Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran.
J Endourol. 2011 Jun;25(6):927-31. doi: 10.1089/end.2010.0638. Epub 2011 May 4.
To compare the effects of one-stage vs gradual dilation techniques during percutaneous nephrolithotomy (PCNL) on postoperative renal scar formation and overall renal function.
Of 152 adult patients who underwent surgery during the study period, 48 were randomized into two groups. In group 1 (n=19), gradual tract dilation with Alken metallic dilators was used, and in group 2 (n=29), one-stage tract dilation was used. We compared patient demographics, intraoperative and preoperative parameters, postoperative overall renal function, and renal scar formation on the target renal pole.
Access time (P=0.001; 95% confidence interval [CI]: 3.19-6.30) and radiation exposure during access (P=0.03; 95% CI: 0.03-0.66) were significantly shorter in group 2. In group 1, the decrease in mean technetium-99m dimercaptosuccinic acid (99m-Tc DMSA) uptake from 44.1±20.1% to 43.4±19.6% 4 weeks postoperatively (-0.7%±0.5%; P=0.27; 95% CI: -0.56-1.93) was not significant. In group 2, however, there was a significant decrease in post-PCNL 99m-Tc DMSA uptake 2 (-2.4±0.3%, from 50.1±13.5% to 47.7±13.8%; P=0.001; 95% CI: 1.13-3.66). Four weeks after surgery, new scar formation or progression of the preoperative scar at the site of access were seen in 14 of 29 (48.3%) patients who were treated with one-stage dilation whereas only 2 of 19 (11.0%) patients who were treated with gradual dilation developed new scarring at the access site (P=0.007).
Although the one-stage tract dilation technique reduced radiation exposure and access time, in the short term, it may cause more parenchymal damage than the gradual dilation technique.
比较经皮肾镜取石术（PCNL）中一期扩张与逐渐扩张技术对术后肾瘢痕形成和整体肾功能的影响。
在研究期间接受手术的 152 例成年患者中，48 例随机分为两组。在组 1（n=19）中，使用 Alken 金属扩张器进行逐渐扩张，在组 2（n=29）中，使用一期扩张。我们比较了患者的人口统计学特征、术中及术前参数、术后整体肾功能以及目标肾极的肾瘢痕形成。
组 2 的通道建立时间（P=0.001；95%置信区间[CI]：3.19-6.30）和通道建立期间的辐射暴露（P=0.03；95%CI：0.03-0.66）显著缩短。在组 1 中，术后 4 周时，锝-99m 二巯丁二酸（99m-Tc DMSA）摄取量从 44.1±20.1%降至 43.4±19.6%（-0.7%±0.5%；P=0.27；95%CI：-0.56-1.93），但无显著意义。然而，在组 2 中，PCNL 后 99m-Tc DMSA 摄取量明显下降 2（从 50.1±13.5%降至 47.7±13.8%；-2.4±0.3%；P=0.001；95%CI：1.13-3.66）。术后 4 周时，在接受一期扩张治疗的 29 例患者中，有 14 例（48.3%）出现新的瘢痕形成或术前瘢痕在通道部位进展，而在接受逐渐扩张治疗的 19 例患者中，只有 2 例（11.0%）出现通道部位新的瘢痕形成（P=0.007）。
尽管一期通道扩张技术减少了辐射暴露和通道建立时间，但在短期内，它可能比逐渐扩张技术造成更多的实质损伤。
