Department of Urology, Great Western Hospital Swindon, Swindon, United Kingdom.
Department of Urology, University Hospital Southampton National Health Service Trust, Southampton, United Kingdom.
J Endourol. 2021 May;35(5):728-735. doi: 10.1089/end.2020.0743. Epub 2020 Dec 16.
Kidney stone disease in the pediatric setting is rare, but the incidence is rising. Mini-percutaneous nephrolithotomy (mPCNL) is one of the newer surgical interventions to have been developed in recent decades. The aim of this study was to carry out a systematic review (SR) to formally evaluate the safety and efficacy of pediatric mPCNL, which was defined as PCNLs using tract size between 15F and 20F. An SR was carried out in accordance with Cochrane guidelines and A MeaSurement Tool to Assess systematic Reviews (AMSTAR) checklist. Original studies reporting on outcomes of mPCNL with 20 or more patients (aged ≤18 years) were included. Eight studies were finally identified, which satisfied our predefined criteria. This included two randomized trials and six cohort studies. A total of 384 patients with a weighted mean age of 7.5 years (range: 0.5-18 years) and a male:female ratio of 3:2 underwent mPCNL. The weighted mean stone size was 1.2 cm (range: 0.8-3.5 cm). The weighted mean operative time and length of hospital stay were 76.8 minutes (range: 20-120 minutes) and 4.6 days (range: 1-33 days), respectively. The most common location(s) of stones were lower pole (57%) and renal pelvis (24.3%). The weighted mean initial and overall stone-free rates were 87.9% (range: 76%-97.5%) and 97% (range: 91.3%-100%), respectively. None of the cases required intraoperative conversion to standard PCNL. Complications occurred in 19% ( = 73) of patients. The weighted mean transfusion rate reported across studies was 3.3% (range: 0%-10.3%). mPCNL is safe and effective in the pediatric population. Further randomized studies will help determine its formal role in pediatric endourology and help guideline recommendations accordingly.
小儿肾结石疾病较为罕见，但发病率正在上升。微创经皮肾镜取石术（mPCNL）是近几十年来发展起来的较新的手术干预措施之一。本研究旨在进行系统评价（SR），以正式评估小儿 mPCNL 的安全性和疗效，小儿 mPCNL 定义为使用通道大小在 15F 至 20F 之间的 PCNL。SR 是根据 Cochrane 指南和 A MeaSurement Tool to Assess systematic Reviews（AMSTAR）清单进行的。纳入了报告 mPCNL 治疗 20 例或更多患者（年龄≤18 岁）的原始研究。最终确定了 8 项符合我们预设标准的研究。其中包括两项随机试验和六项队列研究。共 384 名平均年龄为 7.5 岁（范围：0.5-18 岁）、男女比例为 3:2 的患者接受了 mPCNL。平均结石大小为 1.2cm（范围：0.8-3.5cm）。平均手术时间和住院时间分别为 76.8 分钟（范围：20-120 分钟）和 4.6 天（范围：1-33 天）。结石最常见的部位为下极（57%）和肾盂（24.3%）。平均初始和总体结石清除率分别为 87.9%（范围：76%-97.5%）和 97%（范围：91.3%-100%）。术中无病例需转为标准 PCNL。19%（73 例）的患者发生并发症。研究报告的平均输血率为 3.3%（范围：0%-10.3%）。mPCNL 在小儿人群中是安全有效的。进一步的随机研究将有助于确定其在小儿腔内泌尿外科中的正式作用，并相应地帮助指南建议。
