position.

研究目的：本研究旨在评估经皮肾镜碎石术（percutaneous nephrolithotomy, PCNL）分别采用俯卧位与完全仰卧位时，治疗孤立肾鹿角形结石的有效性与安全性。
材料与方法：本研究回顾性分析18例接受PCNL治疗的孤立肾鹿角形结石患者的临床病历资料。其中12例患者采用俯卧位行PCNL（A组），剩余6例采用完全仰卧位行PCNL（B组）。本研究收集并分析两组患者的人口学特征、穿刺通道数量、手术时长、结石清除率、血红蛋白水平、住院时长及并发症发生情况。分别于术前及术后3个月检测两组患者的血清肌酐水平、收缩压与舒张压，并记录新发高血压的发生情况。
结果：两组患者均未出现需输血的情况，亦未发生腹腔或胸腔脏器损伤事件。A组与B组的平均手术时长分别为104分钟（范围：72~145分钟）与128分钟（范围：80~170分钟）。一期结石清除率分别为91.7%与83.3%。随访期末，两组均未出现新发高血压病例。术后3个月随访时，两组患者的血清肌酐水平均出现相似程度的下降（分别对应p=0.004与p=0.029）。B组患者的收缩压改善情况具有统计学意义（p=0.034）。
结论：无论是采用俯卧位还是完全仰卧位，PCNL用于孤立肾鹿角形结石患者的治疗时均具备良好的安全性，且结石清除率处于可接受的较高水平。短期随访结果显示，采用完全仰卧位行PCNL的患者收缩压得到显著改善。