Kallidonis Panagiotis, Kyriazis Iason, Kotsiris Dimitrios, Koutava Adamantia, Kamal Wissam, Liatsikos Evangelos
Department of Urology, University of Patras , Patras, Greece .
J Endourol. 2017 Apr;31(S1):S4-S9. doi: 10.1089/end.2016.0571. Epub 2016 Dec 16.
Literature suggests that the percutaneous punctures for percutaneous nephrolithotomy (PCNL) must be performed at the papilla of the renal calix and a puncture at the infundibulum or the direction of the pelvis is not advisable because of increased hemorrhagic risk. A prospective randomized study was conducted to investigate the safety in terms of blood loss of the infundibular approach for PCNL.
Patients with renal stones with an accumulative size of at least 2 cm were randomly assigned to one of two parallel groups to undergo PCNL with either papillary (Group 1) or infundibular (Group 2) renal access. The primary outcome measures were the reduction in hemoglobin on first postoperative day and the need for transfusion during the first postoperative month. Secondary endpoints included the operative and fluoroscopy time, number of accesses performed, overall complication rate, hospitalization time, and complications up to 3 months.
In total, 27 and 28 patients were enrolled in Groups 1 and 2, respectively. Patient age, body mass index, and stone size were similar among the groups (p = 0.672, 0.256, and 0.889, respectively). Reduction in hemoglobin and transfusion rate did not differ among Groups 1 and 2 (p = 0.916, p = 1.0, respectively). Operative time was higher in the case of Group 1 (p = 0.027). The overall complications rate was 7.4% for Group 1 and 7.14% for Group 2. Hospitalization time was not significantly different in the study groups (p = 0.724).
The infundibular approach for PCNL to the posterior middle renal calices is not associated with higher blood loss or transfusion rate in comparison with the respective approach to the fornix of the papilla when the currently described technique is performed.
文献表明，经皮肾镜取石术（PCNL）的经皮穿刺必须在肾盏乳头处进行，由于出血风险增加，不建议在肾盂漏斗部或肾盂方向进行穿刺。进行了一项前瞻性随机研究，以调查PCNL漏斗部入路在失血方面的安全性。
累积大小至少为2 cm的肾结石患者被随机分配到两个平行组之一，接受经乳头（第1组）或漏斗部（第2组）肾入路的PCNL。主要结局指标是术后第一天血红蛋白的降低以及术后第一个月内输血的需求。次要终点包括手术时间和透视时间、穿刺次数、总体并发症发生率、住院时间以及术后3个月内的并发症。
第1组和第2组分别纳入了27例和28例患者。各组之间的患者年龄、体重指数和结石大小相似（分别为p = 0.672、0.256和0.889）。第1组和第2组之间血红蛋白的降低和输血率没有差异（分别为p = 0.916，p = 1.0）。第1组的手术时间更长（p = 0.027）。第1组的总体并发症发生率为7.4%，第2组为7.14%。研究组之间的住院时间没有显著差异（p = 0.724）。
当采用目前描述的技术时，PCNL进入肾中后盏的漏斗部入路与进入乳头穹窿部的相应入路相比，不会导致更高的失血量或输血率。
