在ECIRS和美国指导的卧式PCNL时代,谁还需要多个访问站点?
Ziv Savin1, Adam Daniel Geffner2, Eve Frangopoulos3
1Department of Urology, Icahn School of Medicine at Mount Sinai, 424 W. 59th Street,Suite 4F, NY, New York, 10019, USA. zivsavin23@gmail.com.
World journal of urology
|January 17, 2026
概括
通过皮肤进行多次切入的瘤切除术 (PCNL) 在较新的技术中并不常见. 石头总负担是最主要的预测因素,在微创手术过程中需要多个通道.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 最少侵入性的手术
背景情况:
- 多次访问PCNL通常用于大型复杂的结石,并具有更高的并发症率.
- 像内镜联合内手术 (ECIRS) 和超声波 (美国) 引导的卧床PCNL等新技术旨在降低发病率.
- 确定多个接入通道的术前预测因素对于优化这些程序至关重要.
研究的目的:
- 在ECIRS和美国指导的卧床PCNL期间识别多个访问通道的当代术前预测因素.
- 评估现代PCNL技术中多访问程序的必要性.
- 通过了解多次访问PCNL的风险因素,改善手术规划和患者的结果.
主要方法:
- 对250名近期接受美国指导的卧底PCNL (如上所述使用ECIRS) 的患者的分析.
- 使用后勤回归和灵敏度分析来确定与需要多个接入通道相关的术前因素.
- 对所有患者进行了至少一年的随访.
主要成果:
- 只有7%的患者需要多次访问程序.
- 多变量分析确定总石头负担是唯一重要的预测因素 (OR = 1.038).
- 确定了>34.5毫米的最佳石头负荷切割值;在非角的情况下,上极石是显著的.
结论:
- 多访问PCNL很少 (7%) 与当前的ECIRS和美国指导的卧底技术.
- 关键的手术前风险因素包括线性石头总负荷和上极石头.
- 术前确定这些因素对于优化手术规划和结果至关重要.
相关概念视频
01:25Urinary Tract Calculi VI: Surgical Management
384
Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
384
01:22Imaging Studies V: Intravenous Urography and Retrograde Pyelography
1.1K
IntroductionIntravenous Urography (IVU) and Retrograde Pyelography (RP) are important diagnostic imaging techniques used to evaluate the urinary system. These methods help identify structural abnormalities, obstructions, and functional issues in the kidneys, ureters, and bladder. Both procedures use iodine-based contrast media to enhance the visibility of urinary tract structures on X-ray images, though they differ in their methods and indications.1. Intravenous Urography (IVU)Intravenous...
1.1K
01:24Imaging Studies II: Ultrasonography
371
IntroductionUltrasonography, or renal ultrasound, is a noninvasive medical imaging technique that uses high-frequency sound waves to visualize the kidneys, ureters, bladder, and surrounding tissues.Indications for Urinary System UltrasonographyUrinary system ultrasonography is indicated in various clinical scenarios, such as:Kidney Stones (Urolithiasis): To detect and monitor the size and presence of kidney or urinary tract stones.Hydronephrosis: To assess the dilation of the renal pelvis and...
371
01:28Imaging Studies I: Kidney, Ureter, and Bladder Studies
284
Kidney, Ureter, and Bladder (KUB) StudiesKidney, Ureter, and Bladder (KUB) studies are standard diagnostic imaging procedures used to assess the anatomy of the urinary system. They are commonly utilized for patients experiencing abdominal pain or urinary symptoms. By using a simple X-ray of the abdomen, KUB studies can reveal structural and pathological abnormalities within the kidneys, ureters, and bladder. These studies are particularly valuable in diagnosing kidney stones, urinary...
284
01:19Imaging Studies VII: Vascular Imaging
312
DefinitionRenal angiography, also known as renal arteriography, is an imaging technique used to obtain a comprehensive view of blood flow and the vascular structure of blood vessels in the kidneys and surrounding areas.PurposeRenal angiography detects blood vessel abnormalities in the kidneys, such as aneurysms, stenosis, thrombosis, vascular tumors, and renal artery stenosis. It evaluates kidney function and guides interventional treatments like angioplasty or stent placement.Pre-Procedure...
312
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
321
Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
321