1Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
2Guangdong Key Laboratory of Urology, Guangzhou, China.
J Endourol. 2019 Aug;33(8):634-638. doi: 10.1089/end.2018.0747. Epub 2019 Mar 7.
To evaluate the safety and efficacy of new generation super-mini percutaneous nephrolithotomy (New-SMP) in the treatment of ≥20 mm renal stones. We retrospectively analyzed the New-SMP procedures (14F) performed in the cases with ≥20 mm renal stones between April 1, 2016 and July 1, 2018. The cases with ipsilateral Double-J stent and/or nephrostomy tube preoperatively, ipsilateral ureteral stone, uncorrected coagulopathy, active urinary tract infection, congenital abnormalities, and urinary diversion were excluded. Of totally 188 included cases, 8 (4.3%) were children (≤14 years) and 180 (95.7%) were adults. The cases had a mean age of 47.14 ± 15.13 years, a mean stone size of 31.57 ± 9.8 mm, and a mean S.T.O.N.E score of 7.02 ± 0.73. The New-SMP took a median operative time of 35 minutes (range 6-127). A total of 173 (92%) cases received single-access-tract procedure. The drop in hematocrit was 14.62 ± 8.36 g/L after the procedure. The serum white blood cells (WBCs) increased to 2.58 ± 2.89 × 10/L. The mean hospital stay was 2.4 ± 1.5 days. New-SMP had a stone-free rate of 84% within 48 hours and 91.5% at 3 months postoperatively. Five (2.7%) cases required auxiliary procedures. The tubeless rate was 87.2%, including 44.1% cases with total tubeless, 41.5% cases with Double-J stent, and 1.6% cases with ureteral catheter. Totally 9.6% cases got fever (>38°C), 1.0% cases had urosepsis, and no cases developed shock. In addition, no transfusion and arterial embolization were required. New-SMP could be a safe and efficacious approach for the management of ≥20 mm renal stones. The novel modified technique and system may extend the indication of SMP to large renal stones. Further clinical studies and direct comparisons between New-SMP and other available modalities of percutaneous nephrolithotomy are required.
评估新一代超微经皮肾镜取石术（New-SMP）治疗≥20mm 肾结石的安全性和疗效。我们回顾性分析了 2016 年 4 月 1 日至 2018 年 7 月 1 日期间接受≥20mm 肾结石治疗的患者的 New-SMP 手术（14F）。排除术前同侧双 J 支架和/或肾造瘘管、同侧输尿管结石、未纠正的凝血障碍、活动性尿路感染、先天异常和尿流改道的患者。共纳入 188 例患者，其中 8 例（4.3%）为儿童（≤14 岁），180 例（95.7%）为成人。患者平均年龄为 47.14±15.13 岁，平均结石大小为 31.57±9.8mm，平均 S.T.O.N.E 评分为 7.02±0.73。New-SMP 的中位手术时间为 35 分钟（范围 6-127 分钟）。173 例（92%）患者行单通道手术。术后血细胞比容下降 14.62±8.36g/L。血清白细胞（WBC）增加至 2.58±2.89×10/L。平均住院时间为 2.4±1.5 天。术后 48 小时内无石率为 84%，术后 3 个月时为 91.5%。5 例（2.7%）患者需要辅助治疗。无管率为 87.2%，其中 44.1%的患者完全无管，41.5%的患者放置双 J 支架，1.6%的患者放置输尿管导管。共有 9.6%的患者发热（>38°C），1.0%的患者发生败血症，无休克病例。此外，不需要输血和动脉栓塞。New-SMP 是治疗≥20mm 肾结石的一种安全有效的方法。新型改良技术和系统可能将 SMP 的适应证扩展至大肾结石。需要进一步的临床研究和 New-SMP 与其他可用经皮肾镜取石术方式之间的直接比较。
