Department of Urology, Skåne University Hospital, Malmö, Sweden.
Department of Urology, Sen Jorj Austria Hospital, Istanbul, Turkey.
Eur Urol. 2017 Aug;72(2):220-235. doi: 10.1016/j.eururo.2017.01.046. Epub 2017 Feb 23.
Miniaturized instruments for percutaneous nephrolithotomy (PNL), utilizing tracts sized ≤22 Fr, have been developed in an effort to reduce the morbidity and increase the efficiency of stone removal compared with standard PNL (>22 Fr).
We systematically reviewed all available evidence on the efficacy and safety of miniaturized PNL for removing renal calculi.
The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Since it was not possible to perform a meta-analysis, the data were summarized in a narrative synthesis.
After screening 2945 abstracts, 18 studies were included (two randomized controlled trials [RCTs], six nonrandomized comparative studies, and 10 case series). Thirteen studies were full-text articles and five were only available as congress abstracts. The size of tracts used in miniaturized procedures ranged from 22 Fr to 4.8 Fr. The largest mean stone size treated using small instruments was 980mm. Stone-free rates were comparable in miniaturized and standard PNL procedures. Procedures performed with small instruments tended to be associated with significantly lower blood loss, while the procedure duration tended to be significantly longer. Other complications were not notably different between PNL types. Study designs and populations were heterogeneous. Study limitations included selection and outcome reporting bias, as well as a lack of information on relevant confounding factors.
The studies suggest that miniaturized PNL is at least as efficacious and safe as standard PNL for the removal of renal calculi. However, the quality of the evidence was poor, drawn mainly from small studies, the majority of which were single-arm case series, and only two of which were RCTs. Furthermore, the tract sizes used and types of stones treated were heterogeneous. Hence, the risks of bias and confounding were high, highlighting the need for more reliable data from RCTs.
Removing kidney stones via percutaneous nephrolithotomy (PNL) using smaller sized instruments (mini-PNL) appears to be as effective and safe as using larger (traditional) instruments, but more clinical research is needed.
为了降低发病率并提高结石清除效率，与标准经皮肾镜取石术（>22Fr）相比，现已开发出用于经皮肾镜取石术的微型仪器，其使用的通道尺寸≤22Fr。
我们系统地回顾了所有关于微型经皮肾镜取石术治疗肾结石的疗效和安全性的现有证据。
该综述是根据系统评价和荟萃分析的首选报告项目进行的。由于不可能进行荟萃分析，因此数据以叙述性综合的形式进行总结。
在筛选了 2945 篇摘要后，纳入了 18 项研究（两项随机对照试验[RCT]、六项非随机对照研究和十项病例系列研究）。13 项研究为全文文章，5 项仅作为会议摘要提供。微型手术中使用的通道大小范围从 22Fr 到 4.8Fr。使用小器械治疗的最大平均结石大小为 980mm。微型和标准经皮肾镜取石术的无结石率相当。使用小器械进行的手术往往与出血量显著降低相关，而手术时间往往显著延长。两种经皮肾镜取石术类型的其他并发症无明显差异。研究设计和人群存在异质性。研究局限性包括选择和结果报告偏倚，以及缺乏对相关混杂因素的信息。
这些研究表明，微型经皮肾镜取石术在肾结石的清除方面至少与标准经皮肾镜取石术一样有效和安全。然而，证据质量较差，主要来自小型研究，其中大多数为单臂病例系列研究，只有两项为 RCT。此外，使用的通道尺寸和治疗的结石类型存在异质性。因此，偏倚和混杂的风险较高，这突出表明需要来自 RCT 的更可靠数据。
经皮肾镜取石术（PNL）使用较小尺寸的器械（微创经皮肾镜取石术）似乎与使用较大尺寸（传统）器械一样有效和安全，但需要更多的临床研究。
