Department of Urology, A.O.R.N. Antonio Cardarelli, Naples, Italy -
Department of Urology, A.O.R.N. Antonio Cardarelli, Naples, Italy.
Minerva Urol Nephrol. 2021 Apr;73(2):253-259. doi: 10.23736/S2724-6051.20.03836-9. Epub 2020 Jul 7.
The aim of this study was to compare four renal access techniques in percutaneous nephrolithotomy (PCNL).
A total of 437 patients who underwent PCNL at our center from January 2015 to December 2019 were included in the analysis. Telescopic metallic coaxial dilation (TMD) was used in 146 patients, single step balloon dilation (BD) in 98 patients, one-shot dilation with 30F Amplatz (OS 30F) in 106 patients, and one-shot dilation with 16F Amplatz (OS 16F) in 87 patients. Primary endpoints were perioperative outcomes and complications of the procedures.
Similar baseline characteristics were observed in the four groups. Fluoroscopy time was significantly shorter in OS 30F and OS 16F groups (P<0.0001). The drop in hemoglobin level was not significantly different between TMD and BD groups, but it was significantly lower in OS 16F group versus the OS 30F group and lower in OS 30F group versus the BD Group (P<0.0001). Despite this, the rate of blood transfusion was similar across groups (P=0.837). Moreover, a smaller tract was associated with reduced postoperative morbidity including time to nephrostomy removal (P=0.001), hospital stay (P<0.0001), VAS scale (P<0.0001). There were no significant differences in postoperative complications (P=0.683), and Clavien-Dindo grade ≥3 complication rates (P=0.486) among the groups. Stone-free rates and number of auxiliary procedures required to achieve stone-free status were also similar among all groups (P=0.964 and 0.988, respectively). Multinomial logistic regression analysis showed that BMI (P=0.002), stone size (P=0.002) and previous PCNL (P=0.038) were predictive factors associated with the choice of OS 16 approach.
Different dilation methods are equally effective and safe to use in a PCNL procedure for kidney stone treatment, allowing similar stone free rates and risk of complications. The OS dilation techniques seem to allow a shorter X-ray exposure time, which might be beneficial for both patients and operators. The use of a 16 F dilator can reduce the postoperative morbidity. Risk of sepsis should be always kept in mind.
本研究旨在比较经皮肾镜取石术（PCNL）中四种肾脏入路技术。
纳入 2015 年 1 月至 2019 年 12 月在我院接受 PCNL 的 437 例患者。采用伸缩式金属同轴扩张（TMD）的患者 146 例，采用单步球囊扩张（BD）的患者 98 例，采用一次性扩张 30F Amplatz（OS 30F）的患者 106 例，采用一次性扩张 16F Amplatz（OS 16F）的患者 87 例。主要终点为手术期间的结果和并发症。
四组患者的基线特征相似。OS 30F 和 OS 16F 组的透视时间明显缩短（P<0.0001）。TMD 组和 BD 组的血红蛋白水平下降无显著差异，但 OS 16F 组显著低于 OS 30F 组和 BD 组（P<0.0001）。尽管如此，各组的输血率相似（P=0.837）。此外，较小的通道与减少术后发病率相关，包括经皮肾造瘘管去除时间（P=0.001）、住院时间（P<0.0001）、VAS 量表（P<0.0001）。各组术后并发症（P=0.683）和 Clavien-Dindo 分级≥3 并发症发生率（P=0.486）无显著差异。各组的结石清除率和达到结石清除状态所需的辅助手术次数也相似（P=0.964 和 0.988）。多项逻辑回归分析显示，BMI（P=0.002）、结石大小（P=0.002）和既往 PCNL（P=0.038）是与 OS 16 法选择相关的预测因素。
不同的扩张方法在治疗肾结石的 PCNL 手术中同样有效和安全，可达到相似的结石清除率和并发症风险。OS 扩张技术似乎可以缩短 X 射线暴露时间，这对患者和操作人员都可能有益。使用 16 F 扩张器可以减少术后发病率。应始终注意脓毒症的风险。
