Department of Urology, Kasturba Medical College, Manipal, Karnataka, India.
Department of Urology, Istanbul Medipol University Hospital, Istanbul, Turkey.
World J Urol. 2021 Jun;39(6):2155-2161. doi: 10.1007/s00345-020-03409-3. Epub 2020 Aug 31.
To compare efficacy and safety between superior calyceal access and inferior calyceal access for pelvic and/or lower calyceal renal stones.
Consecutive patients presenting with Pelvic and/or inferior calyceal renal calculi were allocated to the superior calyceal access (group 1) or inferior calyceal access (group 2) treatment arm. Allocation of treatment access was based on the surgeon's preference. Variables studied included stone free rate, operating time, intraoperative and postoperative complications. Statistical analysis was executed using SPSS, Version 16.0. The statistical significance was evaluated at 5% level of significance (p value < 0.05).
Between July 2018 and February 2019, 63 patients were included in each group. The percutaneous inserted guidewire entered the ureter in 92% in group1 and 74.6% in group 2 (p = 0.034). Stone fragments migrated to the middle calyx in 3.2% in group1 and 9.5% in group 2 (p = 0.033). A second puncture was required in one patient in group 1 and in 5 patients in group 2 (p = 0.04). The operative duration (minutes) was 13.46 ± 1.09 in the group 1 while 16.58 ± 1.44 in the group 2 (p = 0.002). Thoracic complications (hydropneumothorax) occurred to 2 patients in superior calyceal access group managed with intercostal tube drainage (p = 0.243).Post operatively blood transfusion was required in two patients in group 2 (p = 0.169). Angioembolization was done in one patient among the inferior calyceal access approach (p = 0.683). Complete stone clearance assessed at 3 months was 96.8% in group 1 and 85.7% in group 2 (p = 0.046).
Superior calyceal access is a safe and most efficacious in terms of achieving complete stone clearance rate with reduced operative time, minimal blood loss, less need for a second puncture and auxiliary procedures at minimal complications.
Clinical trials registry - INDIA; CTRI/2018/07/014,687.
比较肾盂和/或下盏肾结石行上盏入路和下盏入路的疗效和安全性。
连续就诊的肾盂和/或下盏肾结石患者被分配至上盏入路（组 1）或下盏入路（组 2）治疗组。治疗入路的分配基于外科医生的偏好。研究的变量包括无结石率、手术时间、术中及术后并发症。采用 SPSS 版本 16.0 进行统计分析。以 5%的显著性水平（p 值<0.05）评估统计学意义。
2018 年 7 月至 2019 年 2 月，每组纳入 63 例患者。在组 1 中，92%的经皮插入导丝进入输尿管，在组 2 中为 74.6%（p=0.034）。结石碎片迁移至中盏在组 1 中为 3.2%，在组 2 中为 9.5%（p=0.033）。组 1 中有 1 例患者需要再次穿刺，组 2 中有 5 例患者需要再次穿刺（p=0.04）。组 1 的手术时间（分钟）为 13.46±1.09，组 2 为 16.58±1.44（p=0.002）。上盏入路组有 2 例患者发生胸腔并发症（液气胸），经肋间引流管处理（p=0.243）。组 2 中有 2 例患者术后需要输血（p=0.169）。下盏入路组有 1 例患者行血管栓塞术（p=0.683）。3 个月时完全结石清除率在组 1 为 96.8%，组 2 为 85.7%（p=0.046）。
上盏入路安全有效，能达到较高的完全结石清除率，同时手术时间更短、失血量更少、需要再次穿刺和辅助操作的次数更少，并发症也更少。
印度临床试验注册处； CTRI/2018/07/014,687。
