Pérez-Fentes Daniel Adolfo, Gude Francisco, Blanco Benito, Freire Camilo García
1 Department of Urology, Complejo Hospitalario Universitario de Santiago de Compostela , Santiago de Compostela, Spain .
J Endourol. 2015 Jan;29(1):13-7. doi: 10.1089/end.2014.0081.
Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large and complex kidney stones, having increased its safety and effectiveness over the last years. Nonetheless, there is little known about its impact on quality of life (QoL). This study aimed at evaluating the effects of PCNL on patients' QoL in the short and long term.
We prospectively studied 40 consecutive cases who underwent PCNL. QoL was measured using the short form-36 (SF-36) questionnaire, 2 weeks before surgery and then in the third postoperative month and a year after. Changes in QoL were assessed under statistical and clinical relevance criteria.
PCNL has rendered 70% of the cases completely stone free with a 35% complication rate (33% Clavien I+II). The baseline scores of all SF-36 domains were worse than the referral population. Three months after PCNL, bodily pain was the only dimension whose change was relevant for patients (effect size [ES]=0.71, minimal clinically important difference [MCID]=0.56). A year after, this favorable effect of PCNL on body pain is still present, being also beneficial on both role physical (ES=0.58, MCID=0.52) and the physical component summary (ES=0.56, MCID=0.43). Social function was also close to reaching clinical relevance a year after the procedure (ES=0.66, MCID=0.72).
Kidney stone disease considerably affects the patients' QoL. PCNL not only has good outcomes rendering the kidney stone free without major complications but produces an immediate body pain relief. This is perceived as relevant by the patients even a year after the procedure, when some other physical aspects of QoL also get better, helping patients to restore their social activities.
经皮肾镜取石术（PCNL）是治疗大的复杂性肾结石的首选方法，在过去几年中其安全性和有效性有所提高。然而，关于其对生活质量（QoL）的影响却知之甚少。本研究旨在评估PCNL对患者短期和长期生活质量的影响。
我们前瞻性地研究了40例连续接受PCNL的患者。使用简短健康调查问卷（SF-36）在手术前2周、术后第3个月和术后1年测量生活质量。根据统计学和临床相关性标准评估生活质量的变化。
PCNL使70%的病例结石完全清除，并发症发生率为35%（33%为Clavien I+II级）。所有SF-36领域的基线评分均低于参考人群。PCNL术后3个月，身体疼痛是唯一对患者有显著变化的维度（效应量[ES]=0.71，最小临床重要差异[MCID]=0.56）。术后1年，PCNL对身体疼痛的这种有利影响仍然存在，对角色身体功能（ES=0.58，MCID=0.52）和身体成分总结（ES=0.56，MCID=0.43）也有益。术后1年社会功能也接近达到临床相关性（ES=0.66，MCID=0.72）。
肾结石疾病严重影响患者的生活质量。PCNL不仅有良好的效果，能使肾结石清除且无重大并发症，还能立即缓解身体疼痛。即使在术后1年，患者也认为这很重要，此时生活质量的其他一些身体方面也有所改善，有助于患者恢复社交活动。
