Singh Vishwajeet, Sinha Rahul Janak, Gupta Dheeraj Kumar, Pandey Mohit
Department of Urology, King George Medical University, Lucknow, India.
Urol Int. 2014;92(4):392-5. doi: 10.1159/000353973. Epub 2013 Oct 16.
We performed a prospective randomized comparison of retroperitoneoscopic pyelolithotomy (RP) versus percutaneous nephrolithotomy (PNL) for solitary pelvic stones >3 cm and assessed the outcome results.
From 2010 to 2012, 44 patients with a solitary pelvic stone >3 cm without any anatomical abnormality were randomized to either RP or PNL on a 1:1 ratio. Stone-free rate, number of procedures per patient and complications were recorded.
The stone-free rate on the first postoperative day was 95.5% in the RP group versus 72.7% in the PNL group (p = 0.04). The stone-free rates at 3 months were similar between the two groups. Blood loss, visual pain analog score and analgesic requirement on the first postoperative day were significantly higher in the PNL group whereas the mean operative time and overall complications were similar between the two groups.
In patients with solitary large pelvic stones, RP is associated with lesser blood loss, postoperative pain and analgesia as well as with a higher stone-free rate in the immediate postoperative period in comparison to PNL. However, the stone clearance rate remains the same at 3 months in both groups.
我们对后腹腔镜肾盂切开取石术（RP）与经皮肾镜取石术（PNL）治疗直径>3 cm的孤立性盆腔结石进行了前瞻性随机对照研究，并评估了结果。
2010年至2012年，44例直径>3 cm且无任何解剖异常的孤立性盆腔结石患者按1:1比例随机分为RP组或PNL组。记录结石清除率、每位患者的手术次数和并发症情况。
RP组术后第1天的结石清除率为95.5%，而PNL组为72.7%（p = 0.04）。两组3个月时的结石清除率相似。PNL组术后第1天的失血量、视觉模拟疼痛评分和镇痛需求显著更高，而两组的平均手术时间和总体并发症相似。
对于孤立性大盆腔结石患者，与PNL相比，RP在术后即刻失血量更少、术后疼痛和镇痛需求更低，且结石清除率更高。然而，两组3个月时的结石清除率相同。
