Department of Urology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
J Endourol. 2021 Apr;35(4):451-456. doi: 10.1089/end.2020.0533. Epub 2021 Jan 29.
Miniaturization of percutaneous nephrolithotomy (mPCNL) was proposed to decrease postoperative bleeding, as there is decreased parenchymal injury compared with standard percutaneous nephrolithotomy (SPCNL). Published randomized controlled trials (RCTs) evaluating bleeding after mPCNL have shown conflicting results. Hence, the evidence to say that mPCNL offers less postoperative bleeding is not robust. Prospective RCT was done by comparing mPCNL and SPCNL for treatment of renal stones of size 1 to 3 cm. Patients with active urinary tract infection, renal malformation, uncorrected coagulopathy, and raised serum creatinine (>1.5 mg/dL) were excluded. Blood loss was evaluated by measuring fall in hemoglobin and hematocrit on postoperative day 1. Postoperative pain was evaluated by visual analogue scale (VAS) score at 6, 24, and 48 hours. A total of 60 patients (30 in each arm) were enrolled during the study period. All the baseline preoperative variables were comparable in both the groups. The SPCNL group had a significantly higher drop in hematocrit level as compared with mPCNL (4.6 ± 3.1% 3.1 ± 2.1%, = 0.02). The mean fall in hemoglobin was higher in SPCNL as compared with mPCNL (1.61 ± 0.9 gm% 1.21 ± 0.7 gm%, = 0.07), but it was not significant. Blood transfusion (BT) rate was comparable in both the groups (one patient in each group). The mPCNL group had significantly less VAS scores at 6 hours (3.27 ± 1.20 4.40 ± 1.52, = 0.002) and 24 hours (2.10 ± 0.54 2.83 ± 1.05, = 0.001) after surgery. Postoperative complications and hospital stay were comparable in both the arms. mPCNL is associated with less postoperative bleeding and pain than SPCNL. However, the small tract size does not prevent against the clinically significant bleeding requiring BT.
经皮肾镜碎石术（PCNL）的微创化被提出以减少术后出血，因为与标准 PCNL 相比，它对实质组织的损伤更小。已发表的评估微创 PCNL 后出血的随机对照试验（RCT）结果相互矛盾。因此，微创 PCNL 术后出血较少的证据并不充分。本前瞻性 RCT 通过比较微创 PCNL 和标准 PCNL 治疗大小为 1 至 3cm 的肾结石来进行。患有活动性尿路感染、肾畸形、未纠正的凝血障碍和血清肌酐升高（>1.5mg/dL）的患者被排除在外。通过测量术后第 1 天血红蛋白和血细胞比容的下降来评估失血量。术后疼痛通过视觉模拟评分（VAS）在术后 6、24 和 48 小时进行评估。
在研究期间共纳入 60 名患者（每组 30 名）。两组的所有基线术前变量均相似。与微创 PCNL 相比，标准 PCNL 组的血细胞比容水平下降幅度明显更高（4.6±3.1%与 3.1±2.1%，=0.02）。与微创 PCNL 相比，标准 PCNL 组的血红蛋白下降幅度更高（1.61±0.9gm%与 1.21±0.7gm%，=0.07），但差异无统计学意义。两组的输血（BT）率相似（每组各有 1 名患者）。微创 PCNL 组术后 6 小时（3.27±1.20 与 4.40±1.52，=0.002）和 24 小时（2.10±0.54 与 2.83±1.05，=0.001）的 VAS 评分明显较低。两组术后并发症和住院时间相似。
微创 PCNL 与标准 PCNL 相比，术后出血和疼痛更少。然而，小通道尺寸并不能防止需要 BT 的临床显著出血。
