Department of Urology, Muljibhai Patel Urological Hospital , Nadiad, Gujarat, India .
J Endourol. 2013 Dec;27(12):1444-9. doi: 10.1089/end.2013.0177. Epub 2013 Nov 19.
The energy source used for stone fragmentation is important in miniperc. In this study, we compared the stone fragmentation characteristics and outcomes of laser lithotripsy and pneumatic lithotripsy in miniperc for renal calculi.
After Institutional Review Board approval, 60 patients undergoing miniperc for renal calculi of 15 to 30 mm were equally randomized to laser and pneumatic lithotripsy groups. Miniperc was performed using 16.5F Karl Storz miniperc sheath and a 12F nephroscope. Laser lithotripsy was performed using a 550-μm laser fiber and 30 W laser with variable settings according to the need. Pneumatic lithotripsy was performed using the EMS Swiss lithoclast. Patient demographics, stone characteristics, intraoperative parameters, and postoperative outcomes were analyzed.
The baseline patient demographics and stone characteristics were similar in both groups. The total operative time (P = 0.433) and fragmentation time (P=0.101) were similar between the groups. The surgeon assessed that the Likert score (1 to 5) for fragmentation was similar in both groups (2.1 ± 0.8 vs 1.9 ± 0.9, P=0.313). Stone migration was lower with the laser (1.3 ± 0.5 vs 1.7 ± 0.8, P=0.043), and fragment removal was easier with the laser (1.1 ± 0.3 vs 1.7 ± 1.1, P=0.011). The need for fragment retrieval using a basket was significantly more in the pneumatic lithotripsy group (10% vs 37%, P=0.002). The hemoglobin drop, complication rates, auxiliary procedures, postoperative pain, and stone clearance rates were similar between the groups (P>0.2).
Both laser lithotripsy and pneumatic lithotripsy are equally safe and efficient stone fragmentation modalities in miniperc. Laser lithotripsy is associated with lower stone migration and easier retrieval of the smaller fragments it produces.
在微通道经皮肾镜取石术中，碎石的能量源很重要。本研究比较了激光碎石术和气压弹道碎石术在微通道经皮肾镜取石术治疗肾结石中的碎石特点和效果。
本研究经机构审查委员会批准，将 60 例行微通道经皮肾镜取石术治疗 15-30mm 肾结石的患者等分为激光组和气压弹道碎石术组。微通道经皮肾镜取石术采用 16.5F Karl Storz 微通道经皮肾镜取石术鞘和 12F 肾镜。激光碎石术采用 550μm 激光光纤和 30W 激光，根据需要进行可变设置。分析患者的人口统计学资料、结石特征、术中参数和术后结果。
两组患者的基线人口统计学资料和结石特征相似。两组的总手术时间（P=0.433）和碎石时间（P=0.101）相似。术者评估的碎石 Likert 评分（1-5 分）在两组间相似（2.1±0.8 分比 1.9±0.9 分，P=0.313）。激光组结石迁移率较低（1.3±0.5 比 1.7±0.8，P=0.043），激光组碎石碎片更容易取出（1.1±0.3 比 1.7±1.1，P=0.011）。气压弹道碎石术组需要用篮筐取出碎石碎片的情况明显更多（10%比 37%，P=0.002）。两组的血红蛋白下降量、并发症发生率、辅助手术、术后疼痛和结石清除率相似（P＞0.2）。
激光碎石术和气压弹道碎石术在微通道经皮肾镜取石术中均是安全且有效的碎石方式。激光碎石术可降低结石迁移率，更容易取出其产生的较小结石碎片。
