Ozgor Faruk, Kucuktopcu Onur, Ucpinar Burak, Yanaral Fatih, Binbay Murat
Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey.
Int Braz J Urol. 2017 Jul-Aug;43(4):679-685. doi: 10.1590/S1677-5538.IBJU.2016.0291.
To evaluate the predictive value of the distance from skin to calyx (SCD) on the outcome and complication rates of patients undergoing mPNL.
Patient's charts, who had undergone mPNL between June 2012 and June 2015, were analyzed retrospectively. Patients who had a preoperative computerized tomography (CT) were enrolled into the study. Two separateurologists evaluated the CT scans and calculated the SCD defined as the distance between the skin and surface/lateral edge of the calyx, which was the preferred site of entry for percutaneous access. The average value of the two measurements was included inthe final analysis to avoid bias. The mean SCD was 75mm. According to the median SCD value, patients were divided into two groups: group 1 (SCD ≤75) and group 2 (SCD >75).
A total of 140 patients and 130 patients were enrolled in groups 1 and 2, respectively. The mean operation time and the mean fluoroscopy time was significantly longer in group 2 (p:0.004 vs. p:0.021). The rate of blood transfusion was significantly higher in group 1 (6 patients). None of patientsin group 2required blood transfusion (p:0.017). Stone-free status after a single session of mPNL was 67.1% in group 1 and 75.4% in group 2 (p:0.112). After additional procedures, stone-free rates increased to 84.3% and 85.4% in group 1 and group 2, respectively (p:0.802).
Our study demonstrated that longer SCD was not a predictive factor for stone-free rates after mPNL. However, SCD over 75mm was associated with longer operation time and fluoroscopy time with lower rates of transfusion.
评估皮肤至肾盏距离(SCD)对微创经皮肾镜取石术(mPNL)患者手术结果及并发症发生率的预测价值。
回顾性分析2012年6月至2015年6月期间接受mPNL治疗的患者病历。纳入术前进行过计算机断层扫描(CT)的患者。两名独立的泌尿外科医生评估CT扫描结果,并计算SCD,即皮肤与肾盏表面/外侧边缘之间的距离,该部位是经皮穿刺的首选入路点。为避免偏差,最终分析采用两次测量的平均值。平均SCD为75mm。根据SCD中位数,患者分为两组:第1组(SCD≤75)和第2组(SCD>75)。
第1组和第2组分别纳入140例和130例患者。第2组的平均手术时间和平均透视时间明显更长(p值分别为0.004和0.021)。第1组的输血率明显更高(6例患者)。第2组无患者需要输血(p值为0.017)。单次mPNL术后结石清除率第1组为67.1%,第2组为75.4%(p值为0.112)。经过额外手术后,第1组和第2组的结石清除率分别升至84.3%和85.4%(p值为0.802)。
我们的研究表明,较长的SCD并非mPNL术后结石清除率的预测因素。然而,SCD超过75mm与手术时间和透视时间延长以及输血率降低相关。