经皮肾镜取石术治疗肾结石的微创通道。

Minimally invasive tract in percutaneous nephrolithotomy for renal stones.

机构信息

Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.

出版信息

J Endourol. 2010 Oct;24(10):1579-82. doi: 10.1089/end.2009.0581.

DOI:10.1089/end.2009.0581

PMID:20839954

Abstract

AIM

The aim of this study was to assess the efficacy, safety, and morbidity of minimally invasive tract in percutaneous nephrolithotomy (Mini-PCNL) for renal stones in comparison with the standard PCNL.

PATIENTS AND METHODS

In a randomized trial, 69 patients (72 renal units) undergoing Mini-PCNL (group 1) from May 2004 to December 2007 were compared with a similar group of 111 (115 renal units) patients undergoing standard PCNL (group 2). Patients who needed more than one percutaneous tract or who had simultaneously undergone the two techniques on the same renal unit were excluded from the study group. Chi-square test was performed for statistical analysis of qualitative variables, and Student's t-test for quantitative variables. A p-value of <0.05 was considered significant.

RESULTS

The two groups had comparable demographic data and some outcome of characteristics such as time of stay in hospital, postoperative pain, dose of postoperative analgesics, ratio of positive fever, and stone-free rates for some types of stones (e.g., staghorn stone and simple renal pelvis stone). The stone-free rate for multiple caliceal stones (85.2% vs. 70.0% in group 1 and group 2) was significantly higher in the Mini-PCNL group (p < 0.05). The incidence of bleeding necessitating transfusion (1.4% vs. 10.4% in group 1 and group 2) was significantly lower in the Mini-PCNL group (p < 0.05). In group 1, operative time for different stone types such as staghorn stone, simple renal pelvis stone, and multiple caliceal stones were 134.3 ± 19.7, 89.4 ± 21.5, and 113.9 ± 20.3 minutes, respectively, which were significantly longer than that for group 2 (118.9 ± 21.5, 77.0 ± 17.6, and 101.2 ± 19.1 minutes) (p < 0.05).

CONCLUSION

Mini-PCNL is safe and effective for managing renal calculi in adult patients. Although smaller working sheath is associated with longer operative time, Mini-PCNL has significantly lower incidence of bleeding necessitating transfusion and higher stone-free rate for multiple caliceal stones in comparison with the standard PCNL.

摘要

目的

本研究旨在评估微创经皮肾镜取石术（Mini-PCNL）治疗肾结石的疗效、安全性和发病率，并与标准经皮肾镜取石术（PCNL）进行比较。

患者与方法

在一项随机试验中，2004 年 5 月至 2007 年 12 月期间，69 例（72 个肾脏单位）接受 Mini-PCNL（第 1 组）的患者与 111 例（115 个肾脏单位）接受标准 PCNL（第 2 组）的患者进行了比较。需要多个经皮通道或同一肾脏单位同时接受两种技术的患者被排除在研究组之外。采用卡方检验对定性变量进行统计学分析，采用 Student's t 检验对定量变量进行分析。p 值<0.05 被认为具有统计学意义。

结果

两组患者的人口统计学数据和某些特征的结果相似，如住院时间、术后疼痛、术后镇痛药剂量、发热阳性率和某些类型结石（如鹿角结石和单纯肾盂结石）的结石清除率。多发性肾盏结石的结石清除率（第 1 组为 85.2%，第 2 组为 70.0%）在 Mini-PCNL 组显著更高（p<0.05）。需要输血的出血发生率（第 1 组为 1.4%，第 2 组为 10.4%）在 Mini-PCNL 组显著更低（p<0.05）。第 1 组中，鹿角结石、单纯肾盂结石和多发性肾盏结石的手术时间分别为 134.3±19.7、89.4±21.5 和 113.9±20.3 分钟，明显长于第 2 组（118.9±21.5、77.0±17.6 和 101.2±19.1 分钟）（p<0.05）。