《内镜泌尿外科协会临床研究办公室经皮肾镜取石术全球研究：5537 例患者的通道扩张比较》。

The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: tract dilation comparisons in 5537 patients.

机构信息

Hospital St. Maria , Lisbon, Portugal .

出版信息

J Endourol. 2011 May;25(5):755-62. doi: 10.1089/end.2010.0488. Epub 2011 Mar 9.

DOI:10.1089/end.2010.0488

PMID:21388242

Abstract

PURPOSE

The study focused on the use of balloon or telescopic/serial dilation methods in percutaneous nephrolithotomy (PCNL) in the Global PCNL Study.

PATIENTS AND METHODS

Centers worldwide provided data from consecutive patients who were treated with PCNL during a 1-year period. Tract dilation was performed using a balloon or telescopic/serial dilator. Patient characteristics, perioperative complications, and treatment outcomes were assessed by the treating physician. Postoperative complications were graded according to the modified Clavien grading system.

RESULTS

A total of 5537 eligible patients were entered in the database from November 2007 to December 2009, including 2277 (41.1%) who received balloon dilation and 3260 (58.9%) who received telescopic/serial dilation. The predominant method used was telescopic/serial dilation in Asia (94.7%) and South America (98.0%), and balloon dilation in North America (82.6%). In Europe, the rates of balloon (50.7%) and telescopic/serial (49.3%) dilation procedures were similar. The rates of bleeding (9.4% vs. 6.7%), blood transfusions (7.0% vs. 4.9%), and drop in mean hematocrit level (4.5% vs. 2.5%) were higher in the balloon vs. telescopic/serial dilator group. Clavien scores II and IIIA were slightly in favor of the telescopic/serial dilator group. Median operative time was longer in the balloon dilation group (94.0 min vs. 60.0 min).

CONCLUSIONS

The Global PCNL Study has identified differences in the method of dilation used between centers in Asia, Europe, and the United States. In the balloon dilation group, a total longer operative time and higher bleeding and transfusion rates were observed. The differences in outcome may be influenced by patient heterogeneity, including previous anticoagulation therapy or surgical procedures, in addition to the number of stones treated and rate of staghorn calculi, which were all higher in the balloon group.

摘要

目的

本研究侧重于全球经皮肾镜取石术（PCNL）中球囊或扩张器/连续扩张方法的使用。

患者和方法

全世界的中心提供了在 1 年内接受 PCNL 治疗的连续患者的数据。使用球囊或扩张器/连续扩张器进行通道扩张。由治疗医生评估患者特征、围手术期并发症和治疗结果。术后并发症根据改良的 Clavien 分级系统进行分级。

结果

2007 年 11 月至 2009 年 12 月，共纳入 5537 例符合条件的患者进入数据库，其中 2277 例（41.1%）接受球囊扩张，3260 例（58.9%）接受扩张器/连续扩张。亚洲（94.7%）和南美洲（98.0%）主要采用连续扩张器方法，北美（82.6%）主要采用球囊扩张。在欧洲，球囊（50.7%）和扩张器/连续（49.3%）扩张的比例相似。球囊组出血（9.4%比 6.7%）、输血（7.0%比 4.9%）和平均血细胞比容水平下降（4.5%比 2.5%）的发生率较高。Clavien 评分 II 和 IIIA 稍微有利于扩张器/连续组。球囊扩张组的中位手术时间较长（94.0 分钟比 60.0 分钟）。