Objective To analyze the incidence and related factors of pleural injuries after percutaneous nephrolithotomy (PCNL). Methods A retrospective analysis was conducted on clinical data of 78 patients who underwent PCNL via the 12th rib superior approach in the Department of Urology of Anhui Provincial Corps Hospital of Chinese People's Armed Police Force from February 2023 to May 2025. The basic information (gender, age, BMI, stone size, disease duration, and complications), surgical conditions (side of surgery, stone location, puncture calyx, puncture approach), and the relationship between the costoclavicular angle (VA) and pleural injury were evaluated. Results A total of 78 patients underwent PCNL via the 12th rib superior approach. There was no relationship between the gender, age, BMI, stone size, duration of illness, complications, side of surgery, stone location, and chest injuries among the patients. 14 patients developed pleural injuries, which were divided into a pleural injury group, including 8 cases of pneumothorax, 5 cases of pleural effusion, and 1 case of hemothorax, and 64 patients did not have pleural injuries, which were divided into a control group. The constituent ratio of pleural injuries was significantly higher when the puncture site was in the superior calyx than when it was in the middle and lower calyces; the constituent ratio of pleural injuries was higher in the 10th intercostal space than in the 11th intercostal space(5/9 vs. 4/60) , and the differences were statistically significant (P＜0.05); the number of cases with RVA 40°-45° in the pleural injury group was significantly higher than that with RVA46°-50° and RVA>50°, and the number cases with RVA 40°-45° in the control group was significantly lower than that with RVA46°-50° and RVA>50; when compared between groups, the percentage of cases with RVA40°-45° and RVA>50° was significantly different; the mean RVA in pleural injury group was significantly lower than that in the control group [(44.32°±3.46°) vs. (52.17°±4.32°)], and the differences were statistically significant. Conclusions The higher the puncture site in the superior calyx of the kidney and the smaller the RVA, the greater the chance of pleural injury; RVA is closely related to pleural injuries and can be used as an important predictive factor for the occurrence of pleural injuries after PCNL.
Key words
percutaneous nephrolithotomy /
pleural injury /
pleural effusion /
hemothorax /
pneumothorax /
rib-vertebral angle
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References
[1] Türk C, Petrík A, Sarica K, et al. EAU guidelines on interventional treatment for urolithiasis [J]. Eur Urol, 2016,69(3):475-482.
[2] Sourial M W, Francois N, Box G N, et al. Supracostal access tubeless percutaneous nephrolithotomy: Minimizing complications [J]. World J Urol, 2019,37(7):1429-1433.
[3] Ashwin S P, Mohd S A, Sarita S, et al. Efficacy and safety of supracostal access for mini percutaneous nephrolithotomy in pediatric patients[J]. Urology, 2020,137(3):152-156.
[4] 向呈浩,杨浩毅,梁紫轩, 等.经皮肾镜取石术并发胸腔积液3例并文献复习[J].临床医学进展,2023,13(8): 13550-13554.
[5] 邓艳红,陈伟明,刘先保. 经皮肾镜碎石取石术中严重胸腹腔积液并肾动脉损伤一例报道[J].广州医科大学学报,2024,52(2):61-64
[6] 徐君林,谢江凌,冉 强,等.经皮肾镜取石术后尿胸1例报告[J].中华泌尿外科杂志, 2024, 45(6): 475-476.
[7] Yan M Y, Lin J, Chang H C, et al. Supracostal tubeless percutaneous nephrolithotomy is not associated with increased complication rate: a study of safety and efficacy of supracostal versus subcostal access[J]. BMC Urol, 2018,18(1): 1-7.
[8] 弓鹏峰,宋广来,曹赟杰,等.经皮肾镜碎石取石术严重并发症临床分析[J].江苏医药, 2020, 46(12):1295-1296.
[9] Palnizky G, Halachmi S, Barak M, et al. Pulmonary complications following percutaneous nephrolithotomy: A prospective study[J]. Curr Urol, 2013,7(3):113-116.
[10] Kamo N, Kaido T, Uozumi R, et al. Preoperative ascites and/or pleural eff was a predictor of massive albumin use after liver transplantation [J]. Surg Gastroenterol, 2019, 24(1): 22-30.
[11] Yutaro T K, Kazumi T C, Shuzo H M, et al. Hemothorax during miniaturized endoscopic combined intrarenal surgery under ureteroscope-assisted ultrasound-guided access[J]. IJU Case Rep, 2019,2(5):257-260.
[12] Abhishek B, Jonathan E K, Nicholas S, et al. Nephropleural fistula after supracostal approach for PCNL: report of two cases with review of literature[J]. BMJ Case Rep, 2021,14(4):e241360.
[13] Hwang T K. Percutaneous nephroscopic surgery[J]. KoreanJ Urol,2010,51(5):298-307.
[14] 吴 迪, 张宝勋, 吴文弼, 等.彩色多普勒血流联合超声实时监控在经皮肾镜取石术中的临床应用[J].陇东学院学报,2024,35(5):73-77.
[15] Kundan M H, Sidhaant N G, Rhea G H, et al. Empyema resulting from a nephro-pleural fistula in an adult with polycystic kidney disease with obstructive uropathy[J]. Cureus, 2024,16(4):e57671.
[16] Sinha M, Krishnappa P, Subudhi S K, et al. Supracostal percutaneous nephrolithotomy: A prospective comparative study[J].Indian J Urol, 2016, 32(1):45-49.
[17] Muhammad R S, Rashid A,Tham T M, et al. Urinothorax with fungal empyema-a rare and unique combination[J]. Respirol Case Rep, 2025,13(4):e70182.
[18] 黄苏溪, 海拉提,孙丙华,等.经皮肾穿刺在肾镜取石术中的应用及创新[J].武警医学,2025,36(9):803-810.
[19] Ng F C, Yam W L, Lim T Y B, et al. Ultrasound-guided percutaneous nephrolithotomy: Advantages and limitations[J]. Investig Clin Urol, 2017,58(5):346-352.
[20] Kazemi R, Jandaghi F, Montazeri F, et al. Acute liver injury and contralateral pleural effusion as two rare complications following percutaneous nephrolithotomy: a case report [J]. Am J Clin Exp Urol,2024,12(1):46-51.
[21] Ahmet Güzel,Taylan Oksay,Sefa A O, et al. Costovertebral angle as a novel tool for predicting the thoracic complication risk following percutaneous nephrolithotomy requiring supracostal access [J]. Can Urol Assoc J, 2021,15(11):E608-E613.
[22] U P L, Chun H Y, Guan C T.Predictive factors for percutaneous nephrolithotomy bleeding risks [J]. Asian J Urol,2024,11(1):105-109.
[23] 赵亚兵,何文强,王光策,等.经皮肾镜取石术致胸腔积液的病例特点[J]. 河南医学研究, 2021, 30(15): 2721-2724.
[24] Gupta K, Tomer N, Connors C, et al. Is outpatient totally tubeless standard percutaneous nephrolithotomy safe and efficacious?[J]. J Endourol,2025,39(4):336-342.
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