Department of Urology, Sindelfingen-Boeblingen Medical Center, Sindelfingen, Germany.
J Endourol. 2010 Jul;24(7):1075-9. doi: 10.1089/end.2010.0111.
A benefit of miniaturized percutaneous nephrolithotomy (MPCNL) compared with conventional percutaneous nephrolithotomy (PCNL) has not been demonstrated as yet. Thus, the aim of this study was to evaluate the outcome of conventional vs MPCNL and to determine if MPCNL offers an advantage for the patient.
A prospective, nonrandomized series of 50 consecutive patients with solitary calculi (lower pole or the renal pelvis) were treated either by conventional PCNL (26F) or MPCNL (18F). Ultrasound or holmium laser were used for lithotripsy. Patients were treated tubeless after uncomplicated MPCNL, with thrombin-matrix tract closure and antegrade Double-J catheter placement. After PCNL, all patients received 22F nephrostomies. Demographic data, stone characteristics, perioperative course, and complication rates were assessed.
Patients characteristics were comparable in both groups, except for stone size, which was 18 +/- 8 mm (MPCNL) and 23 +/- 9 (PCNL; P = 0.042). Operative time was comparable in both groups (48 +/- 17 vs 57 +/- 22 min, not significant [NS]). After MPCNL, 96% were stone free at day 1 vs 92% after PCNL (NS). Significant complications did not occur in both groups. Minor complications were: Fever, 12% (MPCNL) vs 20% (PCNL; NS); bleeding, 4% vs 8%; perforations, 0% vs 4% (all NS). Overall outcome was not influenced by body mass index. Calcium oxalate stones were predominant with 75%. Patients after tubeless MPCNL had less pain (visual analogue score, 3 +/- 3 vs 4 +/- 3; P = 0.048.) and needed slightly less additional pain medication (25 +/- 12 mg/d vs 37 +/- 10 mg/d piritramid; NS). Hospital stay was significantly shorter after MPCNL (3.8 +/- 28 vs 6.9 +/- 3.5 d; P = 0.021.).
Both techniques were safe and effective for the management of renal calculi. While stone-free rates were comparable in our series, MPCNL showed advantages in terms of shorter hospital stay and postoperative pain. The lower stone burden and the tubeless fashion of MPCNL, however, might have influenced these results.
与传统经皮肾镜取石术（PCNL）相比，微创经皮肾镜取石术（MPCNL）的优势尚未得到证实。因此，本研究旨在评估传统 PCNL 与 MPCNL 的结果，并确定 MPCNL 是否对患者有益。
前瞻性、非随机的连续 50 例单发肾结石（下极或肾盂）患者，分别采用传统 PCNL（26F）或 MPCNL（18F）治疗。结石粉碎采用超声或钬激光。MPCNL 术后无并发症患者采用经尿道膀胱镜下凝血酶基质管腔闭合和顺行双 J 管置入。PCNL 后，所有患者均接受 22F 肾造瘘管引流。评估患者的人口统计学数据、结石特征、围手术期情况和并发症发生率。
两组患者的一般资料无显著差异，除结石大小外，MPCNL 组为 18 ± 8mm，PCNL 组为 23 ± 9mm（P = 0.042）。两组手术时间相当（48 ± 17 与 57 ± 22 分钟，差异无统计学意义[NS]）。MPCNL 术后第 1 天结石清除率为 96%，PCNL 术后为 92%（差异无统计学意义[NS]）。两组均未发生严重并发症。轻微并发症包括发热 12%（MPCNL）与 20%（PCNL）（差异无统计学意义[NS]）、出血 4%与 8%、穿孔 0%与 4%（均 NS）。BMI 对整体疗效无影响。草酸钙结石占 75%。MPCNL 术后患者疼痛较轻（视觉模拟评分，3 ± 3 与 4 ± 3；P = 0.048），术后需要的止痛药物略少（哌替啶 25 ± 12mg/d 与 37 ± 10mg/d；差异无统计学意义[NS]）。MPCNL 术后住院时间明显缩短（3.8 ± 28 与 6.9 ± 3.5d；P = 0.021）。
两种技术治疗肾结石均安全有效。本研究结石清除率相当，但 MPCNL 在住院时间和术后疼痛方面具有优势。MPCNL 的结石负荷较低且无需留置肾造瘘管，可能是导致这些结果的原因。
