Department of Urology, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey,
Department of Urology, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey.
Urol Int. 2020;104(9-10):741-745. doi: 10.1159/000505081. Epub 2020 Jan 21.
To compare the efficacy of the middle calyx access (MCA) and lower calyx access (LCA) in the treatment of lower pole kidney stones.
The data of patients with isolated lower pole kidney stones who underwent percutaneous nephrolithotomy via MCA or LCA between 2009 and 2019 were evaluated retrospectively. Pre-, peri-, and postoperative parameters of the groups (LCA group and MCA group) were compared. A value of p < 0.05 was considered significant.
A total of 601 patients with lower pole kidney stones were included in the study. LCA was performed for the initial tract in 400 patients, and MCA was performed in 201 patients. There were no significant differences in terms of age, gender, laterality, body mass index, previous operation history, stone burden, duration of fluoroscopy, and stone-free rate between the groups. Operation time was significantly longer in the LCA group (p = 0.041). In the LCA group, additional access was required in 50 cases, which was significantly higher than in the MCA group (p = 0.013). Clinically insignificant residual fragments (CIRF) were present in 28 patients (7%) in the first group (significantly higher vs. MCA: p = 0.044). There were no statistically significant differences in terms of overall complication and transfusion rates.
MCA had superior outcomes in terms of operation time, CIRF rate, hemoglobin drop, and requirement of an additional tract compared to LCA. Further studies evaluating the efficacy of MCA in lower pole kidney stones should be performed to verify our results.
比较中叶穿刺入路（MCA）和下叶穿刺入路（LCA）在治疗下极肾结石中的疗效。
回顾性分析 2009 年至 2019 年间接受经皮肾镜取石术治疗的孤立性下极肾结石患者的资料。比较两组（LCA 组和 MCA 组）的术前、术中和术后参数。p 值<0.05 为差异有统计学意义。
本研究共纳入 601 例下极肾结石患者。400 例患者采用 LCA 作为初始通道，201 例患者采用 MCA。两组在年龄、性别、侧别、体重指数、既往手术史、结石负荷、透视时间和结石清除率方面无显著差异。LCA 组的手术时间明显较长（p=0.041）。在 LCA 组中，有 50 例需要额外的通道，明显高于 MCA 组（p=0.013）。在第一组中，28 例（7%）存在临床无意义的残余碎片（CIRF）（显著高于 MCA 组：p=0.044）。两组在总体并发症和输血率方面无统计学差异。
与 LCA 相比，MCA 在手术时间、CIRF 发生率、血红蛋白下降和需要额外通道方面具有更好的效果。需要进一步研究评估 MCA 在治疗下极肾结石中的疗效，以验证我们的结果。
