Emiliani Esteban, Talso Michele, Baghdadi Mohammed, Traxer Olivier
Hôpital Tenon, Department of Urology, Université Pierre et Marie Curie - Paris VI, Paris, France.
Fundacion Puigvert, Department of Urology, Universidad Autonoma de Barcelona, Spain.
Cent European J Urol. 2017;70(1):69-75. doi: 10.5173/ceju.2017.930. Epub 2017 Mar 14.
Miniaturization of instruments has changed the paradigms of percutaneous nephrolithotomy (PCNL). To date, however, few studies have analyzed the possible renal trauma generated by PCNL tract dilation. The purpose of this study is to evaluate and compare systematically the renal injury of all PNCL dilation techniques in pork kidneys (PK) and cadaveric kidney models (CK).
Twelve dilation devices were tested (from 4.8 to 30 French (Fr)) including micro- and mini- PCNL kits, the Alken dilation set, 20 and 30 ATM balloons and the Amplatz set. Each device was tested six times in PK and CK. Morphologic analysis of tract defects of the different models and dilators were made measuring the longest axis and the area of renal parenchymal damage.
When comparing the PK and CK dilation tract areas to the device areas, major differences were seen with the 20 ATM 30 Fr balloon (p = 0.0001 and 0.008) respectively, the sequential Amplatz dilation to 30 Fr (p = 0.0005 and 0.0006) respectively, and the Alken 30 FR dilation (p = 0.012 and 0.02) respectively. The 30 Fr dilations were 32.76 mm (mean) larger than the instruments themselves, while the ≤24 Fr dilations were 11.6 mm (mean) larger than the instruments themselves.
When comparing devices and tract areas, the dilation tract area exceeded device area by 11.6 mm at dilations up to 24 Fr 32.76 mm with dilations of 30 Fr. Overall, PK had significantly larger injuries than CK models.
器械的小型化改变了经皮肾镜取石术（PCNL）的模式。然而，迄今为止，很少有研究分析PCNL通道扩张可能产生的肾损伤。本研究的目的是系统评估和比较在猪肾（PK）和尸体肾模型（CK）中所有PCNL扩张技术对肾脏的损伤。
测试了12种扩张器械（4.8至30法式（Fr）），包括微型和小型PCNL套件、阿尔肯扩张套件、20和30 ATM球囊以及安普茨套件。每种器械在PK和CK中各测试6次。通过测量不同模型和扩张器通道缺损的最长轴和肾实质损伤面积，对其进行形态学分析。
将PK和CK扩张通道面积与器械面积进行比较时，分别在20 ATM 30 Fr球囊（p = 0.0001和0.008）、依次扩张至30 Fr的安普茨扩张器（p = 0.0005和0.0006）以及阿尔肯30 FR扩张器（p = 0.012和0.02）中观察到显著差异。30 Fr扩张器造成的通道比器械本身平均大32.76 mm，而≤24 Fr扩张器造成的通道比器械本身平均大11.6 mm。
比较器械和通道面积时，扩张至24 Fr时通道面积比器械面积大11.6 mm，扩张至30 Fr时大32.76 mm。总体而言，PK的损伤明显大于CK模型。
