Department of Urology, Guangdong Key Laboratory of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Department of Urology, Jose R. Reyes Memorial Medical Center, Manila, Philippines.
BJU Int. 2020 Jul;126(1):168-176. doi: 10.1111/bju.15066. Epub 2020 May 25.
To comparatively evaluate the clinical outcomes of super-mini percutaneous nephrolithotomy (SMP) and mini-percutaneous nephrolithotomy (Miniperc) for treating urinary tract calculi of >2 cm.
An international multicentre, retrospective cohort study was conducted at 20 tertiary care hospitals across five countries (China, the Philippines, Qatar, UK, and Kuwait) between April 2016 and May 2019. SMP and Miniperc were performed in 3525 patients with renal calculi with diameters of >2 cm. The primary endpoint was the stone-free rate (SFR). The secondary outcomes included: blood loss, operating time, postoperative pain scores, auxiliary procedures, complications, tubeless rate, and hospital stay. Propensity score matching analysis was used to balance the selection bias between the two groups.
In all, 2012 and 1513 patients underwent SMP and Miniperc, respectively. After matching, 1380 patients from each group were included for further analysis. Overall, there was no significant difference in the mean operating time or SFR between the two groups. However, the hospital stay and postoperative pain score were significantly in favour of SMP (both P < 0.001). The tubeless rate was significantly higher in the SMP group (72.6% vs 57.8%, P < 0.001). Postoperative fever was much more common in the Miniperc group (12.0% vs 8.4%, P = 0.002). When the patients were further classified into three subgroups based on stones diameters (2-3, 3-4, and >4 cm). The advantages of SMP were most obvious in the 2-3 cm stone group and diminished as the size of the stone increased, with longer operating time in the latter two subgroups. Compared with Miniperc, the SFR of SMP was comparable for 3-4 cm stones, but lower for >4 cm stones. There was no statistical difference in blood transfusions and renal embolisations between the two groups.
Our data showed that SMP is an ideal treatment option for stones of <4 cm and is more efficacious for stones of 2-3 cm, with lesser postoperative fever, blood loss, and pain compared to Miniperc. SMP was less effective for stones of >4 cm, with a prolonged operating time.
比较超微经皮肾镜取石术（SMP）和微创经皮肾镜取石术（Miniperc）治疗>2 cm 尿路结石的临床疗效。
这是一项国际性多中心回顾性队列研究，于 2016 年 4 月至 2019 年 5 月在五个国家（中国、菲律宾、卡塔尔、英国和科威特）的 20 家三级医院进行。对 3525 例直径>2 cm 的肾结石患者进行 SMP 和 Miniperc 治疗。主要终点为结石清除率（SFR）。次要结局包括：出血量、手术时间、术后疼痛评分、辅助手术、并发症、无管化率和住院时间。采用倾向评分匹配分析来平衡两组间的选择偏倚。
共 2012 例患者接受 SMP 治疗，1513 例患者接受 Miniperc 治疗。匹配后，每组各有 1380 例患者纳入进一步分析。总体而言，两组的平均手术时间或 SFR 无显著差异。然而，SMP 组的住院时间和术后疼痛评分明显更优（均 P < 0.001）。SMP 组的无管化率明显更高（72.6% vs 57.8%，P < 0.001）。Miniperc 组术后发热更为常见（12.0% vs 8.4%，P = 0.002）。进一步根据结石直径将患者分为三组（2-3、3-4 和>4 cm）。SMP 的优势在 2-3 cm 结石组中最为明显，随着结石增大而减弱，后两组的手术时间延长。与 Miniperc 相比，SMP 治疗 3-4 cm 结石的 SFR 相当，但治疗>4 cm 结石的 SFR 较低。两组间输血和肾栓塞无统计学差异。
我们的数据表明，SMP 是<4 cm 结石的理想治疗选择，对于 2-3 cm 结石更为有效，与 Miniperc 相比，术后发热、出血量和疼痛更少。SMP 治疗>4 cm 结石的效果较差，手术时间延长。
