[仰卧位经皮肾镜取石术向迷你经皮肾镜取石术治疗复杂肾结石的演变：可行性研究。]

[Evolution from Percutaneous nephrolithotomy to Mini-PCNL in supine position on the treatment of complex renal calculi: feasibility study.].

作者信息

de Fata-Chillón Fernando Ramón, Gimbernat-Díaz Helena, Redondo-Redondo Cristina, Meilán-Hernández Elisa, Mateo-Martínez Erika

机构信息

Servicio de Urología. Hospital Universitario de Getafe. Madrid. España.

出版信息

Arch Esp Urol. 2017 Jun;70(5):542-549.

PMID:28613206

Abstract

OBJECTIVES

Mini-PCNL is a potentially less invasive technique than standard percutaneous nephrolithotomy (PCNL). We present our experience and results comparing both approaches in large burden complex renal calculi.

METHODS

Prospective non randomized study comparing PCNL (24/26F nephroscope; Group A) and Mini-PCNL (15/18F; Group B) perioperative and postoperative results, in 40 (20 each group) consecutive patients between 2013 and 2014. We analyze demographic data, hemoglobin drop, urine culture, stone characteristics, operative time, puncture, number and size of the tract, disintegration energy sources, nephrostomy placement, hospital stay, stone free rate and Clavien-Dindo complications.

RESULTS

Evolution has shown growth for Mini-PNL, with the last 17 consecutive cases performed by this approach. No preoperative differences in laterality, age, gender or ASA were found; but there were differences in BMI (median Group A: 26.35 kg/m2; Median Group B: 33.05 kg/m2, p = 0.008). Median calculi surface area (SA = length × width × π × 0.25) was higher for mini-PNL (6.69 cm2 vs 14.14; p=0.003). The operative time was longer for mini-PNL (120 vs 162.5 min, p = 0.03). Only one case (5%) required transfusion in NLP 24/26F. Mini-PCNL was associated with tubeless technique (55%) (p = 0.022), which explains lower 24 h postoperative pain, after surgery, measured by VAS (p =0.0004). The hospital stay was equivalent (median: 2 days; p=0.8). Both techniques showed efficacy (SFR at 3 months 80%). There were no statistically significant differences between the number and severity of complications between groups (Group A: 15%, 66.7% Clavien II, Group B: 15%; 66.7% Clavien II, p = 1).

CONCLUSIONS

Mini-NLP can manage kidney stones and even large staghorn calculi without nephrostomy in a high percentage of patients. The technical evolution towards a small caliber approach maintains the effectiveness of the procedure without impacting its safety, with benefits perceived by patients such as less postoperative pain.

摘要

目的

迷你经皮肾镜取石术（Mini-PCNL）是一种相较于标准经皮肾镜取石术（PCNL）侵入性可能更小的技术。我们展示了在处理大负荷复杂性肾结石时比较这两种方法的经验和结果。

方法

对2013年至2014年间连续的40例患者（每组20例）进行前瞻性非随机研究，比较PCNL（24/26F肾镜；A组）和Mini-PCNL（15/18F；B组）的围手术期和术后结果。我们分析了人口统计学数据、血红蛋白下降情况、尿培养、结石特征、手术时间、穿刺情况、通道数量和大小、碎石能量来源、肾造瘘管放置、住院时间、结石清除率和Clavien-Dindo并发症。

结果

发展显示Mini-PCNL呈增长趋势，最近连续17例采用该方法进行手术。在患侧、年龄、性别或美国麻醉医师协会（ASA）分级方面未发现术前差异；但在体重指数（BMI）方面存在差异（A组中位数：26.35kg/m²；B组中位数：33.05kg/m²，p = 0.008）。Mini-PCNL的结石表面积中位数（SA = 长×宽×π×0.25）更高（6.69cm²对14.14cm²；p = 0.003）。Mini-PCNL的手术时间更长（120分钟对162.5分钟，p = 0.03）。在24/26F的PCNL中只有1例（5%）需要输血。Mini-PCNL与无管技术相关（55%）（p = 0.022），这解释了术后24小时通过视觉模拟评分法（VAS）测量的疼痛较低（p = 0.0004）。住院时间相当（中位数：2天；p = 0.8）。两种技术均显示出疗效（3个月时结石清除率为80%）。两组之间并发症的数量和严重程度无统计学显著差异（A组：15%，Clavien II级占66.7%，B组：15%；Clavien II级占66.7%，p = 1）。