Department of Urology. Ankara City Hospital. Ankara. Turkey.
Department of Urology. Şişli Hamidiye Etfal Training and Research Hospital. İstanbul. Turkey.
Arch Esp Urol. 2021 Nov;74(9):867-874.
To compare the efficacy and safety of prone and supine percutaneous nephrolithotomy (P/SPNL) with special emphasis on tubeless (T) and totally tubeless (TT) surgery.
This retrospective, single-surgeon, consecutive series comparison study involved 361 consecutive patients who under went PNL operations in either the prone or Galdakao-modified Valdivia supine positions between September 2016 and March 2020. Indication for surgery was a stone diameter greater than 2 cm. The two groups were compared in terms of preoperative demographics, stone parameters, and perioperative data.
The groups were similar in terms of preoperative demographics, while the blood transfusion rate was insignificantly higher in PPNL (7% vs 3.3%, p=0.165). Mean operative time (58.0±20.6 vs 54.1±15.9 min., respectively, p=0.165), fluoroscopy time (p=0.895), and Clavien complication rates (p=0.87) were similar. SPNL exhibited a significantly (p<0.001) higher rate of T operations (23, 37.7%) than PPNL (46, 15.3%). TT cases were also higher with SPNL (14% vs 29.5%,p=0.003). Urine leakage (p=0.085) and post-operative JJ stent placement (p=0.180) rates were statistically similar between the two groups. Length of hospital stay was approximately one day shorter for T cases in both groups (PPNL: 1.37±0.80 vs 2.26±1.28 days, p=0.001; SPNL: 1.65±0.83 vs 2.76±2.27 days, p=0.028). Stone free rates were 91.3% and 88.5% for PPNL and SPNL, respectively (p=0.488).
SPNL has proved to be as safe and effective as its prone counter part, with similar stone-free and complication rates. T and TT-PNL seem more viable with SPNL, which will increase patient comfort and allow shorter hospitalization times.
比较俯卧位和仰卧位经皮肾镜取石术（P/SPNL）的疗效和安全性，特别强调无管（T）和完全无管（TT）手术。
这是一项回顾性、单外科医生、连续系列比较研究，纳入了 2016 年 9 月至 2020 年 3 月间接受 PNL 手术的 361 例连续患者，手术适应证为结石直径大于 2cm。两组在术前人口统计学、结石参数和围手术期数据方面进行了比较。
两组在术前人口统计学方面相似，而俯卧位经皮肾镜取石术（PPNL）的输血率显著更高（7%比 3.3%，p=0.165）。手术时间（分别为 58.0±20.6 分钟和 54.1±15.9 分钟，p=0.165）、透视时间（p=0.895）和 Clavien 并发症发生率（p=0.87）相似。仰卧位经皮肾镜取石术（SPNL）的 T 手术（23 例，37.7%）显著高于俯卧位经皮肾镜取石术（46 例，15.3%）（p<0.001）。SPNL 的 TT 病例也更高（14%比 29.5%，p=0.003）。两组尿液漏出（p=0.085）和术后 JJ 支架放置（p=0.180）率统计学上无差异。两组 T 病例的住院时间均缩短了一天左右（PPNL：1.37±0.80 天比 2.26±1.28 天，p=0.001；SPNL：1.65±0.83 天比 2.76±2.27 天，p=0.028）。PPNL 和 SPNL 的结石清除率分别为 91.3%和 88.5%（p=0.488）。
SPNL 已被证明与俯卧位经皮肾镜取石术一样安全有效，结石清除率和并发症发生率相似。T 和 TT-PNL 在 SPNL 中似乎更可行，这将增加患者舒适度并缩短住院时间。
