Dauw Casey A, Borofsky Michael S, York Nadya, Lingeman James E
Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana.
J Endourol. 2016 Sep;30(9):987-91. doi: 10.1089/end.2016.0437. Epub 2016 Aug 22.
Percutaneous nephrolithotomy (PCNL) is considered the gold standard for treatment of large renal calculi. Although several investigators have examined the feasibility and outcomes associated with PCNL in obese patients, these studies have been limited by small sample size, lack of a comparator group, or few patients at body mass index (BMI) extremes. We thus compared outcomes of superobese (BMI >50) patients undergoing PCNL vs both an "overweight" and "ideal" cohort.
We used a prospectively maintained database to identify ideal (BMI 18.5-25), overweight (BMI 25.1-49.9), and superobese (BMI ≥50) patients who underwent PCNL. Our primary objective was to compare surgical outcomes between groups measured by the percent of patients who required secondary PCNL. We then compared complication rates, need for transfusion, and length of stay (LOS) using chi-square testing and ANOVA where appropriate.
A total of 1152 patients were identified of which 254 were classified as ideal, 840 as overweight, and 58 as superobese. The overweight cohort had a higher mean age and greater proportion of males, whereas staghorn stones were more common in the superobese group. Comorbid conditions were more commonly observed in the superobese cohort. Otherwise, the groups were similar. Surgical outcomes were comparable with 47.2%, 42.0%, and 38.0% of ideal, overweight, and superobese patients requiring secondary PCNL (p = 0.25) with no difference in complication rates, need for transfusion, or LOS.
PCNL can be effectively and safely performed in superobese patients with no difference in surgical outcomes or complications when compared to ideal or overweight patient cohorts.
经皮肾镜取石术（PCNL）被认为是治疗大型肾结石的金标准。尽管有几位研究者探讨了PCNL在肥胖患者中的可行性和治疗效果，但这些研究存在样本量小、缺乏对照组或体重指数（BMI）处于极端值的患者数量少等局限性。因此，我们比较了接受PCNL的超级肥胖（BMI>50）患者与“超重”和“理想”队列患者的治疗效果。
我们使用一个前瞻性维护的数据库，识别接受PCNL的理想体重（BMI 18.5-25）、超重（BMI 25.1-49.9）和超级肥胖（BMI≥50）患者。我们的主要目标是比较各组之间的手术效果，以需要二次PCNL的患者百分比来衡量。然后，我们在适当的情况下使用卡方检验和方差分析比较并发症发生率、输血需求和住院时间（LOS）。
共识别出1152例患者，其中254例被归类为理想体重，840例为超重，58例为超级肥胖。超重队列的平均年龄较高，男性比例较大，而鹿角形结石在超级肥胖组中更为常见。超级肥胖队列中合并症更为常见。除此之外，各组相似。手术效果相当，理想体重、超重和超级肥胖患者中分别有47.2%、42.0%和38.0%需要二次PCNL（p = 0.25），并发症发生率、输血需求或住院时间无差异。
与理想体重或超重患者队列相比，PCNL可以在超级肥胖患者中有效且安全地进行，手术效果或并发症无差异。
