Demirci A, Raif Karabacak O, Yalçınkaya F, Yiğitbaşı O, Aktaş C
Dışkapı Yıldırım Beyazıt Training and Research Hospital, Urology Clinic, 06110 Ankara, Turkey.
Dışkapı Yıldırım Beyazıt Training and Research Hospital, Urology Clinic, 06110 Ankara, Turkey.
Prog Urol. 2016 May;26(6):353-9. doi: 10.1016/j.purol.2016.04.003. Epub 2016 May 10.
Percutaneous nephrolithotomy (PNL) and retrograde intrarenal surgery (RIRS) are the standard treatments used in the endoscopic treatment of kidney stones depending on the location and the size of the stone. The purpose of the study was to show the radiation exposure difference between the minimally invasive techniques by synchronously measuring the amount of radiation the patients and the surgeon received in each session, which makes our study unique.
This is a prospective study which included 20 patients who underwent PNL, and 45 patients who underwent RIRS in our clinic between June 2014 and October 2014. The surgeries were assessed by dividing them into three steps: step 1: the access sheath or ureter catheter placement, step 2: lithotripsy and collection of fragments, and step 3: DJ catheter or re-entry tube insertion.
For the PNL and RIRS groups, mean stone sizes were 30mm (range 16-60), and 12mm (range 7-35); mean fluoroscopy times were 337s (range 200-679), and 37s (range 7-351); and total radiation exposures were 142mBq (44.7 to 221), and 4.4mBq (0.2 to 30) respectively. Fluoroscopy times and radiation exposures at each step were found to be higher in the PNL group compared to the RIRS group. When assessed in itself, the fluoroscopy time and radiation exposure were stable in RIRS, and the radiation exposure was the highest in step 1 and the lowest in step 3 in PNL. When assessed for the 19 PNL patients and the 12 RIRS patients who had stone sizes≥2cm, the fluoroscopy time in step 1, and the radiation exposure in steps 1 and 2 were found to be higher in the PNL group than the RIRS group (P<0.001).
Although there is need for more prospective randomized studies, RIRS appears to be a viable alternate for PNL because it has short fluoroscopy time and the radiation exposure is low in every step.
经皮肾镜取石术（PNL）和逆行肾内手术（RIRS）是根据肾结石的位置和大小用于肾结石内镜治疗的标准方法。本研究的目的是通过同步测量患者和外科医生在每次手术中接受的辐射量来显示微创技术之间的辐射暴露差异，这使得我们的研究具有独特性。
这是一项前瞻性研究，纳入了2014年6月至2014年10月期间在我们诊所接受PNL的20例患者和接受RIRS的45例患者。手术分为三个步骤进行评估：步骤1：放置穿刺鞘或输尿管导管；步骤2：碎石和收集碎片；步骤3：插入DJ导管或重新置入导管。
PNL组和RIRS组的平均结石大小分别为30mm（范围16 - 60）和12mm（范围7 - 35）；平均透视时间分别为337秒（范围200 - 679）和37秒（范围7 - 351）；总辐射暴露分别为142毫贝克勒尔（44.7至221）和4.4毫贝克勒尔（0.2至30）。发现PNL组在每个步骤的透视时间和辐射暴露均高于RIRS组。就其本身而言，RIRS的透视时间和辐射暴露是稳定的，PNL中辐射暴露在步骤1最高，在步骤3最低。对于结石大小≥2cm的19例PNL患者和12例RIRS患者进行评估时，发现PNL组在步骤1的透视时间以及步骤1和步骤2的辐射暴露均高于RIRS组（P<0.001）。
尽管需要更多的前瞻性随机研究，但RIRS似乎是PNL的一种可行替代方法，因为它的透视时间短且每个步骤的辐射暴露低。
4级。
