Stevan B. Streem Center for Endourology and Stone Disease, Glickman Urological and Kidney Institute Cleveland Clinic, Cleveland, OH 44195, USA.
Urology. 2013 Feb;81(2):251-6. doi: 10.1016/j.urology.2012.10.004.
To evaluate the intraoperative outcomes of percutaneous renal access using fluoroscopic-guided access (FGA) vs endoscopic-guided access (EGA).
A retrospective record review was conducted of patients undergoing percutaneous nephrolithotomy (PCNL), categorized by the method of achieving renal access. Patients were randomly assigned to 1 of 2 endourologists: 1 practicing EGA and the other practicing FGA. Patient demographics, baseline characteristics, and operative and postoperative outcomes were compared using univariate and multivariate analysis.
From August 2010 to January 2012, 159 patients underwent PCNL (40% EGA, 60% FGA). No significant difference was observed between groups in age (P = .06), American Society of Anesthesiologists Physical Status Classification (P = .7), number of stones (P = .058), cumulative stone diameter (P = .051), number of calyces involved (P = .82), and stone density (P = .49). Body mass index (BMI) was higher in patients undergoing EGA (P = .013). Patients undergoing EGA had shorter fluoroscopy time (3.2 vs 16.8 minutes, P <.001) and lower access number (1.03 vs 1.22 P = .002). Fluoroscopy time was longer for FGA than for EGA after adjusting for BMI, staghorn stones, and access number (P <.001). No significant difference was noted in change in hemoglobin, blood transfusion rate, operative time, or intraoperative complications between groups. Procedures were aborted due to bleeding more commonly in the FGA (8%) than in the EGA group (0%, P = .02) A secondary procedure for stone management was required in 2 (3.2%) of the EGA group compared with 12 (12.5%) of the FGA group.
EGA is safe and effective and leads to decreased fluoroscopy time, decreased need for multiple accesses, and decreased risk of early termination of the procedure or need for secondary procedures.
评估经皮肾镜取石术中使用透视引导入路(FGA)与内镜引导入路(EGA)的术中结果。
对接受经皮肾镜取石术(PCNL)的患者进行回顾性病历记录审查,根据实现肾入路的方法对患者进行分类。患者被随机分配给 2 位泌尿科医生中的 1 位:1 位实践 EGA,另 1 位实践 FGA。使用单变量和多变量分析比较患者的人口统计学、基线特征以及手术和术后结果。
2010 年 8 月至 2012 年 1 月,有 159 名患者接受了 PCNL(40%EGA,60%FGA)。两组在年龄(P=0.06)、美国麻醉医师协会身体状况分类(P=0.7)、结石数量(P=0.058)、结石总直径(P=0.051)、受累肾盏数量(P=0.82)和结石密度(P=0.49)方面无显著差异。接受 EGA 的患者的体重指数(BMI)更高(P=0.013)。接受 EGA 的患者的透视时间更短(3.2 分钟与 16.8 分钟,P<0.001),入路数量更少(1.03 与 1.22,P=0.002)。在调整 BMI、鹿角形结石和入路数量后,FGA 的透视时间比 EGA 长(P<0.001)。两组之间血红蛋白变化、输血率、手术时间或术中并发症无显著差异。由于出血,FGA 组(8%)的手术更频繁地中止,而 EGA 组(0%)则中止(P=0.02)。EGA 组中有 2 例(3.2%)需要进行结石管理的二次手术,而 FGA 组中有 12 例(12.5%)需要进行二次手术。
EGA 安全有效,可减少透视时间、减少多次入路的需要,并降低手术早期终止或需要二次手术的风险。