Department of Urology, XinQiao Hospital, Third Military Medical University, 37 XinQiao Street, Shapingba District, Chongqing, 400037, China.
Department of Urology, Southwest Hospital, Third Military Medical University, Chongqing, China.
World J Urol. 2019 Jul;37(7):1441-1447. doi: 10.1007/s00345-018-2526-x. Epub 2018 Oct 25.
To compare the perioperative and long-term outcomes of retroperitoneal laparoscopic pyelolithotomy (RLP) and percutaneous nephrolithotomy (PCNL) for the treatment of staghorn calculi.
From May 2011 to March 2017, eligible patients with staghorn calculi were randomly assigned to two groups: RLP and PCNL. Patients underwent the operations prospectively. Subsequently, a follow-up protocol was performed. Perioperative data related to the efficacy, safety and long-term outcomes (stone recurrence and functional changes in the affected kidney) were comparatively analyzed between the two groups.
Overall, 105 patients underwent surgical treatment, including 51 in the RLP group and 54 in the PCNL group. There was no difference in demographics or stone characteristics between the two groups. The single-session stone-free rate (SFR) was higher (88.2% vs. 64.8%), the mean hemoglobin drop was lower (0.4 ± 0.3 vs. 1.7 ± 0.9 g/dL), the rate of postoperative fever was lower (5.9% vs. 20.4%), but operative time was longer (135.7 ± 35.5 vs. 101.9 ± 41.2 min) and the total cost was more expensive (5546 ± 772 vs. 3861 ± 402 USD)in the RLP group than in the PCNL group (all p < 0.05). The mean increase in the split function (8.3 ± 3.1 vs. 4.2 ± 2.4 mL/min) and the rate of improvement of the affected kidney (56.3% vs. 35.3%) were significantly higher in the RLP group than in the PCNL group at 1 year after surgery (both p < 0.05). However, the rate of stone recurrence was similar between the groups at a mean follow-up of 47.3 ± 18.6 months.
PCNL remains the first-line treatment for most cases of staghorn calculi. Nevertheless, in some selected cases with the extrarenal and dilated pelvis, RLP can be considered as an alternative management of staghorn calculi, which was associated with a high single-session SFR, low rates of complications, and better functional preservation of the affected kidney.
比较后腹腔镜肾盂切开取石术（RLP）与经皮肾镜碎石取石术（PCNL）治疗鹿角形结石的围手术期和长期疗效。
2011 年 5 月至 2017 年 3 月，符合条件的鹿角形结石患者被随机分为两组：RLP 组和 PCNL 组。患者前瞻性接受手术治疗。随后，进行了随访方案。比较两组患者的疗效、安全性和长期结果（结石复发和受影响肾脏功能变化）的围手术期数据。
共有 105 例患者接受了手术治疗，其中 RLP 组 51 例，PCNL 组 54 例。两组患者的人口统计学和结石特征无差异。单次结石清除率（SFR）更高（88.2% vs. 64.8%），平均血红蛋白下降幅度更低（0.4 ± 0.3 vs. 1.7 ± 0.9 g/dL），术后发热率更低（5.9% vs. 20.4%），但手术时间更长（135.7 ± 35.5 比 101.9 ± 41.2 min），总费用更高（5546 ± 772 比 3861 ± 402 美元）（均 P < 0.05）。RLP 组术后 1 年时，分肾功能的平均改善（8.3 ± 3.1 比 4.2 ± 2.4 mL/min）和受影响肾脏的改善率（56.3% vs. 35.3%）明显高于 PCNL 组（均 P < 0.05）。然而，在平均随访 47.3 ± 18.6 个月后，两组结石复发率相似。
PCNL 仍然是大多数鹿角形结石的一线治疗方法。然而，在某些具有肾外和肾盂扩张的选定病例中，RLP 可作为鹿角形结石的替代治疗方法，其单次结石清除率高、并发症发生率低，受影响肾脏的功能保存更好。
